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Last month the Centers for Medicare and Medicaid Services (CMS) updated the Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Toolkit) to version 1.4. If a Medicare beneficiary decided to self-administer their WCMSA, they should review the Self-Administration Toolkit for WCMSAs.

This Toolkit describes the process and guidelines for beneficiaries managing their WCMSA account and walks them through the set-up of their WCMSA through its depletion (exhaustion).

Also available are copies of the Account Expenditure for Lump Sum Account (Attestation Letter), Account Expenditure for Structured Annuity (Attestation Letter) and a Transaction Record Sample.

Medicare beneficiaries can use the Transaction Record Sample (or a similar document) to keep track of all deposits to and withdrawals from their WCMSA account. The account expenditure letters are blank and can be used to submit the required annual attestation that the Medicare beneficiary correctly used the funds in the WCMSA account.

This Toolkit:

– – Describes the self-administration process and guidelines, from when you first set up the WCMSA bank account until all of its funds have been used.
– – Explains who you will work with to manage your WCMSA account.
– – Discusses the two types of WMCSA accounts, lump sum and structured. The lump-sum account is discussed first, and the Toolkit includes a section on Topics Unique to Structured WCMSA Accounts later on.
– – Covers special circumstances, such as when your Medicare beneficiary status changes.

A WCMSA may be funded in one of two ways. A lump sum, in which the beneficiary receives one check or deposit for the entire WCMSA, from their settlement. Or a structured settlement, in which the beneficiary receives an initial deposit and smaller annual payments in following years.

Once a WCMSA account is set up, it can only be use it to pay for medical treatment or prescription drugs related to the beneficiary’s WC claim, and only if the expense is for a treatment or prescription Medicare would cover. This is true even if the beneficiary is not yet a Medicare beneficiary (not yet enrolled in Medicare).

If an item or service is not covered by Medicare, the beneficiary will have to pay for it themselves or with other insurance. WCMSA funds may not be used for services that Medicare does not cover.

The WCMSA account may also be used to pay for the following costs when they are directly related to the account:

– – Cost of copying documents
– – Mailing fees/postage
– – Any banking fees related to the account
– – Income tax on interest income from the account

Beneficiaries will need to keep clear and accurate records of everything they do with the WCMSA account. Medicare will use these records to determine if the account funds were spent properly.