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Centers for Medicare and Medicaid Services

CMS Carrier-Intermediary Directory

Medicare Secondary Payer Recovery Contractor

Summary of Medicare Modernization Act 2003 (PDF)

CMS Policy Memorandums:

WCMSA Reference Guide  March 29, 2013

CMS Policy Memorandum released 5/11/2011(PDF)

  • Reiteration of WCMSA review thresholds
  • No statutory provisions requiring MSA submission

CMS Policy Memorandum released 6/8/2010 (PDF)

  • New rated age language to be included WCMSA proposals

CMS Policy Memorandum released 4/3/2009(PDF)

  • CMS will begin reviewing prescription drug allocations starting 6/1/2009.
  • Methodology for pricing future prescription drug treatment is AWP

CMS Policy Memorandum released 8/25/2008(PDF)

  • Policy on implantable devices
  • Replacement of "Beneficiaries requesting termination of an MSA account" - rated ages must be on insurance carrier or broker letterhead and have a statement that all rated ages are included

CMS Policy Memorandum released 5/20/2008(PDF)

  • CMS will only use CDC Life Table 1 (total population) starting 7/1/2008

CMS Policy Memorandum released 04/25/2006 (PDF)

CMS Policy Memorandum released 12/30/2005 (PDF)

CMS Policy Memorandum released 07/11/2005 (PDF)

CMS Policy Memorandum released 10/15/2004(PDF)

  • Topics include:
  • Use of WC Fee Schedule vs. Full Actual Charges for WC Medicare
  • Set-aside Arrangement (WCMSA);
  • 2) Self-administration of a WCMSA;
  • 3) Up-front Settlement of Future Medicals vs. WCMSA;
  • 4) Inflation Adjustment/Discount to Present Value;
  • 5) Structured WCMSAs;
  • 6) WC Claim Resolution Where Medicals Remain Open

CMS Policy Memorandum released 5/07/2004(PDF)

  • Replaces the previously issued policy regarding administrative fees and attorney costs issued in the prior 2001 & 2003 memos.
  • Costs and attorney fees for establishment and administration of the MSA cannot be charged to the MSA.

CMS Policy Memorandum released 5/23/2003 (PDF)

  • Provides discussion regarding threshold reviews in workers’ compensation cases
  • Continues to answer various Q & A regarding settlements and MSP

CMS Policy Memorandum released 4/22/2003(PDF)

  • Cites applicable Federal Laws
  • Provides examples of “reasonable expectation” of Medicare enrollment
  • Provides more detailed scenarios of workers’ compensation settlements and MSP involvement.

CMS Policy Memorandum released 7/23/2001(PDF)

  • Addresses how RO should evaluate workers’ compensation settlements while taking Medicare’s interest into account.
  • Discusses commutation / compromise settlements and MSA’s.
  • Offers various Q & A scenarios

Other Guidance:

CMS Prescription Drug Set-Aside Guidance for Submitters(PDF)

  • CMS uses REDBOOK
  • Accurate and complete documentation must be submitted
  • Must include evidence of tapering of medications
  • Expiration of patent issues
  • Off-label usage issues
  • Drug utilization review issues
  • Brand versus generic
  • Multiple manufacturers - CMS will use the lowest priced generic manufacturer

WCMSA Operating Redacted Rules (4/22/2010)(PDF)

  • CMS's operating rules with regard to WCMSAs

CMS Medicare and Medicaid paper-based manuals

CMS Medicare Coverage Home Page

Code of Federal Regulations Title 42

Longshore and Harbor Worker's Compensation

Adminastar Federal

Palmetto GBA

Social Security Office Locator

Special Needs Alliance

US National Library of Medicine

Associations

American Academy of Estate Planning Attorneys

American Association for Homecare

American Association of Legal Nurse Consultants

American Association of Nurse Life Care Planners

American Association of Occupational Health Nurses (AAOHN)

American Association of People with Disabilities

American Public Health Association (APHA)

Association of Trial Lawyers of America (ATLA)

Association of Workers' Compensation Claims Professionals

Center for Medicare Advocacy

DRI

International Association of Industrial Accident Boards and Commissions (IAIABC)

International Association of Rehabilitation Professionals

National Academy of Elder Law Attorneys

National Association of Disability Evaluating Professionals (NADEP)

National Association of Independent Insurance Adjusters

National Association of Insurance Commissioners (NAIC)

National Association of Social Workers (NASW)

National Center for Policy Analysis

National Structured Settlements Trade Association (NSSTA)

Risk and Insurance Management Society, Inc.

Society of Settlement Planners

UWC-Strategic Services on Unemployment and Workers' Compensation

Resources for Public Health Graduate Students

Master's in Public Health Program Directory

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