CMS releases Section 111 Quick Reference Guide

CMS has issued an MMSEA Section 111 Mandatory Insurer Reporting Quick Reference Guide for non-GHP Insurers. The guide has been developed to provide the following:

  • Explaination of MMSEA Section 111 reporting, and how it may affect you
  • Help in determine if you are an MMSEA Section 111 “Responsible Reporting Entity” (RRE)
  • An overview on how to set up and begin reporting
  • Description of the various options you have for reporting
  • An outline of the data “input and response” process
  • Help in identifying resources for additional instruction and information on how to access free computer based training and other resources

The Quick Reference Guide is available here.

The SMART Act Is Introduced in the United States Senate

On October 17, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) was introduced in the United States Senate by Senators Ron Wyden (D-OR) and Rob Portman (R-OH). The Senate bill number is S. 1718.

The SMART Act was previously introduced in the United States House of Representatives in March 2011 by representatives Ron Kind (D-WI) and Tim Murphy (R-PA). The House bill number is H.R. 1063.

The SMART Act proposes major amendments to the Medicare Secondary Payer Statute (MSP) in a number of areas, including MMSEA Section 111 reporting and conditional payment recovery.

A detailed overview of the proposals contained in the SMART Act is outlined in NuQuest/Bridge Pointe’s Settlement News (March 2011), a copy of which can be obtained here. http://dev.nqbp.com/sites/default/files/March2011SettlementNews.pdf

To chart the progress of the SMART Act in Congress, the reader may wish to consult the following resources http://www.govtrack.us/congress/billtext.xpd?bill=h112-1063

or http://marccoalition.com/MSP_Reform.html

Smith v. Sound Breeze Condo Association of Groton

Smith v. Sound Breeze Condo Ass’n of Groton
No. KNLCV 095012261s, 2011 WL 803067
(Ct. Sup. Ct., Feb. 3, 2011)

In this case, the RRE requested permission to file a set of non-standard interrogatories to obtain the plaintiff’s name, address, social security number, birth date and gender so that it could determine Medicare status for Section 111 purposes.

However, the plaintiff objected on grounds that (a) the plaintiff was a not a Medicare beneficiary and, thus, the request was outside the scope of permissible discovery; (b) the request was overly broad and aimed at procuring non-discoverable private information; and (c) that the request was premature for Section 111 purposes.

The court rejected all of the plaintiff’s arguments and ruled that the requested information was relevant and ordered the plaintiff to produce same. Recognizing the plaintiff’s privacy concerns, the court also included a protective order as part of its ruling restricting the RRE’s use of this information solely for Section 111 compliance purposes.

Hackley v. Garofano

Hackley v. Garofano
No. CV 095031940S,
2010 WL 3025597
(Ct. Sup. Ct., July 1, 2010)

This case involved a 16 year old plaintiff who was injured in a motor vehicle accident. Since the plaintiff was a minor, his father had to bring the action on his behalf. The parties reached a settlement for $7,500, but the carrier refused to release the settlement monies until it was provided with both plaintiffs’ social security numbers and other information so it could determine their Medicare status under Section 111.

However, the plaintiffs refused to release this information on grounds that (a) the injured plaintiff was only 16 years old and that based on his age alone the carrier could determine that he was not a Medicare beneficiary; (b) the father’s social security number was “entirely irrelevant” for Section 111 reporting purposes; and (c) the law firm’s confidentiality policy (established per Connecticut law) prohibited the release of the plaintiff’s social security numbers.

The court rejected all of the plaintiffs’ arguments and ruled that the carrier could condition reimbursement of the settlement funds on the plaintiffs’ provision of their social security numbers in order to determine its reporting responsibilities under Section 111.

Seger v. Tank Connection LLC

Seger v. Tank Connection LLC,
8:08 CV 75,
2010 WL 16652353
(D. NE., April 22, 2010)

In this case, the Responsible Reporting Entity (RRE) requested that the plaintiff produce his social security number and other information so the RRE could use the Section 111 Query Process system to determine Medicare status. However, the plaintiff refused to provide this information citing privacy and other concerns.

The court ordered the plaintiff to release his social security number and the other information requested by the RRE. In reaching its decision, the court found that the requested information was relevant and permissible under applicable federal discovery rules in light of the new reporting mandates imposed under Section 111.