Recent CMS Guidance On Mandatory MSP Reporting
David Stevens, Wednesday, May 27, 2009 | Filed under: Health Plans, Legislation, Cafeteria Plans
As we
reported last year, the Mandatory Medicare Secondary Payer Reporting Program went into effect as of January 1, 2009. Since our initial report on this Program, the Centers for Medicare and Medicaid Services (“CMS”) have issued several updated versions of the Group Health Plan User Guide for use by responsible reporting entities (“RREs”). An RRE is defined as “an entity serving as an insurer or third-party administrator for a group health plan … and, in the case of a group health plan that is self-insured and self-administered, a plan administrator or fiduciary.”
“ACTIVE COVERED INDIVIDUALS”
The updated User Guide clarifies and updates a number of aspects of the new Program. For example, it makes clear that individuals covered by COBRA are
excluded from the definition of “active covered individuals” – those individuals for whom the RRE must report. It also increases the minimum age threshold used in the definition of “active covered individuals” from 45 to 55. However, this age threshold will revert to 45 on January 1, 2011.
“FINDER FILE” OPTION
CMS has unveiled an alternative to using the age threshold for purposes of the mandatory reporting requirement. Under the “finder file” option, an RRE sends a “query file,” through which CMS identifies any Medicare beneficiaries who are currently known to CMS and returns those positive identifications to the RRE. The RRE then submits the required records for those identified Medicare beneficiaries.
The CMS User Guide notes, however, that the use of the “finder file” option is
not a foolproof method of identifying all individuals for whom an RRE is required to report. Moreover, CMS reminds “finder file” users that this probability of under reporting must be “carefully weighed by any RRE considering the finder file reporting option.”
FSAs, HSAs, AND HRAs
CMS has also updated the explanation of the reporting requirements applicable to flexible spending accounts (“FSAs”), health savings accounts (“HSAs”), and health reimbursement accounts (“HRAs”). Generally, FSAs and HSAs are not reportable under this Program, but HRAs are considered to be reportable group health plans. However, the latest update to the User Guide provides that RREs need
not report HRA coverage information until October of 2010. This extension is designed to give RREs time to gather the information needed to report on HRA coverage. CMS has indicated that it will provide further guidance on the reporting of HRA coverage at a later date.
DENTAL OR VISION COVERAGE
When offered as a stand-alone product, dental or vision coverage is not reportable. However, RREs are still “responsible for being aware of situations where dental or vision care services are covered by Medicare and pay primary to Medicare for all beneficiaries who have such stand-alone coverage when appropriate.”
DEPENDENTS’ SOCIAL SECURITY NUMBERS
Perhaps most significantly, an extension has been granted for RREs to collect Social Security numbers for dependents whose initial effective date with the plan was
prior to January 1, 2009. RREs now have until January 1, 2011 (instead of 2010) to report on these individuals.
There are important caveats to this extension, however. First, the extension applies only to dependents of participants who were enrolled in the plan prior to January 1, 2009. Moreover, this extension is
not a waiver; these Social Security numbers will still need to be reported by January 1, 2011. Nonetheless, for those RREs that did not have a process in place for collecting dependents’ Social Security numbers before January 1, 2009, this relief provides an opportunity to educate their prior enrollees as to the new requirement and collect the necessary data.
CONCLUSION
The updates discussed in this article are not comprehensive. Any RRE should
download the latest User Guide and review any other updates that may be relevant to their situation.