Author Archives: BSmith

CMS Releases Updated WCMSA Reference Guide 3.3

CMS has released a new version of the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide, 3.3, COBR-Q2-2021-v3.3 dated April 19, 2021. The new Guide includes additional language regarding the calculation of the seed money for structured settlements. When a structured WCMSA is utilized by the parties, in addition to annual payments, a calculation of the […]

Updated Section 111 NGHP Model Language

CMS has released an updated Section 111 Model Language form to assist Responsible Reporting Entities (RREs) in obtaining critical information needed to determine claimants’ Medicare eligibility status.

CMS BCRC and CRC NGHP Town Hall Updates

On April 1, 2021, CMS held its scheduled Town Hall with the Benefits Coordination & Recovery (BCRC) and Commercial Repayment Center (CRC) for Non-Group Health Plans (NGHP).  Although parts of the Town Hall included information that was already disseminated by CMS in the past, there were some specific highlights as noted below. Partial Resolution of […]

CMS Updates Life Tables for WCMSAs

Beginning March 27, 2021, CMS will convert to  the CDC’s “Table 1: Life Table for the total population: United States, 2018” for all Workers’ Compensation Medicare Set-Aside life expectancy calculations.  A link to the 2018 Life Tables can be found here.  The life tables are used by CMS to calculate the length of medical treatment […]

Picture of a pen on top of paper with numbers

CMS NGHP User Guide 6.2

In less than four months, CMS has issued three revised versions of the Non-Group Health Plan (NGHP) Section 111 User Guide.  The most recent version, Guide 6.2, includes some of the following updates: In Chapter IV, Section 6.7.1 of the Guide, CMS notes that those Responsible Report Entities (RREs) who can identify a future Ongoing […]

Picture of a gavel

The PAID Act Becomes Law

The Provide Accurate Information Directly (PAID) Act, has been passed by the U.S. Congress and was signed by President Trump on December 11, 2020.   The purpose of the PAID Act is to address the lack of a centralized process to identify Medicare Advantage Plan and Medicare Part D Prescription Drug Plan beneficiaries.  Currently, the Section […]

CMS News to Note

November was a busy month for CMS with the issuance of a new NGHP User Guide, Version 6.1 and multiple alerts.  Below is a brief summary of these updates.  2021 Recovery Threshold Alert On November 25, 2020, CMS issued a new alert on the 2021 Recovery Thresholds beginning on January 1, 2021.  The alert notes […]

CMS Issues Section 111 NGHP User Guide Version 6.0

The new Section 111 NGHP User Guide 6.0 (Guide) was issued by CMS on October 5, 2020 and contains several updates as noted below. Chapter III, Section 4.6 of the Guide, CMS has specified what items should be included when calculating the Total Payment Obligation to Claimant (TPOC).  CMS notes that the “TPOC amount includes, […]

New WCMSA Reference Guide 3.2 Issued by CMS

On October 5, 2020, CMS issued a new WCMSA Reference Guide (Guide) version 3.2.  Changes to the Guide include defining what major medical centers the Workers’ Compensation Review Contractors (WCRC) utilize for pricing surgical interventions in WCMSAs.  A copy of the new Guide can be found here. Specifically, CMS added a new Appendix 7 to […]