Draft “Request for Proposal” for New WCRC Issued

Draft “Request for Proposal” for New WCRC Issued

The Centers for Medicare and Medicaid Services (CMS) has released a draft Request For Proposal (RFP) for a new Workers’ Compensation Review Contractor (WCRC), as well as a Statement of Work (SOW).  It appears at this point that CMS anticipates awarding the new contract in Q2 of 2017.

The SOW speaks to how the new Review Contractor would address and review “other” Non-Group Health set asides.  It appears CMS is proposing two (2) review categories for Liability and No-Fault Set Asides:  full review and cursory review.  The SOW states in part:

“In the event that the CMS would choose, the contractor shall be ready to implement a
similar process to what exists currently under the WCMSA process to evaluate MSAs for
other applicable NGHP insurances within 90 days of request. NGHP cases other than
workers’ compensation will be broken into two categories, full review and cursory
review, based on proposed settlement amounts.
Full review cases will require a complete review as similarly outlined under the
requirements for WCMSA submissions defined under section C.3.2.1 of this document.
These reviews could represent as much as 11,000 additional cases (based on all FY2015
NGHP demands), or as little as 800 additional cases annually, depending upon industry

Additionally, there are potentially 40,000 cases (based on all FY2015 NGHP demands)
that could require cursory review, only to ensure that all required documents are
appended to the cases file that would be necessary for an amount determination. These
cases will only require evaluation for completeness and potential development.”

So, while the RFP is not final and CMS has not yet promulgated any specific guidelines with respect to Liability and No-Fault MSA’s, it certainly appears CMS may well be positioning itself to start reviewing “other” Non-Group Health set asides – possibly as early as 2017.

The draft RFP and SOW can be viewed via the link below:




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