Medicare Set-Asides Reporting Starts Today

Beginning today, workers’ compensation insurance carriers and self-insured entities are required to report certain data related to settlements with Medicare beneficiaries that include a Medicare Set Aside (MSA).
A Workers’ Compensation Medicare Set Aside (WCMSA) is a financial agreement where a portion of a workers’ compensation settlement is set aside to cover future medical expenses related to the work injury, so that Medicare is not paying for treatment that should be covered by the settlement funds.
According to the Feb. 23 notice from the Centers for Medicare and Medicaid Services, so-called Responsible Reporting Entities, or RREs, are now required to report certain data in workers’ compensation Total Payment Obligation to Claimant (TPOC) events (settlements) with Medicare beneficiaries involving an MSA.
This requirement holds regardless of whether a settlement meets CMS’ voluntary review thresholds for submission of an MSA.
CMS said in December that there were 14,862 workers’ compensation set-aside decisions in FY2024, down 5.5% from FY 2023’s 15,743 decisions.
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Small business owners see workers’ compensation insurance as critical in safeguarding their businesses against the high costs of workplace injuries, according to insurtech Pie Insurance’s just-released 2025 State of Workplace Safety Report.
The survey also found that if small businesses could prevent half of workplace injuries, the average annual out of pocket savings — including workers’ compensation, medical expenses, and/or legal costs — could top $10,000.
The report shows more than three-quarters of small businesses are challenged by workplace injuries, half of which were preventable.
More than 30% of small businesses reported over $20,000 on injury-related costs last year. On average, injuries resulted in four lost employee work days and three full business days of disruption during the year.
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An Alabama House committee this week unanimously approved a bill extending workers compensation benefits to public education employees. It now moves to the full House.
The bill creates the Public Education Employee Injury Compensation Trust Fund in the State Treasury with a startup cost of more than $15 million.
It would also allow full-time employees at public schools who are injured on the job to use accrued sick leave for recovery. According to the State Department of Education, public education employees earn one sick day per month.
The benefit would go into effect as soon as it is passed and signed by the governor.
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New Mexico Gov. Michelle Lujan Grisham has signed into law a measure that raises the cap on attorney’s fees in workers’ compensation cases to $30,000, and will raise it again to $32,000 in 2027, and then $34,000 in 2029.
It takes effect on June 20.
State law previously capped the fees an attorney could collect for representing a worker making an accidental injury claim at $22,500.
The new law also allows insurance companies to advance a greater share of the injured worker’s legal costs for discovery, which is the process of gathering evidence in a case and could include testimony from the doctor who treated the injured worker.
Those changes increased the discovery cost advances to $3,500 and will raise it again to $4,000 in 2027, and then $4,500 in 2029.
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