Reduction in Approved MSA Accounts Now Possible
According to the July 10, 2017 version of the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) User Guide, you may now request a reduction in the amount of a CMS-approved workers’ compensation MSA account if you believe the projected care has changed so much that the new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’s previously approved amount. To be eligible for an Amended Review, it must be submitted between one and four years from the original submission date.
This new option is in addition to the two previous options (Option 1, where you believe the CMS determination contains obvious mistakes, such as a mathematical error or requiring the cost of a surgery that was already performed; and Option 2, where you have additional evidence, not already considered by CMS, which was available prior to the original submission date that would warrant a change in CMS’s determination). The Amended Review allows you to submit documents dated after the original submission. However, only one Amended Review is allowed, and it appears it may not be allowed if a prior request for Re-Review under Option 1 or Option 2 has already been made.
Please contact Teague Campbell’s Medicare Settlement Solutions team to assist in your MSA needs.