On July 10, 2017, CMS issued an updated Workers’ Compensation Medicare Set-aside Portal (WCMSAP) User Guide which includes an expanded re-review process. The re-review process now allows for an Amended Review of cases where projected care has changed so much that a previously approved MSA amount will change by at least 10% or $10,000 (whichever is greater). The new proposed MSA amount can be greater or less than the previously approved MSA amount as long as the difference is at least 10% or $10,000.
This new Amended Review option is limited. It is only available in cases originally submitted between 1 and 4 years from the current date. It requires that new medical and/or prescription drug details be included and supporting documentation be provided. Additionally, a change from brand-name to generic drugs can not be the sole reason for the re-review request; there must be an additional change (such as changes in dosage or frequency, additional drugs, or drugs discontinued) to qualify for a re-review request. Importantly, only one Amended Review is available per case, even if the Amended Review is denied.
This is a welcome and positive change that we have been anxiously awaiting. With the opportunity to obtain a reduced MSA due to changes in treatment, clients may be able to settle cases that could not previously settle because the MSA was too high.