MSA Re-Review Process and Reporting Changes

On December 21, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) “Re- Review” Process. Additionally, CMS has updated TPOC timelines and amounts for No Fault, Liability, and Workers' Compensation claims.

Sometime in 2017 CMS plans to communicate the process of “re-review” of previously approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. The revised process is expected to update its existing re-review process to address situations where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially. CMS also expects its updated process to address situations where certain states rely on Utilization Review Processes to justify proposed WCMSA amounts.

Additionally, For Section 111 reporting, the Centers for Medicare & Medicaid Services (CMS) has changed the minimum reportable Total Payment Obligation to the Claimant (TPOC) amounts for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation claims, as follows:

    • Liability is changing from $1000 to $750 for TPOC Dates of 1/1/2017 and subsequent.

    • No-Fault is changing from $0 to $750 for TPOC Dates of 10/1/2016 and subsequent.

    • Workers’ Compensation (WC) is changing from $300 to $750 for TPOC Dates of 10/1/2016 and subsequent.

TPOC amounts that exceed these thresholds must be reported.

For a full copy of Version 5.2 of the Section 111 NGHP User Guide, please click here >>