CMS Extends Implementation Timetable

On May 11 the Centers for Medicare & Medicaid Services (CMS) announced another extension of the timetable for the Mandatory Insurance Reporting (MIR) requirements under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation plans (non-GHP plans). The major changes were that the registration period, the testing period window, and live production file submissions were all extended by three months. The new implementation timetable for non-GHP responsible reporting entities (RREs) is now:

MMSEA Background

In December 2007 Congress enacted the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). Section 111(b)(8) amended the Medicare Secondary Payer (MSP) statute to provide for mandatory insurer reporting by liability insurance (including self-insurance), no-fault insurance, and workers’ compensation plans. The purpose of these amendments, as expressed by its sponsor, Senator Chuck Grassley (R-IA), on the floor of the Senate, is to “improve the Secretary’s [of CMS] ability to identify beneficiaries for whom Medicare is the secondary payer by requiring group health plans and liability insurers to submit data to the Secretary.”

Effective July 1 the MMSEA requires that “applicable plans” must first determine whether a claimant (including an individual whose claim is unresolved) is entitled to Medicare benefits. They must report the “required information” once the case is resolved to the Secretary of Health and Human Services in the “form, manner, and frequency” the secretary prescribes.