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CMS Notice of Proposed Rule on Section 111 Penalties


The most recent Regulatory Agenda from the Department of Health and Human Services includes a notice of a proposed rule on Section 111 reporting penalties. The text of the proposed rule is set out below and may be found here [https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201810&RIN=0938-AT86].

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Medicare Secondary Payer reporting requirements. This rule would propose to remove obsolete Civil Money Penalty (CMP) regulations associated with this repeal. The rule would also propose to replace those obsolete regulations by soliciting public comment on proposed criteria and practices for which CMPs would and would not be imposed under the Act, as amended by Section 203 of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).

The duplicative reporting requirements referenced in the notice are related to the elimination of the IRS-SSA-CMS data match project, which involved group health coverage. However, because Section 203 of the SMART Act applies to non-group health plans and not to group health plans, it is apparent that CMS intends to finally issue proposed regulations specifying circumstances in which penalties may and may not be imposed for noncompliance with Section 111 reporting for non-group health plans. We will continue to keep you updated on this issue and will let you know when CMS begins soliciting comments on circumstances in which penalties may and may not be imposed. If you have any questions or concerns related to compliance with Section 111 reporting requirements, please do not hesitate to contact us.

#DepartmentofHealthandHumanServices #Section111 #SMARTAct #CMS

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