Author: Mark Long, Senior Vice President, Regulatory Affairs, Ametros
Earlier this year in April 2025, the Centers for Medicare & Medicaid Services (CMS) released Version 4.3 of the Workers’ Compensation Medicare Set Aside Reference Guide (WCMSA). CMS also updated the WCMSA Self-Administration Toolkit to Version 1.7 on April 4, 2025. These updates represent a significant shift in how CMS communicates with Medicare beneficiaries and plaintiff attorneys must ensure their clients are prepared.
CMS made it clear: they will now share WCMSA details directly with the injured worker including the approved amount, associated injury codes, and the rules for using those funds in place of Medicare. The WCMSA visibility created by the April 4, 2025 TPOC changes makes the proper administration of WCMSA funds more critical than ever. CMS already highly recommends the use of professional administration like Ametros, and this latest move reinforces just how essential that guidance has become. Attorneys representing injured workers must now take a more proactive role in educating clients about these obligations to protect their Medicare eligibility and avoid costly mistakes.
Why This Matters for Clients
The CMS Notice of Settlement Received Letter (Appendix 5) advises the injured worker (beneficiary) that CMS has received a Notice of Settlement that includes an amount designated for a WCMSA. They advise that this information will assist CMS in making appropriate coordination of benefit decisions. Additionally, CMS will update its systems to indicate that the WCMSA will be utilized to cover related items and services.
The letter also provides a high-level summary of self-administration requirements and provides a link to the self-administration toolkit. Importantly, the letter also includes a warning of some potential consequences. Any Medicare payments that should have been covered by the workers’ compensation settlement, judgment, award, or other payment must be repaid to Medicare.
CMS has also clarified that the Notice of Settlement Received Letter is now sent directly to the Injured Worker (Beneficiary). This letter outlines the requirements for proper administration of WCMSA funds. Previously Medicare only provided this information as part of the WCMSA approval packet which was typically just a few pages included when a MSA was formally submitted. If no submission was made, the injured worker received nothing. This new step marks a significant change: CMS is expanding its communication efforts to reach All Medicare beneficiaries involved in a settlement, even when the WCMSA was not submitted. As a result, the injured workers will now be directly informed of their responsibilities and the consequences of non-compliance. This change places the burden of compliance squarely on injured workers. Without proper legal guidance, clients may unknowingly mismanage their WCMSA funds, risking Medicare denials or repayment demands.
Three Key Updates from WCMSA Reference Guide Version 4.3
- Notice of Settlement Received Letter: To support Medicare set-aside reporting requirements, the Notice of Settlement Received letter has been added to this guide (Appendix 5).
- Amended Review Process: The one-year wait period for amended reviews has been removed (Section 16.3).
- Change of Submitter: The guide has been updated to clarify CMS’ policies around change of submitter (Sections 16.3 and 19.4)
Self-Administration Toolkit Version 1.7: What’s New?
CMS also updated its Self-Administration Toolkit, removing the section on inheritance and reorganizing content for clarity. While these changes may seem minor, they reflect CMS’s broader push for greater accountability and education for injured workers managing their own WCMSAs.
What Plaintiff Attorneys Should Do Now
Attorneys representing injured workers must take the lead in ensuring clients are informed and protected. Key steps include:
- Educating clients on the purpose and rules of WCMSAs during settlement discussions.
- Reviewing the Notice of Settlement Received Letter with clients to ensure they understand their responsibilities.
- Discussing professional administration options, especially for clients who may struggle with self-administration.
- Documenting informed consent regarding WCMSA decisions and administration choices.
Final Thoughts
These recent updates from CMS signal a continued push for greater transparency, accountability, and education around WCMSA administration. With expanded communication to beneficiaries and updated guidance tools, proper compliance is no longer just recommended- it’s essential, and using a professional administrator like Ametros can help ensure funds are managed correctly and consistently with CMS expectations. Plaintiff attorneys must stay ahead of these changes and ensure their clients are fully supported.
For attorneys with questions about how these updates affect their cases or who need help navigating WCMSA compliance, Ametros is available to answer any questions you may have.
To learn more about Ametros, please visit www.ametros.com. If you have a future medical case that could benefit from professional administration, please send us details through our referral form.