MMSEA Section 111 Update

February 18, 2010

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.