At Gallagher Bassett, we believe timely and effective communication is the cornerstone of excellence in our business to maintain trust, alignment, and confidence with our clients and partners.
Recently, the Centers for Medicare & Medicaid Services (CMS) announced an update to workers' compensation (WC) review requirements for Medicare Set-Asides (MSAs), which is outlined below.
Summary of Changes to Zero-Dollar MSA Review Requirements
Effective July 17, 2025, CMS will sunset its practice of reviewing zero-dollar MSAs and settling parties will be unable to obtain CMS approval of a zero-dollar MSA.
CMS outlines the following scenarios when an MSA may not be necessary:
- An individual no longer requires future medical treatment related to the work
- The WC court has determined that there is no responsibility or need for future medical treatment related to the work
- The claim is fully denied with no payments made on the claim, unless they were made within and in accordance with a state's statutory pay without prejudice
Impact: If a claim meets a CMS definition of a zero-dollar allocation, Gallagher Bassett will no longer have to submit for approval, which saves valuable time when approaching settlement. However, it is the parties' responsibility to determine and document the applicability of a zero-dollar MSA now that CMS will no longer issue approvals.
Next Steps and Guidance for Zero-Dollar MSAs
Gallagher Bassett will continue to secure and submit zero-dollar MSAs for applicable claims and settlements up to the July 17, 2025, cutoff date. Until that time, if a WC settlement meets the CMS review thresholds, it remains GB's Best Practice to request and obtain CMS approval for a zero-dollar MSA to protect Gallagher Bassett, to protect our client and carrier partners, and to mitigate risk post-settlement.
After July 17, 2025, it will still be important to properly evaluate whether a zero-dollar MSA is applicable and appropriate, especially considering CMS's requirement for Gallagher Bassett to report MSA data as part of Total Payment Obligation to the Claimant (TPOC) reporting starting April 4, 2025. Therefore, if a claim involves a Medicare beneficiary, securing a zero-dollar MSA evaluation — even though CMS will not review the proposal — is the best path to document the file and to protect our client and carrier partners.
We will continue to keep you informed as the effective date for these changes approaches. If you have questions, please reach out to your client services manager or contact our team.
Make Gallagher Bassett your dependable partner
When making the right decision at the right time is critical to minimize risk for your business, count on Gallagher Bassett's extensive experience and global network to deliver.