HR Tip: Important information about Medicare Set-Aside Arrangements (MSA)

MedLearn article reissued

On November 8, The Centers for Medicare and Medicaid Services (CMS) reissued this MedLearn article to clarify information. Initially, SE17019 was issued on 09/19/17 and addressed acceptance of payment for services from a patient's Liability Insurance Medicare Set-Aside Arrangement (LMSA), No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA), or Workers' Compensation Medicare Set-Aside Arrangement (WCMSA).

The revised MedLearn article now generally references Medicare Set-Asides (MSAs); there is no longer any specific reference to a WCMSA, LMSA, or NFMSA; instead, the term "Medicare Set-Aside Arrangement (MSA)" is utilized. However, the article does not limit the discussion to WCMSAs, even though a formal review process only exists for WCMSAs and goes on further to let providers know that Medicare is always secondary to liability, no-fault, and workers' compensation insurance.

Opioid reserves in Medicare set-asides excessive

While the workers' comp industry has made significant strides in reducing unnecessary opioid use, it is not the case with MSA's according to new report from the California Workers' Compensation Institute. A startling 70% of closed workers' compensation claims in California include cash for future pain prescriptions, requiring funding for decades of opioid use, according to researchers.They also found the prescriptions were often at dangerously high dosage levels and written in conjunction with other high-risk drugs.

Although the report was based on California data, researchers have no reason to believe this problem is any different in any other state. With little oversight, the federal program allows comp claims to close with cash set aside to pay for future drugs and is clearly a matter the industry and government must address.