CMS Publishes Proposed Guidelines for SCHIP Extension Act Compliance

Medicare Set-Aside Blog on August 7, 2008 | Posted by

Last week, the Centers for Medicare and Medicaid Services (CMS) published proposed guidelines in the Federal Register regarding implementation of the new liability and no-fault reporting requirements set forth in Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. CMS’s recommendations for compliance with the new reporting requirements are published in the Federal Register with an invitation for public comments on the methods for collecting and submitting such information and the means of enhancing the quality of data.
When the Extension Act was passed in December 2007, the statute required that, beginning July 1, 2009, insurers would be obligated to determine benefit status of all Claimants and report the claim to the Secretary of Health and Human Services to essentially put Medicare on notice so that its interests remain protected. Agencies that fail to comply with the reporting requirements will be fined $1,000 per day per claimant. At the time of this Act’s passage, limited guidelines were issued to help insurers understand and meet CMS’s expectations. These proposed guidelines are the first step in designing a process to simplify reporting requirements in conjunction with the Act.
In addition to the Federal Register publication, CMS has authored a Supporting Statement to further elaborate on proposed reporting guidelines. The Supporting Statement includes clarification on frequency of submitting information and field requirements (mandatory, optional, and situational). Additionally, it provides definitions for types of insurance plans obligated to comply with the new law.
All in all, we believe this is a solid effort on CMS’s part to provide better guidance for compliance and expectations pending the implementation of the Extension Act next year. While the comments and concerns of the public and industry leaders may (and hopefully will) influence CMS such that this process becomes as efficient as possible, we expect that some guidelines will change over the months.
CMS has created the following website to follow instructions as they are developed:
and comments to the guidelines can be published at on or before September 30, 2008.
For questions and guidance about how to implement your own reporting protocol in advance of the July 1, 2009 deadline, contact MEDVAL or Ask Jen

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