MMSEA Section 111 MSP Mandatory Reporting, GHP User Guide, Version 6.2 (Rev. 2021/11 June); CMS Technical Alert: Inclusion of Part D Information in Section 111 Query Only Response File for Responsible Reporting Entities (RREs) That Provide Primary Prescription Drug Information (June 28, 2021)
CMS has updated its GHP User Guide and issued a technical alert on the Medicare Secondary Payer (MSP) reporting processes for prescription drug coverage, which became mandatory for responsible reporting entities (RREs) effective January 1, 2020 (see our Checkpoint article). As background, certain insurers, TPAs, plan administrators, and fiduciaries are required to report group health plan coverage information (which now includes information about prescription drug coverage) for individuals who are also entitled to Medicare. For insured plans, the RRE is generally the insurer, although if a TPA processes group health plan claims for the insurer, the TPA is the RRE. For self-insured plans with TPAs, the TPA is the RRE, but employers that sponsor self-insured, self-administered group health plans without TPAs may also be RREs. Since RREs may not know whether a covered individual is a Medicare beneficiary, RREs can send CMS a query file to determine an individual’s Medicare status. The recent CMS technical alert and updated GHP User Guide notify RREs that provide primary prescription drug coverage that effective December 11, 2021, the query file layout will include the most recent Medicare Part D prescription drug coverage enrollment information for beneficiaries.
EBIA Comment: Employers may be asked to assist RREs in compiling information about plan participants. And CMS has emphasized the importance of employer cooperation with their plans’ RREs, noting that employers that do not provide the necessary information to the RREs are putting their insurers and TPAs at risk of noncompliance. For more information, see EBIA’s Group Health Plan Mandates manual at Section XXIV.J (“MSP Mandatory Reporting Requirement”). See also EBIA’s Self-Insured Health Plans manual at Section XXV.C (“Coordination of Benefits With Medicare, TRICARE, and Medicaid”); EBIA’s Consumer-Driven Health Care manual at Section XXV.F (“HRAs and Medicare Secondary Payer (MSP) Requirements (Including Mandatory Reporting)”); and EBIA’s COBRA manual at Section XXX.D (“Medicare Secondary Payer (MSP) Rules”).
Contributing Editors: EBIA Staff.