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Home > Resources > News & Information > Regulatory Updates > CMS Publishes Summary of Proposed Mandatory Reporting Requirements Under the Medicare Secondary Payer Rule; Comments Requested

CMS Publishes Summary of Proposed Mandatory Reporting Requirements Under the Medicare Secondary Payer Rule; Comments Requested

Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) amends the Medicare Secondary Payer (MSP) provisions of the Social Security Act to provide for mandatory reporting by group health plan arrangements and by liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws and plans. The Secretary of Health and Human Services has elected not to implement the provision through rulemaking and will implement instead by publishing instructions on a publicly available Web site and submitting an information collection request to the Office of Management and Budget (OMB) for review and approval of the associated information collection requirements. According to this request: Effective January 1, 2009, as required by the MMSEA, an entity serving as an insurer or third party administrator for a group health plan and, in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary must: (1) Secure from the plan sponsor and plan participants such information as the Secretary may specify to identify situations where the group health plan is a primary plan to Medicare; and (2) report such information to the Secretary in the form and manner (including frequency) specified by the Secretary. Effective July 1, 2009, as required by the MMSEA, ‘‘applicable plans’’ must: (1) Determine whether a claimant is entitled to Medicare benefits; and, if so, (2) report the identity of such claimant and provide such other information as the Secretary may require to properly coordinate Medicare benefits with respect to such insurance arrangements in the form and manner (including frequency) as the Secretary may specify after the claim is resolved through a settlement, judgment, award or other payment (regardless of whether or not there is a determination or admission of liability). Applicable plan refers to the following laws, plans or other arrangements, including the fiduciary or administrator for such law, plan or arrangement: (1) Liability insurance(including self-insurance); (2) No-fault insurance; and (3) Workers’compensation laws or plans. As indicated, the Secretary has elected to implement this provision by publishing instructions at a Web site established for such purpose. The Web site is http://www.cms.hhs.gov/MandatoryInsRep/. CMS will use this Web site to publish preliminary guidance as well as the final instructions. The Web site also advises interested parties how to comment on the preliminary guidance. Comments and recommendations must be submitted electronically or by mail by September 30, 2008.

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