As discussed in our previous alert, New Mandatory Medicare Secondary Payer Reporting Rules Imminent, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA), added new mandatory reporting requirements for certain insurers and self-insured entities that will enable the Center for Medicare and Medicaid Services (CMS) to determine when the Medicare program does not have primary payment responsibility for Medicare reimbursable expenses. CMS has now extended the registration deadline until September 30, 2009, for insurers and self-insureds with respect to liability, no-fault and workers’ compensation plans, but has not implemented a corresponding extension for the insurers and self-insurers of group health plans. Registration for all insured and self-funded group health plans should have been completed by April 30, 2009.

The MMSEA provides stiff civil monetary penalties for failure to timely comply. All insurers and self-insured entities should immediately review their insurance programs to determine who is the “responsible reporting entity,” or RRE, to ensure timely compliance.

Revised Implementation Timeline

The revised implementation timeline for liability insurance, no fault insurance and workers’ compensation plans, including self-insurance programs, is:

  • Registration: Each RRE must register between May 1, 2009, and September 30, 2009.
  • Testing: Each RRE must conduct testing from January 1, 2010, through April 1, 2010.
  • Reporting: RREs must submit their first Section 111 Production Claim Input

Files based upon a predetermined window that will fall between April 1, 2010, and June 30, 2010.

Next Steps

Each insurer and self-funded entity that issues or self-insures liability, no-fault or workers’ compensation plans or programs should immediately take the following steps to ensure compliance:

For all entities that have liability, no-fault and/or workers compensation programs:

  • Review and evaluate existing insurance policies, plans and programs, including large deductable, minimum premium, excess and self-administered programs to determine whether the entity is considered self-funded, and thus the RRE, under the new rules. For example, if an entity is covered under a large deductible program but pays claims directly to claimants, the entity, and not the insurer, may be the RRE.
  • If the entity is an RRE, register now.
  • Review contracts with insurers and third-party administrators to determine who will perform the required reporting and whether contract provisions, such as covenants and indemnities, should be revised.

For insurers that issue and/or administer liability, no-fault and/or workers compensation programs:

  • Review policies, plans and programs with each insured to determine whether the insurer or the insured is the RRE.
  • Register as an RRE as appropriate.
  • Review contracts with insureds and third party administrators to determine who will do the required reporting and whether the contracts should be revised to reflect accurately responsibilities.