Current Approach Options for MMSEA Reporting & Other Compliance Issues (MSAs)

1. MARCH 2009 Current Approach Options for MMSEA Reporting & Other Compliance Issues (MSAs) PRESENTOR John V. D’AlusioEVP, Senior Claims OfficerAvizent

2. Medicare, Medicaid and SCHIP Extension Act of 2007 12/29/2007: Signed into law by President Bush Section 111 (p. 18-22): Medicare Secondary Payer Act “Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance and workers’ compensation laws and plans” RRE Responsibilities: Register as an RRE Determine Medicare entitlement status of injured person Submit Medicare entitled claims to CMS/COBC in format prescribed by CMS User Guide

3. Medicare, Medicaid and SCHIP Extension Act of 2007 (continued) “…submit [information]…within a time specified by the Secretary [of Human Health and Services] after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability).” Non-Compliance Penalties “Civil money penalty of $1,000 [per file] for each day of non-compliance with respect to each claimant.” Fining ability does not obtain until 7/1/09 by law. However the 5/11/09 Alert from CMS pushed testing back to 1/1/10 to 3/31/10, and actual reporting to 4/1/10. Therefore, fining may begin as of April 2010.

4. The Impact Medicare, Medicaid and SCHIP Extension Act – Reminder - This is a Federal Law, not a ploy by MSA providers, insurance carriers and TPAs to extract more money from you. -Costs will increase yet again (IT, settlement, potential CMP fines) - Mandatory quarterly reporting of bodily injury claims (WC, GL, No-Fault) where injured party is Medicare entitled. Each claimant’s Medicare entitlement status must be determined. Medicare has agreed to allow each RRE to query the Medicare database monthly. Four data elements are required (name, DOB, gender, SS#) in order to complete the query. Reporting of applicable claims to Medicare above established “thresholds” (for 2010 $5,000 paid on non WC files, and $600 paid on WC MO files).

5. Quarterly SCHIP Reporting – RRE Options Report directly to CMS/COBC yourself. If you use a TPA(s), have the TPA(s) report directly on your behalf as an Account Designee. Use a third party integrator to report on your behalf.

6. On Guaranteed Cost insurance programs, or fully insured programs, the insurance carrier is the RRE. On Deductible Programs, if the carrier funds the losses within the deductible and above the deductible, the carrier is the RRE. If the account funds loss payments within the deductible, the account is the RRE. On Self- Insured programs, the account is the RRE. Excess Insurance, the carrier may become the RRE if they take over handling and funding of the payments. If the account is receiving reimbursement from the carrier and the account continues funding payments to the claimant, the account is the RRE. Key – Whoever is the primary funding agent of the claim loss payments is the RRE Who is an RRE????????

7. CMS is the governmental enforcement agency for both MMSEA and the MSP. The SCHIP Quarterly Reports being sent to CMS/COBC will constitute a “target rich environment” if CMS decides, at some point, to audit MSP compliance. You may be SCHIP compliant without being MSP compliant. The Medicare Entitlement Test should be applied to every claim that is being settled involving irrevocable closure of future medical benefits (if future medical benefits are left open, Medicare is not imperiled). Every SCHIP report will include all claims involving Medicare entitled individuals. However, not all claims included on the SCHIP reports will require Medicare Set-Aside Allocations. Medicare Secondary Payer (MSP) Law Compliance