WCMSA Legislation - a Band-Aid Solution?

Jean Goldstein. @JeanSGoldstein Earlier this week, I was able to connect with Jean Goldstein, Senior Legal Counsel, MSA Compliance at MEDVAL. So, grab your favorite beverage and spend a few minutes catching up with Jean…learn what’s on her mind in regards to workers’ comp:

Q. Jean, tell me what you’ve been up to for the past month? What are some of the top activities or developments for you in the past 30 days?

1. Spending time with my family, visiting museums in Washington, D.C.
2. I was invited to speak at the 2018 California Self-Insurers’ Association fall conference on the very hot topic of conditional payments.
3. Camping in the mountains and disconnecting from the world, in a part of Maryland we have never seen.

Q. What is the primary issue, related to workers compensation, that is occupying your brain space currently?

A. Medicare Secondary Payer (MSP) compliance continues to be a hot topic across the board, from discussions regarding the Centers for Medicare and Medicaid Services (CMS) expanding (or not expanding yet, at least) their voluntary review processes, to nationwide litigation involving Medicare Advantage Plans. Very recently, legislation concerning the Workers’ Compensation Medicare Set-Aside (WCMSA) process, has been introduced. The legislation certainly has a long way to go before being enacted, but the intent of the legislation is to establish the application of state provisions and state fee schedules for WCMSAs as well as, creating a formal appeal process for WCMSAs submitted to CMS for approval.

This legislation is a “band-aid,” introduced to fix some of the inherent challenges and costs associated with obtaining CMS approval for WCMSAs. It does not address or overcome the subjective process of a WCMSA evaluation by CMS; nor does it address CMS’ standardized methods for allocating prescription medications. The overallocation of prescription drugs, and opioids, is a topic that needs to be addressed on various levels, including legislative. Moreover, trying to repair the WCMSA review process with this band-aid will not solve all of the challenges associated with the process. Despite this legislation being introduced, the option to bypass obtaining CMS approval is, and will continue to be a very viable and effective option for those who recognize the continued challenges and costs associated with CMS’ review program. It will be interesting to see if this legislation gets any traction. I invite you to read MEDVAL’s blog for updates on this and other important MSA issues.

Yvonne Guibert. @buzzystreet Comp Laude® Awards Finalists Announced! This is an exciting time of year. I’m happy to see how far the Comp Laude® Awards & Galahas come and proud to say that I have been a part of it’s growth over the years. Today WorkCompCentral announced the nominees and finalists and I can seen first-hand the flurry of activity it has created on social media as well as emails and phone calls I’ve received. While I am not directly involved in the nuts and bolts of Comp Laude® this year, as in previous years, I have all the confidence in Kristen Chavez and her team to make this the best year ever!

Take a look at the complete list of nominees — every person / organization on this list deserves credit for doing a great job. Think someone or an organization is missing? Then take note and be sure to nominate someone next year. Better yet, make plans to attend this year’s event Oct 9 – 11 in San Diego, CA. This is the only industry event aspiring to change the narrative in workers’ compensation. Contact me if you are interested in sponsoring.

#WCMSA #workerscomp #complaudegala #ThoughtfulThursday