Episode 222

Impact of Center for Medicare & Medicaid Service's New Set-Aside Submission Reference Guide on Workers' Compensation Settlements


January 20th, 2022

38 mins 40 secs

Your Host

About this Episode

This episode addresses the January 10, 2022 changes to the Center for Medicare & Medicaid Service’s Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide, Version 3.5 and applies to all jurisdictions where “full-and-final” settlements (including future medical exposure) are allowed.

The Set Aside Reference Guide was updated on January 10, 2022 to state that Medicare no longer gives “non submit” set aside allocations the same deference as “submitted and approved” set aside allocations. This will have a big impact on workers’ compensation settlements. This is new and conflicts with other guidance issued by the Center for Medicare & Medicaid Service regarding both required pre-approval and the review thresholds.

We explain and discuss the following:

  • What the carriers/self-insured obligations are under the Medicare as Secondary payer Act (the “Act”).
  • The options available to carriers and self-insured who want to remain in compliance with the Act.
  • The costs and tradeoffs between the various options for remaining in compliance with the Medicare as Secondary Payer Act.
  • The legal precedence and authority that CMS has and explains the litigation risks of various methods of compliance.
  • The contradictions inherent in the new Reference Guide which makes compliance with the new guidance impossible in some situations.

This audio is from a live webinar provided to clients on January 19, 2022.

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