The Set Aside Reference Guide (WCMSA Ref. Guide Vers. 3.5) was updated on January 10, 2022 to state that Medicare no longer gives “non submit” set aside allocations the same deference as “submitted and approved” set aside allocations. This will have a big impact on workers’ compensation settlements.
This is new and conflicts with other guidance issued by the Center for Medicare & Medicaid Service regarding both required pre-approval and the review thresholds. Two key questions emerge.
First, the new Guide states throughout that submission of a set aside for pre-approval by CMS is not required. All of the language in the Guide that confirms that pre-approval is not required is the same.
Second, the new statement, that CMS will not give deference to “non-submit” allocations conflicts with the fact that many allocations can not be submitted for review, according to Medicare’s own rules.
Greg Lois is hosting a live Q & A session on what this change in guidance from the CMS means for carriers and self-insured employers resolving workers’ compensation claims via “full and final” settlement. Register here: https://attendee.gotowebinar.com/register/2523205883375673614
