Medicare
Mandates Reporting of SSN
Numbers
June
26, 2009
Beginning
January 1, 2009, insurers or TPAs for group health
plans, and plan administrators or fiduciaries of
self-insured and self-administered group health
plans (also known as "responsible reporting
entities" (RREs) will be required to gather
information from plan sponsors and plan
participants to help CMS identify situations in
which the group health plans are (or have been)
primary to Medicare and to report that information
to CMS. Extensive guidance about how and when to
comply with the Section 111 reporting requirements
appears on a dedicated CMS
website.
A
group health plan's RRE is required to provide
information to CMS for all individuals meeting the
definition of an "active covered individual." For
reporting purposes, CMS has defined "active
covered individuals" to include all individuals
covered in a group health plan who:
- effective
January 1, 2009 through December 31, 2010, are
ages 55 through age 64 with coverage based on
their own or a family member's current
employment status (effective January 1, 2011,
age 55 will be reduced to age 45;
- are
age 65 and older with coverage based on their
own or a spouse's current employment status;
- have
been receiving kidney dialysis or have received
a kidney transplant, regardless of their own or
a family member's current employment status; or
- are
under age 55 (effective January 1, 2011, age 55
will be reduced to age 45); are known to be
entitled to Medicare, and have coverage in the
plan based on their own or a family member's
current employment status.
CMS
has indicated that RREs need not include health
FSAs when reporting to CMS. HSAs are not required
to be reported either, so long as Medicare
beneficiaries may not make a current-year
contribution to an HSA and did not contribute to
an HSA during any time that they were Medicare
beneficiaries. Stand-alone dental, vision care,
behavioral and mental health care group health
plan coverage also need not be reported. HRAs are
considered to be group health plans for MSP
purposes, but RREs are not to report HRA coverage
information until the fourth quarter of 2010
(October - December 2010).
RREs
must also obtain Social Security Numbers (SSNs)
for all spouses and other family members who are
active covered individuals, in addition to having
SSNs for the employed individuals. The deadline
for submitting records with Social Security
numbers for spouses and other family members whose
initial date of coverage was prior to January 1,
2009 has been extended by one year (i.e., until
the RRE's file submission in the first quarter of
2011).
An
implementation timeline available on CMS's website
for the MSP reporting provisions shows the dates
for RREs to register with CMS. Registrations with
CMS were scheduled for October 2008 for group
health plans that already have VDSAs and VDEAs
with CMS. Testing of that process was scheduled to
continue through year-end. Registrations for ?new?
group health plans (plans that did not previously
have a VDSA or VDEA) were scheduled for April 2009
and will be handled via a secure COB
website.
Entities that
fail to comply with the mandatory reporting
requirements are subject to a civil monetary
penalty of $1,000 for each day of noncompliance
for each individual whose information should have
been submitted. This fine is in addition to any
other penalties prescribed by law and any
potential claims under the MSP regulations (e.g.,
a claim by Medicare that the group health plan
should have paid primary to Medicare).
