By: HUB’s EB Compliance Team

The Centers for Medicare & Medicaid Services (“CMS”) has suspended the IRS-SSA-CMS Data Match employer reporting requirement. The data match program was designed to help CMS identify Medicare-eligible individuals who also had access to employer-sponsored benefits. The CMS data match reporting website has been shut down and CMS will no longer send letters to employers requesting employee and participant data.

Background

Congress enacted a law (Section 6202 of the Omnibus Budget Reconciliation Act of 1989) to provide CMS with better information about Medicare beneficiaries’ group health plan (“GHP”) coverage. The law required the Internal Revenue Service (“IRS”), the Social Security Administration (“SSA”), and CMS to share information that each agency had about whether Medicare beneficiaries or their spouses were working. The process for sharing this information was called the IRS-SSA-CMS Data Match. The purpose of the Data Match was to identify situations in which another payer, like a GHP, should have paid all or part of a claim that was instead paid by Medicare.

Under the program, employers were required to provide CMS with information about health coverage of their Medicare-eligible workers and spouses. CMS would send a questionnaire to employers requiring the employer to provide certain participant data. To respond to the data request, the employer was required to set up an account with CMS. Once the account was activated, the employer was required to provide information about their health plan and to answer questions about relevant employees and participants.

Program Suspended

Subsequently, the Medicare Access and CHIP Reauthorization Act (“MACRA”) amended some of the Medicare Secondary Payer provisions of the Social Security Act to no longer require this information. Consequently, the IRS-SSA-CMS Data Match program has been discontinued.

Although the IRS-SSA-CMS Data Match process has ended, CMS encourages employers to consider entering into an Employer Voluntary Data Sharing Agreement (“VDSA”) with CMS to exchange GHP and Medicare entitlement data. Some large employers have already entered into VDSAs with CMS to share coverage information. For more information on the VDSA program, see the Voluntary Data Sharing Agreement page here.

Takeaways

While employers are no longer required to report, there has been no change to the reporting requirements for insurers and third-party administrators (“TPAs”). Specifically, the Medicare, Medicaid, and SCHIP Extension Act of 2007 requires insurers that insure group health plan benefits and TPAs that administer self-funded group health plan benefits to report to CMS on individuals covered under their plans. This obligation has not changed. More information on it is available here.

This reporting by insurers and TPAs does not have a direct impact on employers. However, employers should be aware of this reporting for two reasons. First, CMS will know if an employee has GHP coverage. Therefore, if employees have both Medicare and the employer’s coverage and submit a claim to Medicare, the employer may hear from Medicare seeking reimbursement.

Second, when reviewing service contracts (particularly with TPAs for group health plans), employers should make sure the TPA is obligated to complete the reporting. Timely reporting will help identify, on a timely basis, claims that were incorrectly submitted to Medicare. This can prevent further headaches for the employer down the road.

If you have any questions, please contact your HUB Advisor. View more compliance articles in our Compliance Directory.

NOTICE OF DISCLAIMER

The information herein is intended to be educational only and is based on information that is generally available. HUB International makes no representation or warranty as to its accuracy and is not obligated to update the information should it change in the future. The information is not intended to be legal or tax advice. Consult your attorney and/or professional advisor as to your organization’s specific circumstances and legal, tax or other requirements.