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Mandatory New Requirements for Self-Insured Companies

September 16th, 2009

Section 111 adds new mandatory reporting requirements for group health plan (GHP) arrangements and for liability insurance (including self-insurance), no-fault insurance and workers' compensation.  See 42 U.S.C. 1395y(b)(7)-(8).  The implementation deadline date for liability insurance (including self-insurance), no-fault insurance and workers' compensation is April 1, 2010.  An identification number and an on-line account must be established with the Centers for Medicare and Medicaid Services (CMS) by September 30, 2009.  Noncompliance with reporting requirements carries severe civil penalties.

Section 111 requires all insurers, as well as self-insured organizations (including those who carry any sort of co-pay, deductible or self-insured retention), to determine whether a claimant is eligible to received Medicare benefits at the time the claim is settled or at any point during the organizations's ongoing responsiblity for medical payments and, if so, to file detailed electronic reports with CMS that include information about the claimant, injuries claimed, and amount of any payment, settlement or award, among other things.  If an organization, known as a Responsible Reporting Entity (RRE), fails to comply with the reporting requirements, it is subject to the imposition of a civil penalty of $1,000 for each day of noncompliance with respect to each claimant.  Employers with fully insured Group Health Plans and employers who utilize Third Party Administrators (TPAs) for administration of their self-insured GHPs need not register, but should check with their insurers and TPAs if they have any concerns about whether registration has been completed by their insurer or TPA.

For additional information go to the Centers for Medicare and Medicaid Services website link at:  http://www.cms.hhs.gov/MandatoryInsRep/01_Overview.asp#TopOfPage.

This information is intended only to provide general information in summary form. The contents hereof do not constitute legal advice and should not be relied on as such. Specific legal advice should be sought in particular matters.