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Medicare Secondary Payer Mandatory Reporting Requirements Applies to HRAs

On December 17, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a revised MMSEA Section 111 MSP Mandatory Reporting GHP User Guide which states in Section 7.2.7 that CMS considers a Health Reimbursement Account (HRA) to be a Group Health Plan product for Medicare Secondary Payer purposes. Responsible Reporting Entities (RREs) are required to include HRA programs in Section 111 reporting. The CMS User Guide also clarifies that when offered as stand-alone products, dental and vision coverage are not required to be reported for purposes of Section 111 reporting. 

Who is required to report, Meritain Health or the group health plan/employer?
Under the new reporting requirements, Meritain Health is considered to be the RRE and is the party responsible for submitting the quarterly reports to CMS if we are (1) your only TPA and/or (2) you do not self-administer any portion of your benefits. If you utilize another TPA for services and/or self-administer a portion of your benefit plan, Meritain Health will not be responsible for submitting the Section 111 information on behalf of those plans. You will need to contact those vendors to determine what information they may need from you to comply. In addition, if Meritain Health administers your HRA, we will include the required information in our Section 111 report. If you are using another vendor to administer your HRA, you should contact that vendor directly to discuss what information they may need from you to comply with Section 111.

What steps has Meritain Health taken to comply with this new reporting requirement?
Meritain has reviewed the required and optional data elements that must be reported. We are currently running reports to identify what information we are missing and will be reaching out to you shortly for your assistance in gathering this missing information. We especially need everyone's assistance in gathering missing information for primary subscribers and those individuals who have enrolled in the health plan on or after January 1, 2009. In addition, Meritain Health will be contacting you directly when we receive an enrollment form that does not contain social security numbers (SSNs) or any of the other required data elements (i.e., birth date, etc.). 

When is reporting required?
RREs must first register with the Medicare Coordination of Benefits Contractor before reporting can begin, but Meritain Health's first electronic file will not be due until sometime after July 2009. For the 2009 and 2010 reporting years, CMS recognizes that many RREs may not house SSNs for spouses and other dependents. For this reason, CMS has indicated that for spouses and other dependents who are considered to be Active Covered Individuals and whose initial date of coverage was prior to January 1, 2009, an SSN is not required. However, SSNs will be required for these individuals covered prior to January 1, 2009 during the first quarter of 2011. SSNs are still required to be submitted for the primary subscriber and any spouse or dependent whose initial date of coverage is January 1, 2009 or later. 

How does this Act impact me as an employer?
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), as stated above, Meritain Health will need your assistance in gathering SSNs and other information (i.e., date of birth) for those individuals that we currently do not have all the required information on file.

Please refer to our previous article for additional detail regarding this new reporting requirement.