CMS Awards New MSA Review Contract
CMS has awarded its massive Workers’ Compensation Review Contractor (WCRC) for a whopping $60,759,236.00 to Capitol Bridge, LLC. This contract is nearly $12,000,000 larger than that awarded to Provider Resources, Inc. for the 2011 contract (PRI’s contract award was initially for approximately $24,000,000.00; however, that amount doubled to $48,000,000.00 over the life of the contract.
Why is this contract $12,000,000 larger than the previous?
Why is the contract so big? Three big reasons:
- WCMSAs have become the norm. More and more are being submitted;
- Re-review of MSAs now exists; and the big one:
- LMSA review is part of this contract.
LMSAs have been rumored for a long time, but, CMS finally began showing its interest in them recently. First, in the Request for Proposal for the WCRC contract, CMS noted, “Offeror’s shall propose a technical approach for developing recommended amounts for Workers Compensation Medicare Set-asides (WCMSA), Liability Medicare Set-asides (LMSA) and No-fault Insurance Medicare Set-asides (NFMSA)…” Emphasis Added.
Second, CMS issued its Change Request 9893 on February 3, 2017 to state, “CMS will establish (2) new set-aside procedures: a Liability Medicare Set-aside Arrangement (LMSA), and a No-Fault Medicare Set-aside Arrangement.” Emphasis Added.
When will LMSAs become mandatory?
LMSAs, like WCMSAs, will likely never be mandatory; however, Medicare will formalize this LMSA process soon. CMS is apparently aiming for a kick off of that formal process on July 1, 2018.
How many LMSAs does Medicare expect to review?
The CMS Request for Proposal’s Statement of Work indicated, “reviews could represent as much as 11,000 additional cases (based on all FY2015 NGHP demands), or as little as 800 additional cases annually, depending upon industry response.” It is interesting to see CMS acknowledging many potentially-necessary MSAs will be skipped and never created. This acknowledgment does not mean an MSA is necessary or unnecessary, it simply shows CMS is aware the Personal Injury world may not understand the MSA process – yet.
More important, a failure to understand the MSA process, regardless of CMS’s lack of current guidance, may not absolve you from liability in failing to create an MSA.
CMS tried to formalize an LMSA process before, why does it think it can succeed where it once failed?
CMS issued an Advanced Notice of Proposed Rulemaking in 2012 in an effort to formalize the LMSA process. That ANPR went nowhere because it was withdrawn by CMS in 2014. Why is this 2017 attempt different? First, CMS is paying for LMSA review now. The contract increase (while perhaps covering for some inflation and increased WCMSA burden) is large enough to show CMS considered the 800-11,000 review bump from LMSAs. Then, CMS has posted additional information, from the contractor RFP to the Change Notice for its billing/payment agencies, to this June 9, 2016 notice:
“The Centers for Medicare and Medicaid Services (CMS) is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS plans to work closely with the stakeholder community to identify how best to implement this potential expansion.”
CMS also noted it will schedule town hall meetings for discussion on this topic.
Will anything change in MSA review?
CMS has indicated it is looking for a more technological approach to the MSA review process. This means we expect changes to the process, but none have been announced yet.
Between a $12,000,000 contract increase, new (expected) technology, and much more simply because there will be a new contractor reviewing MSAs – get ready for change. We will continue to stay on top of these changes to best serve you when you need a WCMSA, LMSA, or an MSA Opinion Letter.