CMS has prolonged by one yr its deadline for publishing closing laws that might specify how and when it’s going to impose civil cash penalties for violations of the Medicare Secondary Payer (MSP) reporting necessities. As background, accountable reporting entities (RREs) for group well being plans—sometimes insurers or third-party directors (TPAs)—are required to report data to CMS about people who’re each entitled to Medicare and lined below a gaggle well being plan. The stories assist CMS decide whether or not a plan’s protection is major or secondary to Medicare. The Medicare statute authorizes penalties of $1,000 per day for noncompliance with the MSP reporting necessities. In February 2020, CMS issued proposed laws addressing the varieties of violations that might warrant penalties and the way penalties can be calculated (see our Checkpoint article). In response to its established timeline, CMS had three years wherein to finalize the proposals.

Along with noting delays ensuing from the company’s deal with the COVID-19 public well being emergency, CMS justifies the one-year extension by explaining that public listening periods in regards to the proposed rule raised further issues that must be researched previous to publishing the ultimate rule. CMS hopes to raised perceive the financial affect of the proposed rule by conducting further evaluation of present reporting information and fascinating in predictive modeling of the penalties that might be imposed had been the ultimate rule in place. Underneath the extension, closing laws are resulting from be printed by February 18, 2024.

EBIA Remark: RREs may additionally be fascinated about a current CMS chart highlighting the highest ten reporting errors over the last half of 2022. Whereas comparatively few employers are RREs, employers which can be group well being plan sponsors could also be requested to help RREs, similar to their insurers or TPAs, in compiling details about contributors of their plans. CMS has emphasised the significance of employer cooperation with their plans’ RREs, and as soon as the laws are finalized, failing to offer crucial data and help may put insurers and TPAs prone to penalties for noncompliance. For extra data, see EBIA’s Group Well being Plan Mandates guide at Sections XXIV.J (“MSP Necessary Reporting Requirement”) and XXIV.Ok (“Enforcement”). See additionally EBIA’s Self-Insured Well being Plans guide at Part XXV.C (“Coordination of Advantages With Medicare, TRICARE, and Medicaid”); EBIA’s Client-Pushed Well being Care guide at Part XXV.F (“HRAs and Medicare Secondary Payer (MSP) Necessities (Together with Necessary Reporting)”); and EBIA’s COBRA guide at Part XXX.D (“Medicare Secondary Payer (MSP) Guidelines”).

Contributing Editors: EBIA Workers.