Workers' Compensation Medicare Set-Aside (WCMSA)

This article highlights key points regarding the Medicare Advantage and Part D programs, their recovery process, and how Verisk can help.

Based on our handling of MSP claims and observations, we note these considerations and issues where further CMS clarity may be helpful.

On June 17th, the Centers for Medicare and Medicaid Services held an “Introduction to Workers’ Compensation Medicare Set-Asides (WCMSAs) Webinar.”

CMS has announced that it will use the “Table 1: Life Table for the total population: United States, 2022” to calculate an adjusted life expectancy.

CMS has announced that it is holding an Introduction to workers’ compensation Medicare set-asides Webinar scheduled for June 17th at 2:00 p.m. (ET).

Major changes are coming to $0 Workers’ Compensation Medicare set-asides (WCMSA) practices starting in July 2025. 

CMS has released an updated Section 111 NGHP User Guide (Version 8.1, May 5, 2025) regarding Section 111 reporting related to non-group health plans.

The DOWC announced it is delaying its implementation of Release 3.1 for FROI/SROI reporting. The transition has been delayed until 7/30/2026.

CMS has released an updated MSPRP User Guide Version 6.5 (April 7, 2025) featuring several updates.

Effective April 7, 2025, CMS will permit Amended Review requests any time after a WCMSA case approval.

CMS has a released an Alert advising that effective 4/7/2025, Amended Review requests “will be allowed at any time a WCMSA case is approved.”  

CMS releases an updated WCMSA Reference Guide (Version 4.2, January 17, 2025).

CMS released an updated Section 111 NGHP User Guide (Version 7.8) regarding S.111 reporting related to non-group health plans. 

With CMS’s plans to collect WCMSA reporting data through Section 111 TPOC reporting, it may be a good time reconsider the EBMSA landscape.

The EDI & WCIO have discussed a change on how loss costs and rates are filed.