The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows:

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Medicare Secondary Payer reporting requirements. This rule would propose to remove obsolete Civil Money Penalty (CMP) regulations associated with this repeal. The rule would also propose to replace those obsolete regulations by soliciting public comment on proposed criteria and practices for which CMPs would and would not be imposed under the Act, as amended by Section 203 of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).

Pursuant to the SMART Act, civil penalties for non-compliance with Section 111 are up to $1,000 per day, per claimant.  However, no official guidance regarding how these penalties will be determined and enforced has been issued by CMS.  Similar to the Notice issued by the OMB we reported on last week involving Liability Medicare Set-Asides, action to be taken on the Notice of Proposed Rulemaking is set to take place in September 2019.  NuQuest will continue to keep you abreast of any additional developments as they become available.  For  further questions regarding this Notice or for any of your Medicare compliance needs, please contact the NuQuest Legal Team.

CMS Alert: Workers’ Comp Mandatory TPOC Timelines and Thresholds Changed!

Attention Workers’ Comp Insurers –

CMS has announced NEW mandatory thresholds applicable to all WC Settlements, Judgments, Awards and other payments. TPOC Implementation timeline and payment thresholds to claimants have been revised for Section 111 reporting.

Click here to review the revised TPOC dates and dollar amounts.

CMS Alert: Liability Mandatory TPOC Timelines and Thresholds Changed!

Attention Liability Insurers (including Self-Insurers) —

TPOC Implementation timelines and payment thresholds to claimants have been revised for Section 111 reporting. The NEW mandatory thresholds apply to all Settlements, Judgments, Awards and other payments and supersede the current User Guide, version 3.3 and the TPOC Alert dated September 30, 2011.

Click here to review new dates and TPOC dollar amounts.

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.