Key Highlights from CMS’ PAID Act Webinar

On June 23, 2021, CMS hosted a webinar to review changes that will be made to the Section 111 query process in response to the requirements of the PAID Act.  As discussed in our prior blog postings​, which can be found here, beginning December 11, 2021, the CMS query response data will include additional information identifying whether a Medicare beneficiary has been enrolled in a Medicare Part C and/or a Part D prescription drug plan for the last three (3) years.  CMS noted on the webinar that approximately 1 out of 3 beneficiaries are enrolled in a Part C plan and 9 out of 10 beneficiaries have some form of Part D prescription drug coverage. 

CMS began the webinar with a review of the Medicare Secondary program and the PAID Act background.  CMS then went on to discuss the material changes to the query response file, testing to help implement these changes, important dates and resources.  Below are some of the significant highlights from this presentation:

  • As a result of the PAID Act changes, the query response record will increase from approximately 300 characters to over 5,000 characters. 
  • In addition to plan details, the query response will also include the last 3 years of Part C and Part D plan information up to 12 instances.  Because a beneficiary can change plans on an annual basis and may change plans again based upon special circumstances, CMS will provide information for up to 12 plans in the 3-year period.
  • The 3-year period was noted to start from the date of the query.  CMS also noted that, at this time, they do not intend to restrict the number of query files.
  • Technical changes will be needed to meet the new query data requirements and RREs or their agents will to be able to absorb the new fields in their system by December 11, 2021.
  • Query response times should not change with this upgrade to the CMS query system.
  • Section 111 data continues to be provided to Part C and D plans.
  • RREs using Direct Data Entry will be able to access these additional query fields on the COBSW
  • CMS will be hosting a testing period which, although not required, is highly encouraged

In addition to the above, CMS provided the following timeline of events:

  • CMS to host testing webinar on September 9, 2021
  • HEW application update will be available for download on September 13, 2011
  • Testing period is from September 13, 2021 through December 10, 2021
  • Section 111 COBSW Beneficiary Lookup changes will be available as of October 4, 2021 for those RREs using Direct Data Entry
  • PAID Act changes will be implemented by CMS on December 11, 2021

For additional substantive questions, CMS noted that emails can be sent to the following addresses: Part C Mailbox: https://dpapportal.lmi.org/DPAPMailbox/ and Part D Mailbox: [email protected]

For additional information regarding this update or to learn more about of NuQuantics Section 111 Reporting System, please contact the NuQuest Settlement Consultant Team at [email protected].  Our NuQuatics Section 111 Reporting solution will be incorporating all the PAID Act changes and we will continue to make necessary updates based upon CMS’ requirements. 

NuQuest will be hosting its own webinar June 29, 2021 at 2:00 p.m. E.T.  Join us for a full accounting of the PAID Act.  We will take inventory of all the elements of the PAID Act, the new NGHP Section 111 User Guide sections addressing the PAID Act; and recap the “receipts” from the CMS PAID Act Webinar. Click here to register.