CMS Releases 2024 WCMSA Submission Statistics

On November 25, 2024, the Centers for Medicare & Medicaid Services (CMS) published their annual update regarding the Workers’ Compensation Medicare Set-Aside Fiscal Year Statistics. The alert is accessible here, and now provides statistics for submissions reviewed by CMS for fiscal years 2020-2024.

CMS first began making the WCMSA fiscal year statistics publicly available in 2022, which has provided stakeholders with valuable information regarding the number of files completed by CMS and the determinations returned by CMS on those submitted MSAs.

Here are the top takeaways from this year’s updated report:

Submission of WCMSAs to CMS decreased from 15,743 in 2023 to 14,862. This represents a 5.6% decrease from 2023 to 2024.

Sanderson Firm Commentary: Outside of an increase in FY 2023, the number of reviews completed by CMS each year has been declining since 2020. Submission to CMS is always a voluntary process and given the potential risk of a counter higher determination from CMS, many parties continue to explore settlement with non-submit products, so this decrease does not come as a surprise given overall industry trends.

The average WCMSA amount approved by CMS in 2024 was 21% more than the average submitted WCMSA amount.

Sanderson Firm Commentary: This is slightly less than the 22% average increase in FY 2023 but these statistics continue to demonstrate the real risk of receiving a counter higher determination when submitting to CMS. The average WCMSA amount approved by CMS in 2024 was $85,927.43, resulting in an average counter higher of $15,151.85.

There was a small increase to the medical services pricing and a small decrease to the prescription pricing approved by CMS in FY 2024.

Sanderson Firm Commentary: While the average amount allocated for prescriptions by CMS decreased from 2023, prescription medications continue to account for almost 21% of the average MSA amount approved by CMS. Overall, there were minimal changes between the average approved WCMSA amount in 2023 to 2024, confirming CMS’ review process has remained consistent. The best options to receive CMS approval of a submitted MSA are to make sure that all mitigation is completed prior to submission and that medical records, pharmacy records and other supporting documentation is provided to support the exclusion of any high dollar items from the MSA. This may prove to be difficult on some older claims, which is another reason many parties make use of non-submit reports to settle claims.

CMS submission has been and will continue to be a voluntary process, but it will be interesting to see if the new reporting requirements expanding Section 111 Total Payment Obligation to Claimant (TPOC) reporting to include Workers’ Compensation Medicare Set-Aside (WCMSA) information beginning April 4, 2025 will have any impact on whether parties choose to submit MSAs to CMS.

If you have questions regarding these statistics, WCMSAs or if you would like to engage Sanderson Firm’s services, please contact us.