CMS Issues ANPRM on Penalties for Noncompliance with MMSEA Section 111 Reporting

On December 10, 2013, CMS issued an ANPRM relating to circumstances where civil monetary penalties (CMPs) may be imposed for failure to comply with requirements set forth in Section 111 of the MMSEA. This notice will appear in the December 11, 2013 Federal Register, volume 78, number 238. Organizations or individuals seeking to have commentary considered should provide their recommendations via one of the approved delivery methods as specified in the ANPRM no later than 5 pm on February 10, 2014.

This ANPRM is soliciting commentary from insurers, third party administrators and the public and relates to both group health plans (GHP) and non-group health plans (NGHP). Commentary should identify which provision they are addressing specifically by referring to section 1862(b)(7) for GHP plans or section 1862(b)(8) for NGHP plans.

The areas of focus in the requested commentary are identified in the ANPRM are as follows:

  • Practices for which CMPs would or would not be imposed on
    GHPs and NGHPs who are responsible for reporting information to CMS. This
    includes criteria and/or mechanisms CMS may use to evaluate whether and when it would impose CMPs.
  • Methods to determine the dollar amounts for CMPs to be levied against a NGHP responsible reporting entity for non-compliance.
  • Definitions and criteria that constitute “good faith effort(s)” by NGHPs to identify a Medicare beneficiary for the purposes of reporting.

PMSI will be submitting commentary for the ANPRM and recommends that all interested parties do so as well as the comments received will greatly impact how and when CMPs are imposed in the future.

Resource links related to the ANPRM can be found here:

Federal Register:

https://www.federalregister.gov/articles/2013/12/11/2013-29473/medicare-program-medicare-secondary-payer-and-certain-civil-money-penalties

Mandatory Insurer Reporting for NGHP: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Overview.html

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