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.
Form CMS-10265 Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative)
7 Burden Table 12-22-16.doc
5 Supporting Statement Attach D 12-22-16.docx
Mandatory Insurer Reporting (Non-GHP, Federal, System Set-up and Administrative)