[Seeking Help]

I'm in CA.
I read in a reliable source that in some circumstances the C&R agreement itself must be approved by CMS before being approved by a WC judge. (I had assumed it was first approved by the WC judge.) The info went on to say that an IW who is Medicare-eligible at time of settlement and with C&R over $25K must get CMS approval.

I'm trying to understand the process. Does the above apply when the MSA proposal was already approved by CMS? If we need CMS approval on the C&R documents before they go to the WC judge, who submits the C&R documents to CMS for approval and at what stage? That is, are the documents submitted to CMS when we have a draft all parties have agreed upon or only after all parties have signed?

If CMS has concerns about some aspect, can the C&R documents be modified to satisfy those concerns (assuming all parties agree). If so, then I'd think we'd submit the documents to CMS when all parties are satisfied, but before everyone has signed. Is that correct?

Thanks for any knowledge or experience on this that someone can share.

[1171]

CMS approval is not required for a C& R; CMS doesn't even have to approve the set aside.
CMS approval of set aside is only required to protect workers future claims to use Medicare for work injury.
Your source is not reliable.

The WCAB panel explained that, while CMS does not require review of an MSA, if the MSA settlement has not been approved by CMS, CMS is not bound by the amount the parties stipulated to for the MSA and could refuse to pay for future claim-related medical expenses, which is a significant consequence of failing to have the CMS review the MSA. However, if the parties receive CMS approve-covered, claim-related medical bills regardless of the amount of care the applicant continues to require.

https://www.lexisnexis.com/legalnewsroom...ected=true

[Shadow]

Please let us know what your experiences are while you go through this process.

https://www.cms.gov/Medicare/Coordinatio...rview.html

[Seeking Help]

(02-12-2018, 04:15 PM)Shadow Wrote: Please let us know what your experiences are while you go through this process.

https://www.cms.gov/Medicare/Coordinatio...rview.html

Thanks, Shadow.
I am familiar with the situations as to when an MSA proposal should be reviewed by CMS. That has occurred and the MSA proposal was approved by CMS. This information I read recently is referring to having CMS approve the actual C&R documents themselves prior to the WC judge receiving them.

I'm trying to understand how this submission to CMS occurs plus when & who will or can be responsible for submitting it. I'd also like to know if modifications to C&R documents can be made if CMS has any concerns they want clarified. Or is this a one-shot deal with CMS and they either accept or reject the C&R documents? I don't want to be on the losing end of a problem another entity might cause.

[goingback]

This may help: https://www.cms.gov/Medicare/Coordinatio...ission.pdf

[Shadow]

(02-12-2018, 05:35 PM)Seeking Help Wrote:

(02-12-2018, 04:15 PM)Shadow Wrote: Please let us know what your experiences are while you go through this process.

https://www.cms.gov/Medicare/Coordinatio...rview.html

Thanks, Shadow.
I am familiar with the situations as to when an MSA proposal should be reviewed by CMS. That has occurred and the MSA proposal was approved by CMS. This information I read recently is referring to having CMS approve the actual C&R documents themselves prior to the WC judge receiving them.

I'm trying to understand how this submission to CMS occurs plus when & who will or can be responsible for submitting it. I'd also like to know if modifications to C&R documents can be made if CMS has any concerns they want clarified. Or is this a one-shot deal with CMS and they either accept or reject the C&R documents? I don't want to be on the losing end of a problem another entity might cause.

I was told by a " wise man " not to be a MSA administrator for the monies. This is primarily due to what Medicare sees as non medical vs medical expenses. It can be a complicated situation . Take a look at what this entails and make the decision if being an administrator is right for you... Personally I don't think I would want the responsibility.