On December 4, 2023, the Centers for Medicare and Medicaid Services (CMS) released the WCMSA Fiscal Year Statistics 2020-2023, which examines trends in Workers' Compensation Medicare Set-Aside (WCMSA) submissions over the past four years. This follows last year’s inaugural report, which we wrote about here.

We see an uptick in the overall number of submissions from 2022, but like last year it’s still less than the highest released count in 2020 (16,517). In 2023, CMS issued determinations on 15,743 cases, marking the second-highest count since the nation was shocked by the COVID-19 pandemic. This is an increase over last year of 14.5% when CMS issued 13,752 determinations.

While the parties’ average proposed WCMSA amount at the time of submission shows some fluctuation, it has largely remained stable, hovering around the $70,000 to $75,000 mark.

The average CMS approved WCMSA amount in 2023 was $86,452.67, a 21.95% difference when compared to 2023’s total proposed WCMSA average amount of $70,887.33. Prior to 2023, the percent difference ranged from almost 12.98% to 14.62% depending on the year. The 2023 figures are a clear indicator that the WCRC is currently recommending higher allocations than in previous years.

That stated, on average the ratio between the amount for prescription drugs has continued its steady decline from 45% of an approved allocation in 2020 to 30% in 2023.

So while the industry has seen increase in overall recommended WCMSA amounts, we can see that it’s more attributable to medical expenses, which underscores the escalating costs of healthcare services and consequences of the inflation versus prescription costs, which used to dominate the cost of WCMSAs in a more marked fashion in years prior.

ExamWorks Compliance Solutions continuously monitors regulatory and legislative developments in the Medicare Secondary Payer space. For further information about this Report or if you have any questions, contact Ashley McCullen at 832-270-8118.