CMS Hosts Introduction to Workers' Compensation Medicare Set Asides (WCMSAs) Webinar
On June 18, 2025, the Centers for Medicare & Medicaid Services (CMS) hosted an Introduction to Workers' Compensation Medicare Set Asides (WCMSAs) Webinar.
The webinar provided a high level overview of what a WCMSA is, required documentation if submitting an MSA to CMS, a few technical points about submitting in the CMS WCMSA Portal, and a question and answer session.
The majority of the presentation reiterated the information in the CMS WCMSA Reference Guide, but there were a few points of the presentation that stood out:
1. CMS issued a reminder that zero dollar MSAs will no longer be accepted for review effective July 17, 2025 but noted that parties are still responsible for protecting Medicare’s interest. If the parties feel a zero is appropriate, they should evaluate their claim using the criteria laid out in Section 4.2 of the WCMSA Reference Guide to confirm if an MSA is not needed. Additionally, even if no MSA is prepared in the case, the Responsible Reporting Entity will still need to report a zero dollar MSA amount for Medicare beneficiaries as part of their Section 111 reporting.
2. CMS noted that any potential submission would need to meet CMS’ workload thresholds for review. The claimant must either be a Medicare beneficiary and the anticipated total settlement amount must exceed $25,000, or the claimant must have a “reasonable expectation” of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount must exceed $250,000.
CMS specified that even if a case does not meet the threshold amount for submission, Medicare beneficiaries should always consider Medicare’s interest in all Workers Compensation cases and ensure that Medicare is secondary to any applicable Workers Compensation coverage.
3. CMS repeatedly emphasized that submission of an MSA to CMS is a voluntary process. There are no statutes or regulations requiring submission of an MSA to CMS even if a case meets the workload review threshold.
4. CMS also stated that non-submit MSAs may be used to protect Medicare’s interest. Non-submit MSA amounts for Medicare beneficiaries must still be reported to Medicare through Section 111 reporting and CMS will use the MSA information reported to coordinate benefits on a claim. The MSA funds established from a non-submit MSA must be used appropriately and annual attestation of the MSA funds spent in a given year are required the same as is required of MSAs that go through the CMS submission process.
5. There was a question asked about establishing an MSA amount through the settlement documents without the use of an MSA prepared by a vendor. CMS outlined the terms of the WCMSA Reference Guide which states that while CMS is normally not bound by any allocation the parties make, CMS would follow an agreement if made through a judgment, jury verdict, hearing on the merits or other process where the relevant documents have been substantively reviewed by a finder of fact and permitted allocation in a certain manner.
If this has not occurred and CMS determines an MSA is not appropriately funded, then the Medicare beneficiary runs the risk that CMS will find the MSA amount insufficient and may require the beneficiary to exhaust the entire settlement amount on injury related care before Medicare would become the primary payer.
Sanderson Firm Commentary
The presentation from CMS was a good introductory look at WCMSAs and the voluntary CMS submission process and provided acknowledgment of non-submit MSAs being used to adequately protect Medicare’s interest. We always welcome any outreach and education efforts from CMS to stakeholders and look forward to future CMS presentations.
If you have questions regarding this webinar, MSAs or voluntary submission to CMS, please contact us.
