Essentials of MSA Non-Submission Programs
Vice President, Medicare Set-Aside Services
In a recent National Council of Self-Insurers (NCSI) webinar on successfully managing Medicare Set-Aside (MSA) programs, EK Health's Jake Reason, Vice President of MSA Services, discussed best practices for MSA Non-Submission Programs in workers' compensation. Key topics included the following:
- Initial key considerations for establishing a non-submission program
- Key stakeholders
- Designing the methodology for creating Evidenced-Based Medicine MSAs
- Establishing relationships with defense panel
- Measuring the success of a non-submission program
What is a Non-Submission Program?
Essentially, a non-submission program exercises the option of not submitting an MSA for approval from the Centers for Medicare and Medicaid Services (CMS). As the MSA review process is voluntary, sometimes it is advantageous for the parties in workers’ compensation cases to use the “non-submit” option.
In sharing the key elements of a non-submission program, Jake encouraged participants to consider the following:
- Assessment of the current risk appetite of Insurer/Self-Insured Employer
The non-submit candidate should be willing to assume some risk.
- Current exposure/severity of claims
The non-submit candidate should have a lower overall severity for claims in their program.
- Current claims handling practices
The non-submit candidate should have strong, capable claims and legal teams managing claims in adherence with best practices.
- Ability of the claims team to manage/utilize a non-submission program
The non-submit candidate should have a claims team skilled in allocations that support the non-submission option for claims in the program.
- Current clinical practices
The non-submit candidate should leverage all the tools available to them for sound clinical management of claims.
- Pharmacy Benefits Management Options
The non-submit candidate should have a tightly controlled resource for reliable pharmacy history and post-settlement pricing.
- Use of Professional Administration
The non-submit candidate should optimize overall outcomes through the offering of professional administration.
- MSA vendor panel
The non-submit candidate should ensure that the MSA vendor has the resources available to provide multiple different types of allocations (MSAs based on CMS guidelines using Average Wholesale Price, Evidenced Based Medicine MSAs, Non-Medicare Covered Items, etc.).
EK Health is well-versed and experienced in all aspects of MSAs. If you would like us to help you evaluate whether non-submission is ideal for your program, please reach out to explore the opportunities and benefits in greater detail. We would love to help you connect with the ideal MSA solutions for your specific dynamics.
To learn more, please contact our Vice President of Medicare Set-Aside Services at firstname.lastname@example.org.