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.

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.