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CMS Issues WCMSA Self Administration Toolkit For Injured Employees

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WCMSA Self Administration Toolkit Good idea

A WCMSA self-administration toolkit for injured employees was a desperately needed item.  Last week, the Centers for Medicaid and Medicare Services (CMS) created a page with quite an amount of documentation for Workers Comp Medicare/Medicaid Set Asides (WCMSA).

Picture Of Woman With Arm Injured WCMSA Self Administration Toolkit With Plastercast

The page is for injured employees that wish to Self-Administer their MSA account.  The CMS provided a laundry list of documents for claimants that did not wish to have an outside service handle their MSA account.  Click here for the page.   The PDF file for the toolkit is here.

The CMS does a great job of explaining the WCMSA process.   The amount of tracking and materials may be too burdensome for some of the injured employees.   CMS performed well for giving it a try.   The Table of Contents of the guide is below.   The page numbers were intentionally left off the Table.

There are a few interesting yet troubling areas in the guide.  Those will be included in tomorrow’s article.

Table of Contents

Section 1: Introduction
Section 2: Setting Up the WCMSA Bank Account
Section 3: How Your WCMSA is Funded
Section 4: Using the Account

  • What medical and prescription expenses can I pay for from this account?
  • Can I use the account to pay for anything else?

Section 5: What to Tell Your Health Care Providers

  • How should my health care providers calculate the bill?
  • What if my health care provider is also treating me for other problems?
WCMSA Self Administration Toolkit
(c) 123RF

Section 6: Reviewing and Paying Your Bills
Section 7: Keeping Records
Section 8: Annual Attestation

  • Final depletion of funds

Section 9: Reporting Changes

  • Medicare entitlement status

Section 10: Inheritance
Section 11: Topics Unique to Structured WCMSA Accounts

  • What if I do not use all the funds in a year?
  • What happens if my funds run out before the next deposit?

Section 12: Where to Get Help
Section 13: Letters and Examples

  • Letters for your health care providers: Medical providers
  • Letters for your health care providers: Pharmacy providers
  • Lump-sum annual attestation and expenditure letter
  • Lump-sum annual attestation and expenditure letter: Exhausted lump-sum account
  • Structured account attestation and expenditure letter: Annual attestation
  • Structured account attestation and expenditure letter: Temporary exhaustion
  • Structured account attestation and expenditure letter: Permanent exhaustion
  • Transaction Record Sample

Section 14: Glossary

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Table of Contents


Is Social Security Disability Affected by WC?

Social Security Disability Does Workers Compensation have an effect on Social Security Disability?  More precisely, do Social Security Disability applications increase when WC payments decrease?

James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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