MMSEA Section 1111 Update

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The Centers for Medicare & Medicaid Services (CMS) has recently updated the information on its website with respect to the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), Section 111 “Mandatory Insurer Reporting” requirements.

What is the Next Phase of CMS’ MMSEA

The next phase of CMS’ MMSEA Section 111 reporting for liability Total Payment Obligation to Claimants (TPOCs) including settlements, judgments, awards, or other payments now begins on April 1, 2012. Starting April 1, 2012, the liability TPOC reporting threshold will be reduced from $100,000 to $50,000. More importantly all liability TPOCs greater than $50,000 for TOPCs on or after April 2nd through Jun 30th will not be reportable. They are also scheduled to reset again from July 1, 2012, to October 1, 2012.

The new implementation dates are as follows:

  • Reporting is required October 1, 2011, to March 31, 2012, for TPOCs over $100,000
  • Reporting is required April 1, 2012, to June 30, 2012  TPOCs over $50,000
  • Reporting is required July 1, 2012, to September 30, 2012 TPOCs over $25,000
  • Reporting is required October 1, 2012, to Dec 31, 2012, for all TPOCs over $5000
  • Starting in 2015 no threshold amount