CMS’s New Medicare Set-Aside Contractor

CMS can finally move forward with its new Medicare Set-Aside (“MSA”) contractor. While that contract was awarded in September, two organizations challenged that award arguing that CMS “unreasonably failed to permit offerors to make oral presentations and failed to conduct discussions.” More interesting, Arch Systems, LLC argued that the agency “failed to reasonably evaluate the realism” of the winning bid’s proposed price.

CMS’s evaluation of the three bids in question shows the extreme price differences and just how “realistic” each price is compared to the others:








Interestingly, we wrote in September that the contract is much larger than the previous MSA review contract. That is true. Admittedly, we missed an important point: The MSA industry has grown. Industry consensus is that 360,000 MSAs will be submitted to CMS over the life of this $60,759,236.00 contract. That’s $165 per case.

$165/case does not seem realistic to us either.

Nonetheless, CMS declared on December 12, 2017 that Capitol Bridge, LLC will take over as the MSA review contractor. Arch system’s $112 Million dollar bid was simply too high for CMS to agree. Now we can get back to our other questions: Will CMS finally put out guidance regarding Liability MSAs?

If you are uncertain as to whether you need an MSA for any case please consider an MSA Opinion letter drafted by one of our Massive attorneys. If you would like to consult with a Medicare expert, give us a call at 844.633.5436.