MSA Resources & Links



WCMSA Self-Administration Website


Statutory Authority for Medicare’s right of recovery:

42 U.S.C. §1395 y(b)(2) (MSP making Medicare a secondary payer).

42 C.F.R. § 411.45, §411.50 and §411.100 (Medicare may make payment if the primary plan is not expected to make payment in 120 days).

42 C.F.R. §411.24(b). (CMS may disregard a settlement and seek reimbursement of medical expenses from a primary payer).

42 C.F.R. §411.24(e) & (g) (CMS may seek reimbursement from any entity responsible for making primary payment). 


Guidelines pertaining to Liability Medicare Set-aside Allocations (LMSA): See WCMSA resources below for additional guidance on how CMS may treat LMSAs in the future.

CMS Memorandum dated 9/30/11 (Safe harbor for liability cases where treating physician certifies no future treatment is needed).


Guidelines pertaining to Workers’ Compensation Medicare Set-aside Allocations (WCMSA):

CMS Memorandum dated 7/23/01, “Patel Memo”, Establishing WCMSAs.

CMS Memorandum dated 4/22/03, Questions and Answers.

CMS Memorandum dated 5/23/03, Questions and Answers Regarding the Review Threshold.

CMS Memorandum dated 5/7/04, Administrative Fees/Expenses and/or Attorney Costs Cannot be Charged to WCMSA.

CMS Memorandum dated 10/15/04, Question and Answers Regarding Pricing Method, Self Administration and Structured Settlements.

CMS Memorandum date 7/11/05, Frequently Asked Questions.

CMS Memorandum dated 12/30/05, Part D and WCMSAs Questions and Answers. (RESCINDED). 

CMS Memorandum dated 4/25/06, Establishing New Workload Review Threshold of $25,000.00 Total Settlement.

CMS Memorandum dated 7/24/06, Questions and Answers for Part D and Workers’ Compensation Medicare Set-aside Arrangements, supersedes CMS Memorandum dated 12/30/05.

CMS Memorandum dated 8/25/08, Policies Regarding the Pricing of Implantable Devices and Rescinding CMS Memorandum dated 7/11/05 regarding Termination of a WCMSA Account.

CMS Memorandum dated 4/3/09, Pricing of Prescription of Drugs.

CMS Memorandum dated 5/14/10, Clarifying Part D Covered Drugs and Rated Age Language.

CMS Memorandum dated 6/8/10, Clarifying the CMS Memorandum dated 5/14/10 Rated Age Language.

CMS Memorandum dated 5/11/11, Reiterating Guidance on WCMSA Review Thresholds.

CMS Memorandum, “Structured Set-aside Arrangements”

CMS Memorandum, “Prescription Drug Set-aside Guidance for Submitters Effective: June 1, 2009”.



SMART Act of 2012 (H.R. 1845)