CMS Extends Mandatory Insurer Reporting to Jan. 1, 2011

In 2007, Congress passed, and President George W. Bush signed into law, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). It amended the Medicare Secondary Payer (MSP) provisions of the Social Security Act (42 U.S.C. 1395y(b)) to provide for mandatory reporting by group health plan (GHP) arrangements and by liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws and plans (non-GHPs).

MMSEA indicated that “effective July 1, 2009, applicable plans, including (1) Liability insurance (including self-insurance); (2) No-fault; and (3) Workers’ compensation laws or plans must: (A) Determine whether a claimant is entitled to Medicare benefits; and, if so, (B) 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).”

Interim Exempt Reporting Thresholds