The Centers for Medicare & Medicaid Services (CMS) seeks to collect various data elements for the applicable reporting entities for purpose of implementing the mandatory MSP reporting requirements of Section 111 of the MMSEA. This information will be used to ensure that Medicare makes payment in the proper order and/or takes necessary recovery actions. The purpose of this submission is to set forth what information will be collected pursuant to Section 111 and the process for such collection. Section 111 mandates the reporting of information specified by the Department of Health and Human Services Secretary in the form and manner specified by the Secretary (including frequency) Data the Secretary will collect is necessary for both pre-payment and post-payment coordination of benefit purposes, including the recovery actions.
Section 111 establishes separate mandatory reporting requirements for group health plan arrangements as well as for liability insurance (including self-insurance), no-fault insurance, and workers' compensation, also referred to as non-group health plan. With the passage of Section 111, CMS now has the authority to mandate the reporting of insurer MSP information.
PL:
Pub.L. 110 - 173 111
Name of Law: Medicare Secondary Payer (MSP) Mandatory Insurer Reporting Requirements
There are three reasons why GHP burden has been reduced. First, GHP set-up of reporting has been completed and they are only incurring administrative costs to support ongoing reporting.The sources of the data are now limited to just private insurers. Same amount of data as before, but no longer expect to collect it from so many different groups such as fed and state govts. Insurers provide all of the data.
Second, since the Section 111 reporting requirements were first implemented, there was an initial burden on the GHPs to report all outstanding information on their initial files. The number of records being reported now only includes maintenance of old records plus any new records that need to be reported. Therefore, the total volume of record transactions has been reduced from 3.7 million per year to 2.6 million per year.
Third, through industry consolidation, the total number of GHPs that report to CMS has been reduced from 1650 to 1154. This consolidation of resources resulted in fewer duplicative administrative costs.
There are four reasons why NGHP burden has been reduced. First, NGHP set-up of reporting has been completed and they are only incurring administrative costs to support ongoing reporting.
Second, since the Section 111 reporting requirements were first implemented, there was an initial burden on the NGHPs to report all outstanding information on their initial files. The number of records being reported now only includes maintenance of old records plus any new records that need to be reported. Therefore, the total volume of record transactions has been reduced from 2.9 million per year to 2.4 million per year.
Third, for the majority of reporting NGHPs, that are also very small, low volume reporters, CMS developed a simplified reporting process called the Direct Data Entry process that allows the bulk of NGHPs to use a web portal to manually report data, These small entities do not have to incur the higher costs of setting up and maintaining a system to system interface with CMS that only the very largest NGHPs find more cost effective for their reporting. However, the decrease in NGHP burden was only slight because the large number of low volume reporters using the manual Direct Data Entry process are not realizing the economies of scale that the few large NGHP insurers achieved. The larger insurers initially invested in setting up electronic file exchange systems with CMS, so their burden has decreased while, for the bulk of smaller NGHP reporters, hourly burden has remained more constant.
Fourth, through industry consolidation, the total number of NGHPs that report to CMS has been reduced from 21,091 to 18,114. The original estimated burden included potential reporting by state and local governments and federal agencies, as self-insured entities. In practice, private insurers are reporting data that includes data related to these government groups. This consolidation of resources and data reporting streams resulted in fewer duplicative administrative costs for NGHPs and the removal of burden estimates for state and local governments and federal agencies.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative)