The MSA Today

CMS has Overstepped its Statutory and Regulatory Authority

CMS to Deny Future Medicare Payments Unless WCMSA is Approved


"Unless a proposed amount is submitted, reviewed, and approved using the process described in the reference guide prior to settlement, CMS cannot be certain that the Medicare program’s interests are adequately protected. As such, CMS treats the use of non-CMS-approved products as a potential attempt to shift financial burden by improperly giving reasonable recognition to both medical expenses and income replacement. As a matter of policy and practice, CMS will deny payment for medical services related to the WC injuries or illness requiring attestation of appropriate exhaustion equal to the total settlement less procurement costs before CMS will resume primary payment obligation for settled injuries or illnesses. This will result in the claimant needing to demonstrate complete exhaustion of the net settlement amount, rather than a CMS-approved WCMSA amount.”


After reading dozens of industry responses to CMS’ announcement, there was a noticeable lack of legal discussion, an appreciative void of legal review, a quiet acceptance of this new policy by the MSP vendor industry, without an in-depth and comprehensive legal analysis of whether this latest change is appropriate under current law, or whether it goes too far considering current statutory and regulatory law.


For a greater in depth discussion about how CMS has overstepped its statutory and regulatory authority, please visit the Cattie & Gonzalez blog.

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