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Layton City Policy

Personnel Policy Manual

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1116 - Medicare Secondary Payer Mandatory Reporting

Background

In November2009, Layton City signed an agreement with Centers for Medicare & MedicaidServices (CMS) agreeing to establish and implement proper safeguards againstunauthorized use and disclosure of the data exchanged for the purposes ofcomplying with the Medicare Secondary Mandatory Reporting Provisions in Section111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007.

Definitions

CMS:  TheCenters for Medicare & Medicaid Services – is an agency of the Federalgovernment, part of the Department of Health and Human Services.  The CMS is responsible for  the oversight of the Medicare program,including implementing the Section 111 Medical Secondary Reporting (MSP)reporting provisions.

Medicare: Medicare is a Federal program that pays for certain covered health careprovided to enrolled individuals age 65 and older, certain disabledindividuals, and individuals with permanent kidney failure.

Medicare Secondary Payer (MSP):  Refers to situations where another entity isrequired to pay for covered services before Medicare does, and must do sowithout regard to a patient’s Medicare entitlement.  Medicare has been a secondary payer toworkers’ compensation benefit payments since the inception of the Medicareprogram in 1965.  Additions to Medicarelaw and regulations referred to as the "MSP provisions" were enacted in theearly 1980s and have been modified several times since then.  These provisions were amended again bySection 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007.  Medicare is a secondary payer to Group HealthPlans (GHPs) for Medicare beneficiaries who (1) are age 65 and older who haveGHP coverage on the basis of their own or their spouse’s current employmentwith an employer who has at least 20 employees; (2) are younger than age 65 anddisabled and who have GHP coverage on the basis of their own or a familymember’s current employment with an employer having at least 100 employees; or(3) have End Stage Renal Disease (ESRD) and who have GHP coverage on anybasis.  (In this case, Medicare issecondary for a 30 month "coordination" period.)  Medicare is also a secondary payer to certaintypes of "non-GHP" insurance coverage – liability insurance (includingself-insurance), no-fault insurance and, as noted above, workers’ compensation.

Section 111 Mandatory MSP Reporting: The 2007 amendments to the MSPprovision require certain enterprises, referred to as "Responsible ReportingEntities" or "RREs" to report specified information regarding GHP arrangementsand "non-GHP" arrangements to CMS, beginning in 2009.  Data reported for purposes of Section 111 byRREs will be submitted electronically to CMS’ Coordination of BenefitsContractor (COBC).  RREs will registeron-line through a secure web site.  Oncean RRE’s registration application is submitted, the COBC will begin workingwith the RRE to set up the data reporting and response processes.

Policy

1.   As a Responsible Reporting Entity (RRE), Layton City shall followproper safeguards against unauthorized use and disclosure of the data exchangedfor the purposes of complying with the Medicare Secondary Payer ReportingProvisions in Section 111 of the Medicare, Medicaid and SCHIP Extension Act(MMSEA) of 2007. 

2.   Propersafeguards shall ensure that the data obtained shall be used solely inaccordance with Section 1106 of the Social Security Act [42 U.S.C. 1306],Section 1874(b) of the Social Security Act [42 U.S.C. 1395k(b)], Section1862(b) of the Social Security Act [42 U.S.C. 1395y(b)], and the Privacy Act of1974, as amended [5 U.S.C. 552a]. 

3.   LaytonCity’s RRE, and any authorized agent for this Section 111 reporting, shallfollow the appropriate administrative, technical, procedural and physicalsafeguards in accordance with Layton’s Administrative Policy 1114 to protectthe confidentiality of data and to prevent unauthorized access to the dataprovided by CMS.

4.   Theonly entities authorized to have access to the data are CMS, the RRE or itsauthorized agent for Mandatory Reporting. (The RRE must ensure that any agent(s) reporting on behalf of multipleRREs will segregate data reported on behalf of each unique RRE to limit accessto only the RRE and CMS and the agent. The RRE must ensure that access by an agent is limited to instanceswhere it is acting solely on behalf of the unique RRE on whose behalf the datawas obtained.)

Positions Authorized to Access and Maintain Data

The Human Resource Manager, HRAnalyst, Risk Analyst and Assistant City Attorney are authorized to access andmaintain the data exchanged for the purposes of complying with MMSEA of 2007for Layton City.

 

Enacted, 8/1/2011, Previous Policy 1116
Recodified, 1/7/2016, Previous Policy 1119
Amended, 2/4/2016
Amended, 2/4/2016, Previous Policy 1116
 




 
 
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