The below statement regarding WCMSAs was included in the financial report issued by Centers for Medicare and Medicaid Services’ (CMS) for fiscal year 2010 wherein they document an increase in the amount of approved WCMAs in the first 11 months of fiscal year 2010 due to CMS pricing of prescription drugs. However, it is anticipated that there will be a slight decrease in approved WCMSAs going forward as a result of the May 14, 2010 Memorandum which excluded prescription drugs which are not covered by Medicare from WCMSA allocations.
“In addition, the CMS continues to contract for the financial and medical review of proposed Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) amounts that represent monies earmarked in a workers’ compensation settlement for future medical services/items that would otherwise be payable by the Medicare Program. As a result, CMS has calculated and approved WCMSA amounts totaling approximately $1.5 billion over the period October 1, 2009 through August 31, 2010 (payments that Medicare might otherwise erroneously make in terms of beneficiaries’ future medical expenses related to their associated accident, illness, or injury). It should be noted that the increase for the first 11 months of FY 2010 is due to CMS’ independently pricing for inclusion of prescription Part D drugs in WCMSAs amounts, which began June 2009. This current figure may decrease slightly as CMS has allowed WCMSA submitters to remove monies from WCMSA amounts for non-covered part D drugs that were wrongfully included in WCMSA amounts.”
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