04.07.09

CMS Changes Pricing Methodology for Calculating Drugs in MSAs

Posted in Uncategorized, Medicare Set-aside, Workers' Compensation at 10:36 am by admin

On April 3, 2009, CMS released a memorandum announcing that, commencing June 1, 2009, CMS will begin independently pricing prescription drugs costs included in all MSAs.  CMS will rely on Average Wholesale Price (AWP) data, and CMS “will not use or recognize any other pricing, discounting, or calculation methods when determining the adequacy of the prescription drug amounts in WCMSA proposals.”

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04.06.09

CMS Changes Coverage Rules for PET Scans

Posted in Uncategorized, Life Care Planning, Medicare Set-aside, Medical Case Management, Special Needs Trust, Workers' Compensation at 10:12 am by admin

On 4/3/09, CMS issued a decision that expanded coverage for PET (positron emission tomography) scans in the treatment of cancer patients.  Under the new rule, Medicare will cover at least one PET scan for the following eleven types of cancer: