On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) issued revised versions of its guidelines for WCMSAs and for mandatory insurer reporting of workers’ compensation, liability, and no-fault insurance claims involving Medicare beneficiaries.
The new Version 4.3 of the WCMSA Reference Guide clarifies some of the changes that were implemented 1/17/25. While these changes are not expected to cause a significant change in how the vast majority of MSAs are currently handled, here are some of the most important points:
- This guide removes the one-year waiting period for amended review of an approved MSA. This change was announced in January. The new version removes the previous language.
- This guide clarifies the procedure for changing a submitter after a proposed MSA has been sent to CMS. Now, a written release of the original submitter is required, and CMS has clarified that merely changing submitters is not a sufficient basis for an amended review.
The new Version 8.0 of the NGHP User Guide applies to the online interface where insurers and self-insured responsible reporting entities (RREs) submit information to CMS regarding claims involving Medicare beneficiaries. The requirement to report both CMS-approved and “non-submitted” MSAs went into effect on 4/4/25. Here are some highlights of this issue:
- The User Guide has now added fields to the web portal where information about these MSAs is entered and provides some scenarios to assist users when to add this information.
- Starting 10/6/25, vendors (“recovery agents”) who provide Section 111 services to RREs will be required to enter their TIN.
There is one change that still needs further clarification from CMS. This concerns the $750 minimum settlement threshold that triggers the reporting requirement. The new User Guide, Chapter IV purports that this threshold now applies to workers’ compensation and no-fault insurance claims involving non-trauma injuries (alleged ingestion, implantation, or exposure cases); however, Chapter III still states that the threshold does not apply to these cases, and any settlement over $0 should still be reported.
Overall, these changes will still require ongoing diligence when settling claims involving future medical exposure and/or Medicare beneficiaries. For more information, please contact our Medicare Secondary Payer Compliance Team!