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MEDICARE SET-ASIDE (MSA)

"All parties in a workers’ compensation case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving cases that include future medical expenses. The recommended method to protect Medicare’s interests is a WCMSA." CMS

"If you choose to submit a WCMSA for review, CMS requests that you comply with its established policies and procedures. CMS will only review new WCMSA proposals that meet the following criteria:

The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or
The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00."  CMS

Label Item Links Comments
No State or Federal Code The MSA is a creature of an agency memorandum.   CMS
 
 
Regulations/Rules The rules are in various memoranda found on CMS's website and in a new reference guide (see Misc. below)(see above) CMS
 
Websites CMS on Workers' Compensation Medicare Set-aside Arrangements  CMS   
  Submission process Submission   
  WCMSA Portal WCMSA Portal   
Practice Tips Know the rules. At the minimum, there must be an allocation that takes into consideration Medicare's interest. To avoid formal MSAs and the delays inherent in the approval process, some attorneys make multiple settlements, each under $25,000 by a penny or two.    
Articles

The WCMSA Conundrum in California by Robert G. Rassp, Esq.

Social Security Disability, Medicare, and Workers’ Compensation Settlement by Rassp & Allweiss: handout from DWC 21st annual educational conference 2/14

Rassp on MSAs

Rassp & Allweiss

Magazine Articles See the numerous articles of Steven Chapman and Gregg Chapman, Esq. in getMedLegal.com's Magazine Chapman articles
 
Roundtable The Truth About the Medicare Part D Donut Hole By Steven Chapman and Gregg Chapman, Esq. Chapmans 4-13  
Miscellaneous WC MSA Reference Guide 2014 WC MSA Reference Guide 2014  

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