The Center for Medicare and Medicaid Services (CMS) has once again delayed the implementation of Section 111 reporting requirements of the Medicare, Medicaid and SCHIP Extension Act. The Act had imposed new and mandatory reporting requirements for group health plan arrangements, liability insurance (including self-insurance), no-fault insurance, and Workers' Compensation. The new reporting requirements were scheduled to begin in the first quarter of 2011.
Recently, on November 9, 2010, CMS issued an Alert in which they announced a one year delay in the implementation of the Section 111 reporting requirements for certain claims involving liability insurance. The required submission of initial claim reports is extended from the first quarter of 2011, to the first quarter of 2012 for liability insurance TPOC's (Total Payment Obligation to Claimant), including self-insurance, with no Ongoing Responsibility for Medicals (ORM) involvement.
It is important to note that this is not a blanket extension to all claims. The extension does not apply to liability insurance with Ongoing Responsibility for Medicals (ORM). Further, the extension does not apply to no-fault or Workers' Compensation claims.
The recent Alert also provides an extension of current dollar thresholds for liability insurance (including self-insurance) and Workers' Compensation. According to the Alert, the interim dollar reporting threshold set forth in Section 11.4 of the MMSEA 111 Liability Insurance (including self-insurance), no-fault and Workers' Compensation User Guide have all been extended by one calendar year. The threshold amounts will eventually be eliminated over time. With the current extension, the threshold amounts will disappear for claims where the last (most recent) TPOC date is January 1, 2015 and subsequent.