On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) will implement significant changes to the reporting requirements for workers' compensation claims involving Medicare beneficiaries. This new policy aims to enhance oversight and ensure proper coordination of benefits, particularly concerning Medicare Set-Asides (MSAs). Here's a brief overview of what these changes entail and how they will impact the management of workers' compensation claims.

Expanded MSA Reporting Requirements 

CMS has identified gaps in the information it receives about MSAs through the Section 111 reporting process. To address these gaps, CMS is now implementing mandatory reporting requirements and expressing its intent to pursue significant consequences for failure to comply. Effective April 4, 2025, all workers' compensation settlements involving Medicare beneficiaries that include an MSA of $750 or more, must now be reported to CMS. The new requirements will apply regardless of whether the settlement was previously reported under the voluntary MSA process and regardless of whether the MSA met the CMS threshold for review. The review threshold for voluntary MSA submissions remains at $25,000.