Understanding Medicare Set-Aside
Providing Medicare Compliance Solutions since 2010
The passage of the 2007 Medicare Medicaid SCHIP Extension Act (MMSEA) changed the way the insurance and legal communities settle claims that may include the need for future medical treatment. Section 111 of the MMSEA set forth a method that allows Medicare to track and enforce its basic rights of recovery as a secondary payer.
Since the MMSEA was passed, workers’ compensation, general liability, auto liability, and other injury claim settlements have been burdened by confusion and misinformation about the responsibilities of parties entering into a settlement.
MSA Administrators has the expertise to lead your case towards settlement while complying with CMS and their regulations.
Check out these links from CMS.gov to better understand some of the basic principles of Medicare compliance.
- Section 111: The passage of the 2007 Medicare Medicaid SCHIP Extension Act (MMSEA)
changed the way the insurance and legal communities settle claims for Medicare eligible individuals. Section 111 of the MMSEA set forth a method that allows Medicare to track and enforce its basic rights of recovery as a secondary payer. Click here for CMS’s summary of Section 111.
- WCMSA Guide Narrative: CMS Routinely updates the official WCMSA Guidelines. Click here for a link to the most updated document, directly from CMS.
While CMS has been very slow to provide actual rules and regulations regarding the settlement process, they have issued a number of memos which provide insight into complying with the law in the settlement process. Click below to see the memos with our brief explanation.
- May 11, 2011 – WCMSA Workload Review Thresholds
- June 8, 2010 – Memorandum Clarifying the May 14, 2010 Rated Age Language
- April 3, 2009 – Procedures Regarding Methodology for Pricing Future Prescription Drug Treatment
- August 25, 2008 – Pricing of Implantable Devices
- May 20, 2008 – Use of CDC Table 1 in the WCMSA Review Process
- July 24, 2006 – WCMSA Part D FAQs
- April 25, 2006 – WCMSA Low Dollar Threshold
- December 30, 2005 – WCMSA and Part D
- July 11, 2005 – WCMSA FAQs
- July 5, 2005 – Summary High Level Memorandum Info
- October 15, 2004 – WCMSA FAQs
- May 7, 2004 – WCMSA Policy
- May 23, 2003 – WCMSA FAQs
- April 21, 2003 – Workers’ Compensation FAQs
- July 23, 2001 – Commutation of Future Benefits
- June 1, 2009 – CMS Prescription Drug Set-Aside Guidance