Currently, no policy or process allows an individual with a Medicare set-aside (MSA) account to access or release funds during their lifetime other than for what Medicare’s policies authorize, i.e. to pay for healthcare related to the underlying work injury that Medicare otherwise covers. If you would like more information on whether you can reduce or release an MSA if your condition improves, please read on, then contact our team today. Here are some questions you may have:
If a beneficiary or injured individual’s physical condition substantially improves, may the administrator of the MSA arrangement release or reduce the amount of the set-aside?
Without approval from The Centers for Medicare and Medicaid Services (CMS), the administrator of the CMS-approved Medicare set-aside arrangement can’t release or reduce the set-aside amounts. If the treating physician concludes that the beneficiary’s medical condition has substantially improved, then the beneficiary – or his or her representative – may submit a written request to the appropriate CMS RO asking for a reduction of the Medicare set-aside arrangement. This request must include supporting documentation from the treating physician(s). Once the RO receives all pertinent documentation, the RO will then evaluate the request and make a decision. The RO decision is final and not subject to administrative appeal.
The administrator of the CMS-approved Medicare set-aside should not release set-aside funds for any purpose other than the purpose for which the Medicare set-aside was established without approval from the Centers for Medicare and Medicaid Services. However, if the treating physician concludes that the beneficiary’s medical condition has substantially improved, then the beneficiary – or his or her representative – may submit a new MSA proposal covering future expected medical expenses. Such proposals must justify at least a twenty-five percent reduction in the outstanding Medicare set-aside funds. Please bear in mind that the injured individual – or his or her representative – may not submit such a proposal until at least five years after a previous CMS approval letter. All supporting documentation not previously submitted with the original Medicare set-aside proposal must accompany the new proposal. Whatever decision the Centers for Medicare and Medicaid Services makes, the injured person – or his or her representative – does not have the ability to lodge an administrative appeal.
Should CMS determine that the proposal justifies a twenty-five percent or greater reduction, the CMS will issue a new approval letter. After CMS issues a new approval letter, the claimant may receive any funds in the current MSA in excess of the newly-calculated amount.
CMS only allows one review to reduce the amount of the MSA so it is important to wait until the right time to request the reduction.
At present, no policy exists which allows for an individual to access or release funds from their MSA other than to submit a one-time request for decreased MSA amount. Contact MSA Meds today for help with this complicated process.