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Medicare Secondary Payer Mandatory Reporting Requirements

On December 29, 2007, the Medicare, Medicaid, SCHIP Extension Act of 2007 (the "Act") was signed into law. The Act established new Medicare Secondary Payer (MSP) reporting requirements. The new reporting requirements are intended to assist CMS in identifying individuals who are entitled to Medicare and to make a determination as to whether or not the group health plan would be primary to Medicare. Additional guidance is expected from the Centers for Medicare and Medicaid Services (CMS). CMS has established the Section 111 Mandatory Reporting Web site to communicate information and updates.

Who is required to report?
This new reporting requirement will apply to the Responsible Reporting Entity (RRE) who is defined as being either the insurance carrier, third party administrator (TPA) or, in rare cases, the plan administrator of employer-sponsored group health plans that are both self-funded and self-administered. (Note: Separate reporting requirements apply to other types of health plans, such as workers compensation plans and no-fault insurance. This summary does not apply to those types of plans.)

What information must be reported?
Required "data elements" must be reported about "active covered individuals." There are optional data elements an RRE may report on as well. A covered person is an active covered individual if they (1) are between age 45 and age 64 and have coverage based on their own or a family member's current employment status; (2) are age 65 or older and have coverage based on their own or a spouse's current employment status; (3) have been receiving kidney dialysis or have received a kidney transplant, regardless of their own or a family member's current employment status; or (4) are under age 45 and known to be entitled to Medicare, and who have coverage under the plan based on their own or a family member's current employment status.

When is reporting required?
Reporting will be required no more than quarterly and initial electronic reporting will begin sometime in 2009. Meritain Health's first electronic submission will be due between July 1, 2009 and October 1, 2009, based on a schedule to be announced by the CMS' Medicare Coordination of Benefits Contractor (COBC). Before reporting begins, RREs must register with the COBC on or before the dates specified in Section 111.

How does this Act impact employers?
While this Act does not directly impact most employers, (unless the group is both self-funded and self-administered, in which case the requirement lies with the plan administrator) employers may be asked by their TPA or insurer, to report certain information to assist the TPA/insurer in complying. Meritain Health is currently in the process of reviewing our procedures to determine what, if any, additional information will be needed from our clients.

Additional information
Failure to comply with the new reporting requirements could result in substantial fines of $1,000 per day, per individual for which information is not reported.