CMS Releases Updated Self-Administration Toolkit Version 1.5

by J. Shymanski

While dated May 15, 2024, the Centers for Medicare & Medicaid Services (CMS) released version 1.5 of the Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) today. 

There were two sections with minor changes:

Section 1: Introduction

CMS removed the “appropriately exhausted” language and definition.

Version 1.4: Medicare will pay those costs when your WCMSA is “appropriately exhausted” or “depleted”.  “Appropriately” means you spent this money on what it is supposed to be used on, and “exhausted” means the money has all been spent.

Version 1.5: Medicare will pay those costs when your WCMSA is used up (“exhausted” or “depleted”).

Section 4: Using the Account

CMS streamlined language regarding use of the account before becoming a Medicare beneficiary.

Version 1.4: If you are not yet a Medicare beneficiary, pay all your WC-claim-related, Medicare-covered medical and prescription drug expenses from the account. When you become a Medicare beneficiary, continue to pay for WC claim-related expenses from the account until it is fully and appropriately exhausted.

Version 1.5: If you are not yet a Medicare beneficiary, pay all your WC-claim-related, Medicare-covered medical and prescription drug expenses from the account until you become a Medicare beneficiary.

Key Change: Sample Attestations

The main change in the Toolkit is sample attestations. The samples can be found in Section 13: Letters and Examples. Both the Attestation of Expenditure for Lump Sum Account and the Attestation of Expenditure for Structured Annuity document samples added references to annually submitting the forms electronically using the WCMSAP (in addition to the traditional method of mailing the forms to the BCRC).

With the upcoming April 4, 2025, requirement to report WCMSA amounts as part of Total Payment Obligation to Claimant (TPOC) reporting, it appears that CMS will focus on post-settlement administration of Medicare Set-Aside funds.

With the reporting change to TPOC and upcoming activation of the Civil Money Penalties Final Rule in October, now is a good time to review your Section 111 Reporting procedures. If you have any questions about changes to version 1.5 of the Self-Administration Toolkit or would like to learn more about IMPAXX’s Section 111 Reporting services, please contact our Settlement Consulting team at [email protected].