The Medicare, Medicaid and SCHIP Extension Act of 2007 (“SCHIP”) imposes mandatory reporting requirements for group health plans to help the Centers for Medicare and Medicaid Service (“CMS”), the division of Health and Human Services that administers Medicare, Medicaid, and the Children’s Health Insurance Program. Prior to SCHIP, reporting was done on a voluntary basis. Under SCHIP, plan administrators and insurers are subject to the new reporting requirements, which will identify situations where the group health plan is primary to Medicare and report such information to HHS. Plan sponsors of insured plans do not have reporting obligations but plan sponsors of self-insured group health plans are subject to the new rules.
On August 1, 2008, CMS issued a supporting statement (the “Statement”) specifying what information must be collected with respect to plan participants and reported on a quarterly basis. The Statement sets forth the information that must be collected including, inter alia, the social security number (SSN), surname, date of birth, gender, type of insurance coverage, policy holder’s name and SSN, and employer size and group policy number. To download the CMS Statement, go to http://www.srz.com/files/upload/SupportingStatement082808.pdf.
SCHIP also includes broad provisions for the sharing of information between HHS and other entities, including (1) requiring HHS to share information on Medicare Part A entitlement and Part B enrollment with group health plan insurers, TPAs, plan administrators and fiduciaries, and others (e.g., the plan administrator of a plan that is not self-administered); and (2) permitting HHS to share the information it gathers under the new reporting system with unspecified persons and entities for coordination of benefit purposes.
SCHIP authorizes a substantial civil monetary penalty ($1,000 for each day of noncompliance) for each individual for which information should have been submitted but was not. This fine is in addition to any other penalties prescribed by law and Medicare secondary-payer claims, such as a claim by Medicare that the group health plan should have paid primary to Medicare.
The new reporting requirements are effective January 1, 2009.
Employers that sponsor only insured plans will not be subject to the data reporting requirements. Sponsors of self-insured plans that are self-administered, however, should verify that internal policies and procedures have been implemented as necessary to ensure that they (or their thirdparty administrators) satisfy the new mandatory reporting requirements with respect to Medicare-eligible participants, or they should appoint an agent to comply with the new HHS reporting requirements.