Keep current with new legislation and its potential effect on your organization. This regulatory update is for informational purposes only, and provides some key highlights on state initiatives that may impact the Medicare Set-Aside services Genex provides.
Here we are a few days into a new year and CMS has released and updated version of the WCMSA Reference Guide. As you may recall CMS issued Version 2.8 of the WCMSA Reference Guide just a few months ago in the Fall of 2018.
Version 2.9 of the Guide includes the following changes:
- The CMS development letter, issued by CMS when a WCMSA is under review, will no longer contain the name and direct phone number of the individual reviewer and will be replaced with the generic “Workers Compensation Review Contractor (WCRC)” and WCRC customer service number (833) 295-3773 for inquiries (See Appendix 5).
- CMS removed certain references to memoranda on cms.gov website per request by CMS.
- The CDC Life Table has been updated for 2015. CMS will project the cost of the claimant’s future treatment over the claimant’s life expectancy, using the Centers for Disease Control (CDC) 2015 Tables. (See Section 10.3)
- Updates related to spinal cord stimulators and the drug Lyrica (Pregabalin):
Section 9.4.5 Medical Review Guidelines
CMS has revised its guidance related to the spinal cord stimulator (SCS) to include additional information regarding SCS replacements and revisions. Routine replacement of the neurostimulator pulse generator includes the lead implantation up to the number of leads related to the associated code. Revision surgeries should only be used where a historical pattern of a need to relocate leads exists.
Section 9.4.6.2 Pharmacy Guidelines and Conditions
CMS has indicated that Lyrica is considered acceptable for pricing as a treatment for WCMSAs that include diagnoses related to radiculopathy because radiculopathy is a type of neuropathy related to peripheral nerve impingement caused by injury to the supporting structures of the spinal cord.
Last year we began to see CMS include Lyrica back into the WCMSA. This update to the reference guide provides us with a better understanding of CMS’ rationale for now including Lyrica.
To view Version 2.9 of the WCMSA Reference Guide in its entirety please click here: WCMSA Reference Guide V 2.9
For more information/questions about the updated to version 2.9 of the Guide or to make a referral please contact Genex MSA: 1.888.GO.GENEX or msadirect@genexservices.com
