The Centers for Medicare and Medicaid Services (CMS) released the WCMSA Fiscal Year Statistics 2020-2024, which examines trends in Workers' Compensation Medicare Set-Aside (WCMSA) submissions over the past five years. This follows last year’s inaugural report, which we wrote about here.
Of note, there was a slight decline in submissions, average settlement amount, proposed WCMSA amount and WCMSA average proposed allocated. In general, most of the WCMSA totals have not changed much on a year-to-year basis. In 2024, CMS issued 14,862 determinations, which marks a step down from the 15,743 determinations in 2023.
The total settlement amount showed little change at $152,487.15 in 2024. Similarly, the total proposed WCMSA average remained almost unchanged at $70,887.33. This shows a mark of relative consistency on the WCMSA front as far as what CMS has been receiving for proposed allocation amounts.
The average CMS approved WCMSA amount in 2024 was $85,927.43, which is a less than 1% change from 2023’s average approved amount of $86,452.67. $85,927.43 also marks a ~21% difference up from the 2024 proposed allocation amount. This percentage is also in line with how CMS was allocating against the proposed amount in 2023. The 2024 figures, while consistent with 2023, are an indicator that the WCRC is currently recommending higher allocations than in previous years.
However, on average the ratio between the amount for prescription drugs has continued its steady decline. In 2020, the average medication allocation amount was $26,574.31. This amount has declined each year to 2024, which shows the average medication allocation at $17,806.65. Inversely, the average medical treatment (Part A + B) allocation approved by CMS has increased each year from $57,989.02 in 2020 to $68,120.78 in 2024.
So while the industry has seen consistency in the overall recommended WCMSA amounts from 2023 to 2024, 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 Michael Flower at Michael.Flower@examworkscompliance.com.