On January 21, 2025, the Centers for Medicare & Medicaid Services (CMS) sent out an announcement that effective April 7, 2025, amended review requests will be permitted any time after a Workers’ Compensation Medicare Set-Aside (WCMSA) approval letter is sent.
While the WCMSA Reference Guide that was last updated last week on January 17, 2025 will not reflect this change, we expect that a future update will include this update.
What is an Amended Review?
An amended review is essentially a second chance submission when it comes to a Medicare Set-Aside. If a Medicare Set-Aside is approved via the CMS submission process, CMS will permit a second submission on the same case if the circumstances of the case change significantly to justify the greater of a 10% or $10,000 change in the allocation for future medical expenses. While there are some limitations and changes in the amended review process from the original MSA submission, it gives parties a second chance at securing a MSA allocation approved by CMS that may be a better fit for the accounting for future medical expenses and increase the chances of settlement.
So what is changing?
The current CMS requirement for an amended review is that the parties cannot request an amended review until 12 months from the CMS WCMSA approval letter on the original submission had passed. As of April 7, 2025, the parties no longer have to wait out this one year period following CMS approval and can file at any point after CMS issues its WCMSA approval letter. This is a positive change for parties looking to expedite their second chance review with CMS as the 12 month waiting period seemed somewhat arbitrary.
How can ExamWorks help me with amended reviews or other MSAs/allocations for future medical?
ECS and our expert MSA team is available to assist you with your Medicare Set-Aside needs and help make sure your settlements adequately consider Medicare’s interest. We will continue to keep readers apprised of further agency developments from CMS as we monitor this and all areas of MSP compliance closely. ECS MSA clients should address any questions to mspcompliance@examworkscompliance.com. Should you have any questions on these developments please contact Michael Flower at 678-222-5485 or Michael.Flower@ExamWorksCompliance.com.
