Overview = Mandatory Insurer Reporting

Overview

All documents pertaining only to "GHP" = will be=20 domiciled under the "GHP" section tab of this web = page.

All documents pertaining only to = Liability,=20 (including Self-Insurance), No-Fault Insurance and Workers'=20 Compensation, will be domiciled under the same named tab of = this web=20 page.

All documents pertaining to all reporting = entities=20 will be domiciled under the "Overview" tab of this web = page.

August 1, 2008

Medicare Secondary Payer Mandatory=20 Reporting

Section 111 of the Medicare, Medicaid, and SCHIP = Extension Act of=20 2007 (MMSEA) (P.L. 110-173), adds new mandatory reporting=20 requirements for group health plan (GHP) arrangements and = for=20 liability insurance (including self-insurance), no-fault = insurance,=20 and workers' compensation. See 42 U.S.C. 1395y(b)(7) = &=20 (8). The information below includes a section addressing the = Centers=20 for Medicare & Medicaid Services' (CMS) implementation = plans as=20 of June 1, 2008, as well as a brief overview of the = provisions of=20 the law.

Implementation, General

January 1, 2009, implementation date for GHP
July 1, 2009, implementation date for liability = insurance=20 (including self-insurance), no-fault insurance, and = workers'=20 compensation.
A Paperwork Reduction Act (PRA) Notice was published = in the=20 Federal Register, August 1, 2008, (Volume 73, Number 149) = with a=20 link for associated documents.
Implementation may be "by program instruction or = otherwise."
All instructions for implementation will appear at = this site=20 (www.cms.hhs.gov/MandatoryInsRep), through a link to this = site, or=20 as a document which may be downloaded from this site or an = associated link. The materials will include both = draft (when=20 possible) and final documents, including information on = how=20 interested parties may comment on the documents and/or = CMS'=20 implementation of MMSEA section 111.

The types of planned documents include, but are not = limited=20 to:

=E2=80=A2 Statutory = provisions.

=E2=80=A2 August = 1, 2008 Paperwork=20 Reduction Act Federal Register as a link or download.

=E2=80=A2 Supporting statement (with=20 Attachments) for the August 1, 2008 Federal Register PRA=20 notice.

=E2=80=A2 Data = elements for=20 reporting related to GHP arrangements and data elements for=20 reporting related to liability insurance (including = self-insurance),=20 no-fault insurance, and workers' compensation (part of the = PRA=20 supporting statement/Attachments).

=E2=80=A2 Definitions and Reporting=20 Responsibilities (provides details which will assist=20 individuals/entities in determining if they are responsible=20 reporting entities; part of the PRA supporting=20 statement/Attachments).

=E2=80=A2 "ALERT" = regarding=20 collecting Social Security Numbers (SSNs), Medicare Health = Insurance=20 Claim Numbers (HICNs), and Employer Identification Numbers = (EINs),=20 (may be helpful if a responsible reporting entity receives = questions=20 about the collection of SSNs and/or HICNs).

=E2=80=A2 "Opportunity for Public=20 Comment" (provides information on submitting comments to CMS = through=20 a dedicated e-mail address).

=E2=80=A2 Record layouts.

=E2=80=A2 Registration process=20 for reporting.

=E2=80=A2 Time-frames/timelines=20 (provides details on when registration for reporting must be = completed, when reporting will start, time-frames for = testing,=20 etc.).

=E2=80=A2 "User = Guides" for the=20 submission of data

=E2=80=A2 A = suggested model form for=20 the collection of Medicare beneficiary information.

=E2=80=A2 What = Medicare claims=20 processing contractors need to know about Section 111.

The new provisions for GHP arrangements = found at=20 42 U.S.C. 1395y(b)(7):

Add reporting rules; do not eliminate any existing = statutory=20 provisions or regulations.
Include penalties for noncompliance.
Contain provisions for the Secretary to share = information on=20 Part A entitlement and enrollment under Part B.
Who must report: "an entity serving as an insurer or = third=20 party administrator for a group health plan=E2=80=A6and, = in the case of a=20 group health plan that is self-insured and = self-administered, a=20 plan administrator or fiduciary."
What must be reported: data elements determined = by the=20 Secretary.
A voluntary GHP insurer reporting process is already = in place.=20 The mandatory reporting process will build upon the = existing=20 voluntary process.
When/how reporting must be done:

=E2=80=A2 In a form and = manner, including=20 frequency, specified by the Secretary.

=E2=80=A2 GHP = reporting will likely=20 be no more than quarterly.

=E2=80=A2 Submissions will be in an=20 electronic format.

The new provisions for Liability = Insurance=20 (including Self-Insurance), No-Fault Insurance, and Workers' = Compensation found at 42 U.S.C. 1395y(b)(8):

Add reporting rules; do not eliminate any existing = statutory=20 provisions or regulations. The new provisions do = not=20 eliminate CMS' existing processes if a Medicare = beneficiary (or=20 his/her representative) wishes to obtain interim = conditional=20 payment amount information prior to a settlement, = judgment, award,=20 or other payment.
Include penalties for noncompliance.
Who must report: "an applicable plan." = "=E2=80=A6[T]he term=20 'applicable plan' means the following laws, plans, or = other=20 arrangements, including the fiduciary or administrator for = such=20 law, plan or arrangement: (i) Liability insurance = (including=20 self-insurance). (ii) No fault insurance. (iii) Workers'=20 compensation laws or plans."
What must be reported: the identity of a = Medicare=20 beneficiary whose illness, injury, incident, or accident = was at=20 issue as well as such other information specified by the = Secretary=20 to enable an appropriate determination concerning = coordination of=20 benefits, including any applicable recovery claim.
When/how reporting must be done:

=E2=80=A2 In a = form and manner,=20 including frequency, specified by the Secretary.

=E2=80=A2 Information = shall be submitted=20 within a time specified by the Secretary

after the claim is resolved = through a=20 settlement, judgment, award, or other

payment (regardless of = whether or not=20 there is a determination or

admission of liability).

=E2=80=A2 Submissions = will be in an=20 electronic format.

If interested in receiving updates to the Mandatory = Insurer=20 Reporting web page, please use the below link located in = "Related=20 Links Inside CMS" to receive e-mail updates as information = is=20 added.

Downloads
Revised=20 April 10, 2009 - (June 15, 2008) -MMSEA111 - = Opportunity To=20 Comment on CMS' Plans For Implementing Section 111 = (PDF=20 36.2KB) Re-post=20 - February 23, 2009 - Introduction to Section 111 = Mandatory=20 Medicare Secondary Payer Reporting [PDF = 44.9KB] ALERT=20 - Requests for CMS Conference Participation for = Section 111=20 Reporting Issues [PDF 46.4KB] September=20 24, 2008 - MMSEA111 - Registration Process [PDF,=20 79KB] September=20 5, 2008 - MMSEA111 - Implementation Timeline [PDF,=20 16KB] August=20 1, 2008 - MMSEA111 - PRA73 FR 45013 080108 [PDF=20 61KB] August=20 1, 2008 - MMSEA111 - Supporting Statement [PDF,=20 104KB] July=20 2, 2008 - MMSEA111 - What Medicare Claims Processing=20 Contractors Need To Know [PDF 171KB] June=20 23 , 2008 - MMSEA111 - Collection of Social Security = Numbers=20 (SSNs), Medicare Health Insurance Claim Numbers = (HICNs) and=20 Employer Identification Numbers (EINs)(Tax = Identification=20 Numbers) - ALERT [PDF, 56KB] June=20 11, 2008 - MMSEA111 - Statutory Language/Provisions = [PDF,=20 47KB]
Related Links Inside = CMS
For=20 e-mail updates and notifications
Related Links Outside = CMS
There are no = Related Links=20 Outside CMS

Page Last Modified: 04/10/2009 = 2:58:29=20 PM
Help=20 with File Formats and Plug-Ins

Submit Feedback
=