Reminder: Section 111 Reporting of WCMSA Information Begins in April 2025
As announced last year, CMS is expanding the Section 111 reporting process to require reporting of Workers’ Compensation Medicare Set-aside (WCMSA) information for all workers’ compensation TPOCs with a TPOC date on or after April 4, 2025. The new reporting fields are set out below. Information for these fields must be reported regardless of whether CMS approval was obtained.
MSA Amount (Field 37) – Dollar amount of the MSA. If the MSA is funded with an annuity, the MSA amount should be calculated using the annuity payout. The CMS NGHP Section 111 User Guide (Version 7.9) confirms that for MSAs funded with an annuity, the MSA amount should be calculated based “upon the time period used in calculating the purchase price of the annuity or the minimum payout amount (if there is a minimum payout), whichever calculation results in the larger amount.” If no MSA is established, this field should be filled with zeros.
MSA Period (Field 38) – The number of years that the MSA is expected to cover the beneficiary. If no MSA is established, this field should be filled with zeros.
Lump Sum or Structured/ Annuity Payout Indicator (Field 39) – If an MSA is established, this field should be filled with the letter L (L = Lump Sum) or S (S = Structured/Annuity). If no MSA is established, this field should be blank.
Initial Deposit Amount (Field 40) – If the MSA is funded with an annuity, the initial deposit (seed money) amount must be entered. If the MSA is funded with a lump sum or no MSA is established, this field should be filled with zeros.
Anniversary (Annual) Deposit Amount (Field 41) – If the MSA is funded with an annuity, the annual deposit amount must be entered. If the MSA is funded with a lump sum or no MSA is established, this field should be filled with zeros.
Case Control Number (Field 42) – For MSAs that have been submitted to CMS, the CMS Case Control Number should be listed in this field. The Case Control Number is listed on the CMS determination letter. If the case control number is unknown, this field should be filled with spaces.
Professional Administrator EIN (Field 43) – If the MSA is professionally administered, the EIN of the professional administrator should be submitted. The CMS NGHP Section 111 User Guide explains that the administrator will default to the beneficiary if no EIN is entered in this field or if the submitted EIN does not match a registered administrator account on the WCMSA Portal. If the EIN is unknown, this field should be filled with zeros.
RREs should be certain to identify and report the information above for all workers’ compensation TPOCs when the injured party is or was a Medicare beneficiary and the TPOC date is on or after April 4, 2025. CMS has confirmed that the information reported in these fields will be used for coordination of benefits purposes to ensure that Medicare is not paying for related medical expenses when a WCMSA is established. Again, reporting is required even in cases that do not involve CMS approval.
RREs may currently submit test files to CMS with data in these fields. If you have any questions regarding the new reporting requirements, please do not hesitate to contact us.
