The Centers for Medicare and Medicaid Services (CMS) announced on Feb. 16,
2010 that the date for first reporting by non-group health plan (NGHP)
responsible reporting entities (RREs) under Section 111 of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (MMSEA) has been delayed from April 1,
2010 to Jan. 1, 2011.
CMS uses the term “non-group health plan” or NGHP to describe those primary
plans included under MMSEA Section 111 that are not “group health plans,” that
is, liability insurance (including self-insurance), no-fault insurance, and
workers’ compensation plans.
This change will make matters easier for NGHP RREs: they will have more time
to test reporting mechanisms. Other obligations remain unaffected, however. For
example, all NGHP RREs should already be registered with the CMS Coordination of
Benefits Contractor (COBC). The newly-announced delay does not change the
effective dates for what is reportable. RREs must still identify Total Payment
Obligations to Claimants (TPOCs) in existence on or after Jan. 1, 2010, and
Ongoing Responsibility for Medicals (ORMs) in existence on or after July 1,
2009. If a RRE has successfully completed testing for reporting, it can begin
production file reporting before the Jan. 1, 2011 deadline.
CMS will continue NGHP file data exchange testing. All NGHP RREs should be
either engaged in file testing now or preparing for it. CMS has stated that all NGHP
file data exchange testing must be completed by Dec. 31, 2010.
CMS also announced that during the week of Feb. 22, 2010, it will post the
next version of the "Section 111 NGHP User Guide" on its website and a number of
Alerts relating to particular NGHP policy issues. CMS has also stated that,
during that same week, it will post an alert for NGHP RREs describing the steps
those RREs can take to assure their ongoing compliance with the MMSEA Section
111 reporting requirements.
Further updates will be provided as they become available.