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CMS Releases Mandatory Reporting Guidance on Website

    Client Alerts
  • August 22, 2008

At the end of 2007, Congress added Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007, which provides for new mandatory reporting requirements for group health plans.  Effective January 1, 2009, insurers or third-party administrators for group health plans and plan administrators or fiduciaries of self-insured and self-administered group health plans will be required to obtain information from plan sponsors and plan participants in an effort to help the Centers for Medicare and Medicaid Services (CMS) identify situations where the group health plans are or have been primary to Medicare. 

CMS recently posted additional guidance on its website addressing the implementation of the new statutory requirements and indicated that all instructions for reporting will be posted on the website, (the website can be accessed at and contains several downloads with supporting information).  This recent guidance indicates that group health plans must report information in a specific form and manner to the Secretary of HHS.  Submissions to the Secretary must be made electronically through a secure website (currently being developed).  CMS will work with reporting entities to set up a data reporting and response process.  Guidance also addresses who is an “insurer” and “third-party administrator” for purposes of this requirement, the required and optional data elements to report, and when other agents may submit reports on behalf of insurers, third-party administrators and group health plans.

Sponsors of group health plans should review the requirements on the website and continue to check it for additional guidance.