On June 23, 2021, Medicare will debut details relative to the PAID Act (Provide Accurate Information Directly), a new law designed to help Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) better coordinate benefits by providing them with Medicare Beneficiary Part C and Part D enrollment information.

According to the Alert disseminated today by the Centers for Medicare and Medicaid Services’ (CMS) Office of Financial Management Financial Services Group, webinar topics include an introduction of what the PAID Act is, details of the NGHP Section 111 query response file changes, information on the scheduled testing period and implementation timeframes. A Question and Answer session with both CMS staff and the Benefits Coordination and Recovery Center (BCRC) will follow. Details of the webinar are as follows:

Date: Wednesday, June 23, 2021

Time: 1:00 PM EST

Webinar URL: https://www.mymeetings.com/nc/join.php?i=PWXW2072056&p=9205987&t=c

Conference Dial In: 888-469-1074

Conference Passcode: 9205987

Since the PAID Act was signed into law on December 11, 2020, the industry has been awaiting the technical specifications about how Medicare Part C and Part D information will be transferred between CMS and NGHP RREs. According to this law, CMS must provide RREs with each of a Medicare Beneficiary’s enrollments in Part C and/or Part D plans for the most recent three years via the Section 111 reporting query. This information can be utilized by NGHP RREs to determine which Part C and/or Part D plans may have recovery rights for Medicare Conditional Payments. The PAID Act does not create the obligation for primary payers to reimburse conditional payments to Medicare Part C or Part D plans such as the Medicare Secondary Payer laws, which do require Part A/B reimbursements. However, in reliance on the Medicare Secondary Payer laws, case law in multiple jurisdictions has created such an obligation to reimburse Part C/D plans. Ongoing litigation continues to expand this subset in a case-by-case manner. The PAID Act was designed to assist NGHP primary payers with the quandary of a having a legal obligation to reimburse Medicare conditional payments and no resource to identify which plans to repay. The PAID Act serves to eliminate the pay-and-chase method of attempting to satisfy reimbursement obligations.

While the government fleshes out the technical specifications associated with the PAID Act, the industry continues to wait for a final rule to be published regarding Section 111 reporting Civil Monetary Penalties. A draft rule was disseminated on February 13, 2020, with the Official Comment period closed in April of that year.

By way of history, this rule has been in progress since 2013, pursuant to the Strengthening Medicare and Repaying Taxpayers Act (SMART Act) of 2012, which amended the Medicare, Medicaid and SCHIP Extension Act of 2007. The 2007 law rocked the industry by calling for mandatory penalties against NGHP primary payers of up to $1,000 per day per claimant for failure to properly report Section 111 data to Medicare. The SMART Act softened this, making the penalty discretionary rather than mandatory. While the details of what would constitute a full penalty, diminished penalty and/or safe harbor from Civil Monetary Penalties have been referenced in the draft rule, this is not final and is thus subject to change.

For more information about the PAID Act, Medicare Conditional Payment Reimbursement, Section 111 Reporting and Consulting, Civil Monetary Penalties or any other matters, please contact us at info@allankoba.com.