Do I Need An MSA?
Per CMS memorandum of July 11, 2005, Medicare's interests must be considered when settling any Workers' Compensation case - even if the review thresholds are not met.
This criteria also applies to denied claims.
MSP applies to cases that are 1) being closed, 2) require future medical care and 3) wherein the claimant is a "qualified individual".
Qualified Individual:
Class I:
- Claimant is a Medicare beneficiary at the time of settlement
- SSDI for 24 months or longer
- ESRD
Class II:
- Claimant has a "reasonable expectation" of becoming a Medicare beneficiary within 30 months of the date of settlement AND Total settlement amount is $250,000 or greater.
"Reasonable Expectation" includes:
- Claimant has applied for SSD
- Claimant has been denied SSD, but anticipates appealing denial
- Claimant is appealing or re-filing for SSD
- Claimant is 62 ½ or older
- Claimant has ESRD, however does not yet qualify as ESRD patient
Review Thresholds
CMS' current review thresholds for WC cases are as follows:
- (1) The claimant is a Medicare beneficiary at time of settlement and the settlement amount is greater than $25,000 OR
- (2) The claimant is not a Medicare beneficiary at time of settlement but has a "reasonable expectation" of Medicare enrollment within 30 months of the settlement and the settlement amount is greater than $250,000.
