Latest WCMSA Reference Guide “Highly Recommends” Professional MSA Administration
Posted August 10, 2017
CMS has recently indicated their support for the professional administration of Workers’ Compensation Medicare Set-Aside Arrangements. CMS has never opposed professional administration, however, this is the first time where they have specifically stated that professional administration is the preferred path. This recommendation comes from the latest WCMSA Reference Guide Version 2.6.
In Section 17.1 of the Reference Guide, CMS states the following:
Although beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.
Even though there is no mandatory requirement for professional administration, this is the strongest language we have seen to date. What is the exact reason for this? One can only surmise that the strict rules regarding the MSA Administration process are too taxing on injured individuals.
CMS has probably encountered numerous problems with injured individuals trying to maintain the required records of their MSAs. CMS likely has found it too burdensome and demanding for individuals to accurately manage these accounts. Injured parties are required to have access to state fee schedules, AWP drug pricing, maintain accurate accountings, and deal with complex Medicare coverage questions. This burden is coupled with the temptation to misspend funds on items that are neither covered by Medicare nor related to their work injury.
All in all, it appears CMS is finally recognizing the complexities injured individuals face. Not only do they need to worry about correctly maintaining MSA accounts, they also must worry about getting the care they need to maintain a somewhat normal lifestyle. Thus, like many other instances in life, CMS is recommending for individuals to “leave it to the professionals.”