New MSP Reporting For Plans, Insurers and TPAs in SCHIP Law
Under a new MSP reporting requirement, plans working through an insurer, third party administrator (TPA) or plan administrator will have to disclose information on situations in which the group health plan was primary in relation to Medicare.
The requirement is at Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, passed by both chambers of Congress and signed into law on Dec.29. (P. Law No. 110-173) Its effective date will be Jan. 1, 2009.
Health plans and their TPAs will have to divulge the identity of the beneficiary for whom Medicare was primary, the information needed to prove that benefits were properly coordinated with Medicare and an estimate of the amount, if any, that the plan needs to pay back. The U.S. Department of Health and Human Services will write rules to set out specific data that must be submitted.
The law imposes similar requirements on: (1) liability insurance (including self0insurance); (2) no-fault insurance; and (3) workers’ compensation plans, except those plans have until July 1, 2009 to submit their information.
The Act institutes civil money penalties for noncompliance: $1,000 a day for each individual whose information was not submitted. The fines will be in addition to whatever extra sum (including multiples or interest) the plan will have to pay to be primary for those individuals.
The law is another step to ensure that group health plans take more of the financial burden for Medicare-entitled individuals. It comes at the same time as three proposals that would create tougher rules for plans coordinating benefits with government programs.