Voluntary CMS Submission: New Language in Consent to Release Form
Before a proposal for a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) may be voluntarily submitted to the Centers for Medicare & Medicaid Services (CMS) for formal review, the claimant must provide written permission to the submitter by completing a Consent to Release form. In the past, there have been situations where a claimant may have signed a Consent to Release without having an opportunity to review the WCMSA report. The Consent to Release would sometimes be provided at the beginning of the process, before the WCMSA had been prepared. It was not unusual for a claimant (or a party or an attorney) to find out for the first time the WCMSA had been submitted after receiving a copy of the CMS approval letter. In some situations, the claimant did not necessarily agree with or understand the basis for what was originally submitted to CMS, creating issues for the parties who were trying to resolve the medical portion of the workers’ compensation claim.
In a move that would help eliminate such miscommunication, CMS changed the mandatory language for the Consent to Release. As of April 1, 2020, CMS began requiring language indicating the claimant had reviewed the submission package, and the claimant understands the WCMSA intent, submission process, and associated administration. This new section of the Consent to Release also requires at least the claimant’s initials to indicate validations.
CMS recommends the following specific language:
Further, I have had the Workers’ Compensation Medicare Set-Aside Arrangement need and process explained to me, and I approve of the contents of the submission.
Beneficiary Initials _____
See Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, Version 3.3, pp. 41-43 (Centers for Medicare & Medicaid Services, April 19, 2021, COBR-Q2-2021-v3.3).
In our experience, this new CMS requirement offers the parties an opportunity to collaborate on what should be included in the WCMSA proposal, including a final review of the projected causally related future medical treatment and prescription medications. This transparent approach allows the parties to work together with the submitter to make sure the information provided to CMS is accurate, comprehensive, and defensible.
Practice Tip: When requesting completion of a Consent to Release form, also provide a copy of the WCMSA proposal so the claimant has an opportunity to have any questions answered prior to voluntary CMS submission for formal review. Make sure the claimant has provided initials and a signature.
If you have questions about Consent to Release forms or WCMSAs, reach out to Daniel Hayes on our Medicare Settlement Solution team.