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Pursuant to the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the Centers for Medicare and Medicaid Services (CMS) published an Alert, dated July 31, 2009, inviting public comment on draft language that defines, with specificity, the conditions that lead to designation of an applicable plan as a Responsible Reporting Entity (RRE). The period of time for public comment was until August 16. The language, once finalized, will be incorporated into the CMS User Guide for Non-Group Health Plans (NGHP), which was first published in March.

Liability insurance (including self-insurance), no fault, and workers’ compensation are under the overall umbrella of NGHP and the attendant reporting requirements as described and mandated in the Act. The Alert contains important examples of scenarios involving deductibles, fronting policies, private payments and the like that can lead to designation of an insured as a plan and thus as an RRE with an obligation to file Section 111 reports in accord with CMS protocols and requirements. Further, the draft language contains guidance and definitions that apply specifically to workers’ compensation.

The Alert can be viewed as paradigm of the evolving complexities and subtleties of Section 111 reporting requirements against the backdrop of the necessity of RREs to complete registration by Sept. 30, and to commence testing on Jan. 1, 2010. Live reporting of claims will commence April 1, 2010, on those reportable matters with a payment date (Total Payment Obligation to the Claimant, i.e., TPOC) on or after Jan. 1, 2010. We note the subset to this general timeframe in the situations involving Ongoing Responsibility for Medicals (ORM). The regulations provide that ORM’s extant as of July 1, 2009, are generally subject to reporting. Thus, live data submission in 2010 must account for these claims. We would anticipate that ORMs would typically arise in workers’ compensation claims, but are certainly not limited to them.

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