Liability Insurer And Self Insured Entity Reporting Requirements Under The Medicare, Medicaid and SCHIP Extension Act Of 2007 Near Implementation
Beginning May 2009, liability (including self-insurers), no-fault and workers’ compensation insurers will be required to begin the registration process with the Centers for Medicare & Medicaid Services (“CMS”) pursuant to the mandate issued in the Medicare, Medicaid and SCHIP Extension Act of 2007 (hereinafter the “Act”). See, 110 P.L. 173 at Sec. 111, amending Section 1862(b) of the Social Security Act, 42 U.S.C. 1395y(b) (2007). The Act provides a mechanism for the enforcement of insurers and self-insurers’ existing obligations under the Medicare Secondary Payer statute (hereinafter the “MSP”). 42 U.S.C. 1395y(b).
- Whether the insurer was diligent in its efforts to come into regulatory compliance;
- Whether the insurer failed to register as a responsible reporting entity;
- Whether the insurer has registered its reporting agents;
- Whether the insurer has been diligent in transmitting data at other times.
- Can CMS seek to recover the full amount of a settlement even where claims for non-medical payments are contemplated by the agreement;
- Can CMS require an insurer to pay in excess of the negotiated settlement amount;
- Can CMS require an insurer to pay in excess of its policy limits;
- Can an insurer structure its settlements in a manner to limit or control any risk of MSP liability in the future;
- What regulatory impact would a claimant’s refusal to provide information such as Social Security numbers or Medicare ID;
- Does CMS intend to share with other governmental plans (Medicare Advantage or Part D).