CMS Issues Revised Timeline for Reporting Liability TPOCs

After much anticipation and unconfirmed rumors, CMS has issued an alert announcing a delay in Section 111 reporting for certain liability insurance (including self-insurance) TPOC settlements, judgments, awards, or other payments. The implementation date for reporting will be based on the TPOC amount. 

The new implementation dates are as follows:

 

  • Reporting is required January 1, 2012 for TPOCs over $100,000 with a TPOC date on or after October 1, 2011
  • Reporting is required July 1, 2012 for TPOCs over $50,000 with a TPOC date on or after April 1, 2012
  • Reporting is required October 1, 2012 for TPOCs over $25,000 with a TPOC date on or after July 1, 2012
  • Reporting is required January 1, 2013 for all TPOCs over minimum threshold with a TPOC date on or after October 1, 2012

CMS has not made any additional changes to implementation dates. To review this Alert in its entirety, click here.

CMS also announced a limited MMSEA Section 111 reporting exception related to Qualified Settlement Funds (QSFs).   This exception is applicable for RREs for certain liability insurance (including self-insurance), no-fault insurance, and workers’ compensation TPOC settlements, judgments, awards, or other payments where funds have been paid into a QSF prior to October 1, 2011.  MMSEA Section 111 reporting will not be required when ALL of the following criteria are met:

  • The settlement, judgment, award, or other payment is a liability insurance (including self-insurance) TPOC amount; where there is no Ongoing Responsibility for Medicals (ORM) involved; and
  • The settlement, judgment, award, or other payment will be issued by a QSF under Section 468B of the IRC, in connection with a State or Federal bankruptcy proceeding; and,
  • The funds at issue were paid into the trust prior to October 1, 2011.

To review a copy of this alert in its entirety, click here

Additionally, CMS published guidance concerning exposure claims, specifically when Medicare will and will not assert a recovery claim against settlements, judgments, awards or other payments and when MMSEA Section 111 reporting is required.  Several examples are provided as a reference but it is noted that the parties’ are responsible for making a determination regarding this policy.  The alert confirms that the term “exposure” refers to the claimant’s actual physical exposure to the alleged environmental toxins, not the defendant’s legal exposure to liability.  To view a copy of the alert click here

The content of these alerts supersedes the content of the newly released NGHP User Guide and updates will be made to the next version of the User Guide.  PMSI will continue to monitor and keep you informed of any and all changes released by CMS.

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