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On July 31, 2017, CMS published Version 2.6 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The latest version of the Guide includes the following changes:

  • Further clarified expectations of Hearings on the Merits (Section 4.1.4);
  • Clarified jurisdictional verification (Section 9.4.4, Step 5)
  • Updated defined requirements for Spinal Cord Stimulator pricing (Section 9.4.5); • Expanded state-specific statute guidelines (Section 9.4.5);
  • Updated Off Label Medication requirements (Section
  • Clarified total settlement calculations guidelines (Section 10.5.3); • Updated Re-review policy (Section 16.0) • Added required resubmission requirements (Section 16.1) • Updated administration recommendations (Section 17.1) • Added link (Section 17.6)
  • Clarified change of submitter requirements (Section 19.4)
Click below for a side by side comparative analysis of the changes made from Version 2.5 to Version 2.6 of the Workers Compensation Medicare Set Aside Reference Guide.

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