MSP Reporting Rule expanded to include Prescription Drug Coverage
In certain instances in which employer-provided health coverage is available, Medicare only pays after the employer plan pays. The rules governing these situations are known as the Medicare Secondary Payer Rules (MSP rules). The MSP rules are generally applicable to the working aged, individuals with end stage renal disease and certain disabled individuals.
In 2007, an MSP reporting requirement was imposed, primarily on insurers, third party administrators (TPAs) and plan administrators of self-funded, self-administered health plans (known as, responsible reporting entities, “RRE”). The purpose of this reporting obligation is to ensure that the MSP rules are properly administered. Insurers, TPAs and plan administrators are required to register with the Centers for Medicare and Medicaid Services (CMS) to accomplish the required reporting through a dedicated CMS website.
In October, 2018, a law was enacted that expands the reporting obligation to include prescription drug coverage. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) requires reporting for Medicare beneficiaries who have prescription drug coverage other than, or in addition to Medicare Part D, which is primary to Medicare. This includes prescription drug coverage for an individual who is Medicare-eligible and currently employed, or is the spouse or family member of a worker who is covered by a prescription drug plan. Initially, RREs had the option to include prescription drug coverage in its annual report; however, reporting prescription drug coverage becomes mandatory beginning January 1, 2020. As a result, CMS released a revised user guide together with a set of FAQs to assist RREs with their prescription drug coverage reporting obligation.
Generally, employers are not involved in this reporting requirement, except to the extent that the insurer or TPA may ask the employer to assist in collection of the required information.
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