In response to administrative difficulties and instances where Medicare incorrectly functioned as a primary payer, Medicare secondary payer reporting requirements were enacted as part of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA). The mandatory reporting requirements under the MMSEA apply to:

  • Group health plans (GHPs)
  • Liability insurance (including self-insurance)
  • No-fault insurance
  • Workers’ compensation laws and plans

On Aug. 1, 2008, the Centers for Medicare & Medicaid Services (CMS) issued implementation guidance regarding these requirements.

The MMSEA’s reporting requirements for GHPs go into effect Jan. 1, 2009. Pursuant to the requirements, an entity serving as an insurer or third party administrator for a GHP or, in the case of GHPs that are selfinsured and self-administered, the plan administrator or fiduciary, must: (1) secure from the plan sponsor and plan participants specified information to identify situations where the GHP is primary to Medicare; and (2) report such information to Health and Human Services. The implementation guidance issued by CMS provides additional detail on these requirements, including information regarding what data will be collected and the collection process.

The MMSEA’s reporting requirements for liability insurance (including self-insurance), no-fault insurance, and workers’ compensation laws or plans are similar and go into effect July 1, 2009. Entities that fail to comply with the MMSEA’s reporting requirements could be subject to penalties for noncompliance of $1,000 for each day for each individual for whom the reporting requirements have not been satisfied.

Employers should take action now by contacting their insurers and/or third party administrators, or setting up procedures in-house to ensure that these reporting requirements will be met beginning Jan. 1, 2009.