CMS Updates WCMSA Reference Guide, NGHP User Guide, and Self-Administration Toolkit

On April 7, 2025, the Centers for Medicare & Medicaid Services (“CMS”) published Version 4.3 of the Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide (“WCMSA Reference Guide”), Version 8.0 of the Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation User Guide (“NGHP User Guide”), and Version 1.7 of the Beneficiary Self-Administration Toolkit. Here are the key takeaways from Monday’s policy updates:

WCMSA Reference Guide – Version 4.3

·       CMS will now begin to provide Notice of Settlement Received letters to Medicare beneficiaries and/or their representatives upon the Responsible Reporting Entity’s (RREs) WCMSA reporting to CMS.[1] The Notice of Settlement Received letter will serve as confirmation that CMS has received the RRE’s WCMSA Section 111 data, but it will also serve as an important “informational” letter for the Medicare beneficiary. Within the letter, CMS briefly describes the appropriate use of the WCMSA funds, confirms where such funds must be deposited, provides a link to the Beneficiary Self-Administration Toolkit, and contains an enclosed package regarding submission of annual attestations.

·       CMS has now removed the one-year waiting period for Amended Review requests. For more information, please visit our prior blog article here discussing this anticipated policy change.

NGHP User Guide – Version 8.0

·       Beginning October 6, 2025, the Recovery Agent TIN (Recovery Agent's Federal Tax Identification Number) will become a required field if a recovery agent is identified.[2] CMS states that the purpose of this upcoming requirement is to “ensure consistency of [Section 111] data”, and it appears that CMS intends to further ensure that the appropriate recovery agent receives a copy of all conditional payment recovery-related correspondence that is also sent to the RRE.

Beneficiary Self-Administration Toolkit – Version 1.7

·       CMS has removed “Section 10: Inheritance” from Version 1.7. This section previously discussed how the remaining WCMSA funds should be dispersed in the event that the Medicare beneficiary passes away prior to WCMSA exhaustion. It is unclear why this section was removed, but the fact remains that the WCMSA funds will ultimately be dispersed pursuant to state law and/or the terms of the settlement agreement.

·       CMS has now included more detailed information (with screenshots) demonstrating how Medicare beneficiaries may electronically submit their annual WCMSA funding attestations through their Medicare.gov account for those who are self-administering their WCMSA funds.

If you have any questions regarding the WCMSA Reference Guide, NGHP User Guide, or Beneficiary Self-Administration Toolkit updates, please contact us.

[1]  As many readers are likely aware, RREs are now required to report certain WCMSA information (e.g., total WCMSA amount, WCMSA period, etc.) via Section 111 reporting for workers’ compensation settlements which involve Medicare beneficiaries and exceed $750.00.

[2] A “recovery agent” performs conditional payment services (e.g., file disputes and appeals, receives conditional payment correspondence, etc.) on behalf of an RRE.