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Layton City Policy

Personnel Policy Manual

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1116 - Medicare Secondary Payer Mandatory Reporting

Background

In November 2009, Layton City signed an agreement with Centers for Medicare & Medicaid Services (CMS) agreeing to establish and implement proper safeguards against unauthorized use and disclosure of the data exchanged for the purposes of complying with the Medicare Secondary Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007.

Definitions

CMS:  The Centers for Medicare & Medicaid Services – is an agency of the Federal government, 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 care provided to enrolled individuals age 65 and older, certain disabled individuals, and individuals with permanent kidney failure.

Medicare Secondary Payer (MSP):  Refers to situations where another entity is required to pay for covered services before Medicare does, and must do so without regard to a patient’s Medicare entitlement.  Medicare has been a secondary payer to workers’ compensation benefit payments since the inception of the Medicare program in 1965.  Additions to Medicare law and regulations referred to as the "MSP provisions" were enacted in the early 1980s and have been modified several times since then.  These provisions were amended again by Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007.  Medicare is a secondary payer to Group Health Plans (GHPs) for Medicare beneficiaries who (1) are age 65 and older who have GHP coverage on the basis of their own or their spouse’s current employment with an employer who has at least 20 employees; (2) are younger than age 65 and disabled and who have GHP coverage on the basis of their own or a family member’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 any basis.  (In this case, Medicare is secondary for a 30 month "coordination" period.)  Medicare is also a secondary payer to certain types of "non-GHP" insurance coverage – liability insurance (including self-insurance), no-fault insurance and, as noted above, workers’ compensation.

Section 111 Mandatory MSP Reporting: The 2007 amendments to the MSP provision require certain enterprises, referred to as "Responsible Reporting Entities" or "RREs" to report specified information regarding GHP arrangements and "non-GHP" arrangements to CMS, beginning in 2009.  Data reported for purposes of Section 111 by RREs will be submitted electronically to CMS’ Coordination of Benefits Contractor (COBC).  RREs will register on-line through a secure web site.  Once an RRE’s registration application is submitted, the COBC will begin working with the RRE to set up the data reporting and response processes.

Policy

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

  2. Proper safeguards shall ensure that the data obtained shall be used solely in accordance 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)], Section 1862(b) of the Social Security Act [42 U.S.C. 1395y(b)], and the Privacy Act of 1974, as amended [5 U.S.C. 552a].

  3. Layton City’s RRE, and any authorized agent for this Section 111 reporting, shall follow the appropriate administrative, technical, procedural and physical safeguards in accordance with Layton’s Administrative Policy 1114 to protect the confidentiality of data and to prevent unauthorized access to the data provided by CMS.

  4. The only entities authorized to have access to the data are CMS, the RRE or its authorized agent for Mandatory Reporting. (The RRE must ensure that any agent(s) reporting on behalf of multiple RREs will segregate data reported on behalf of each unique RRE to limit access to only the RRE and CMS and the agent. The RRE must ensure that access by an agent is limited to instances where it is acting solely on behalf of the unique RRE on whose behalf the data was obtained.)

Positions Authorized to Access and Maintain Data

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

 

Enacted, 12/01/2009
Amended, 11/10/2015
 




 
 
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