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CMS Medicare Set-Aside Arrangement Reference Guide Updated May 15, 2023

May 17, 2023

 

The Centers for Medicare & Medicaid Services has updated the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide to Version 3.9 effective May 15, 2023.

Version 3.9 of this guide includes the following changes:

  • All WC letters currently signed with CMS’ Director of Financial Services Group name and signature image have been updated to reflect the current CMS customer service contact information (Appendix 5).
  • The CMS Regional Offices are no longer responsible for approving initial determinations. Process language and contact information have been updated throughout the guide (Sections 9.0, 9.4.6, 9.5, and 18.0, and Appendix 5).
  • Clarification has been provided regarding intrathecal pump, spinal cord stimulator, and peripheral nerve stimulator replacement frequency calculation (Section 9.4.5).
  • The maximum time limit for eligibility has been removed from the Amended Review process (Section 16.3).
  • The 94585 ZIP code has been added to the Walnut Creek Medical Center in the table listing major medical centers (Appendix 7).
  • The CDC Life Table link was updated (Section 10.3).

The Reference Guide and other information on Workers’ Compensation Medicare Set Aside Arrangements can be found on CMS's website