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CMS Press Release on Medicare Set-aside Arrangements Delay


CMS Press Release on Medicare Set-Aside Arrangements

Recently, the CMS Press Release on medicare set-aside arrangement was released.  The following is the press release from the CMS website on the insurer TPA reporting requirements. This was the result of the memo covered in my previous post. I also added in the upcoming schedule. Please note that this is not a delay in reporting files to CMS to protect their interest. This is for the mandatory data reporting by all TPA’s and insurance companies.


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MMSEA – Medicaid Medicare Set Aside Arrangements
NGHP – Non-group Health Plan
COBC – Coordination of Benefits Contractor
RRE – Responsible Reporting Entities

MMSEA 111 What’s New
What’s New

February 16, 2010

CMS advises all NGHP RREs that the date for first production NGHP Input Files is changed from April 1, 2010 to January 1, 2011, effective immediately.

NGHP File data exchange testing will continue. All NGHP RREs should now be registered with the COBC, and either in or preparing for file testing status. NGHP file data exchange testing may continue during 2010, as needed.

All NGHP file data exchange testing will be completed by December 31, 2010. NGHP RREs that have completed file data exchange testing at any time are encouraged to proceed to production file data exchange status.

During the week of February 22, on this Website, CMS will post the next version of the “Section 111 NGHP User Guide” and a number of Alerts relating to particular NGHP policy issues.

Also during the week of February 22, on this Website, CMS will post an alert for NGHP RREs describing the steps those RREs can take to assure their ongoing compliance with the Section 111 reporting requirements.

January 11, 2010

Picture of Employees cms press release On Screen Cam

Posted the 2010 GHP Teleconferences Notice and Agenda dated January 6, 2010, to the GHP section page. This document contains the call-in dates, number, and time for all 2010 teleconferences scheduled to-date.

Posted the GHP User Guide, Version 3.0 dated January 6, 2010, to the GHP section page.
Updated the E-Mail Communications/SPAM section of the Reporting Dos and Don’ts section page.

January 6, 2010

Added the October 6, November 3, December 8 and December 15, 2009 NGHP written transcripts to the NGHP Transcripts section page.
Added the GHP Teleconference dates for 2010 to the What’s New and GHP section pages.

January 4, 2010

A new section page titled, MMSEA 111 Alerts has been created to house Alerts received after December 23, 2009. The following documents have been posted to this section page:

Picture Preparing for Handshake CMS Press Release Insurer Reporting

The NGHP Technical Alert Regarding the Addition of DCN to the Query Process and HEW Upgrade dated December 23, 2009.
The NGHP Technical Alert For Claim Input File Field Requirements, dated December 23, 2009.

The GHP Technical Alert Regarding the Addition of DCN to the Query Process and HEW Upgrade dated December 23, 2009.

The Registration Guide For NGHP RREs Who Are Foreign Entities dated December 29, 2009.

The Notice and Agenda for the 2010 NGHP Teleconferences dated December 29, 2009, has been posted to the NGHP section page. This document provides the call in time, phone number and passcode for the 2010 teleconferences.

Future Town Hall Teleconference Meeting Dates – All Town Hall Teleconferences will be held from 1:00 pm to 3:00 pm, EST, unless otherwise noted.

2010 NGHP Town Hall Teleconferences

NGHP Technical Support Questions & Answers

February 10, 2010 – To be rescheduled
March 16, 2010
March 31, 2010
NGHP Policy Questions & Answers

February 25, 2010
2010 GHP Town Hall Teleconferences

January 26
February 18
March 18

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Is Social Security Disability Affected by WC?

Social Security Disability and Workers Comp Study Does Workers Compensation have an effect on Social Security Disability?  More precisely, do Social Security Disability applications increase

James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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