On July 12, 2017, we issued an alert explaining the new WCMSA re-review process, which is referred to as the “Amended Review” process.  A link to that alert can be found here.  Since that alert, CMS has added another requirement to be able to take advantage of the Amended Review process, which is noted in bold below. The current requirements are as follows:

1.  The WCMSA must have been originally submitted between one and four years from the date of the request for Amended Review; and

2.  The case has not yet settled as of the date of the request for re-review; and

3.  An Amended Review for the WCMSA at issue has not already been requested (there is only one Amended Review allowed per WCMSA); and

4.  The requested change must result in the greater of a 10% or $10,000 change in the previously approved amount.  Please note the parties may request that the WCMSA recommendation be increased or decreased by 10%/$10,000, whichever is greater.

Given this new requirement, it is important that you discuss settlement options and timing with your Hedrick Gardner counsel in any case involving an MSA that is going to be submitted to CMS for approval.  Also, feel free to contact Hedrick Gardner’s Medicare Set-Asides and Medicare Compliance Practice Group if you would like to discuss the Amended Review option in greater detail.

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Shannon Metcalf

The information published in Hedrick Gardner Alerts is general in nature and not intended to take the place of legal advice on any particular matter. © 2017 Hedrick Gardner Kincheloe & Garofalo LLP