On April 1, 2024, the Centers for Medicare and Medicaid Services (CMS) released new detailed guidance for reporting workers’ compensation settlements involving individuals who are Medicare eligible. See NGHP User Guide | CMS. As part of a series of new detailed guidance, CMS provided specifics with respect to the information required by CMS when a workers’ compensation settlement is submitted for review. See WCMSA Reference Guide v4.0 April 2024

The requirements include reporting of not only medical expenses (including future medical), but also indemnity and cash payments that were included in settlements. The requirements in many instances are in addition to and may be inconsistent with reporting under the applicable workers’ compensation law. The CMS Guidance has been developed as CMS interpretations for administration and without publication for comment as federal regulations.  

This further expansion of effective requirements without clear statutory authority and without the opportunity to comment through the normal federal regulatory process has imposed significant administrative cost and increased risk in the determination of amounts to be included in workers’ compensation settlements. Federal statutory clarification is needed. UWC supports the bi-partisan COMP Act (HR 7368) that has been introduced by Congressmen Mike Carey (R-OH) and Mike Thompson (D-CA). H.R.7368 – 118th Congress (2023-2024): COMP Act | Congress.gov | Library of Congress

HR 7368 would:

  • Create certainty for calculating the amounts to be included in Workers’ Compensation set-asides.
  • Provide appeal rights from reviews by the Centers for Medicare and Medicaid Services.
  • Provide an optional direct payment of set-aside amounts to Medicare.