[Federal Register Volume 59, Number 134 (Thursday, July 14, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-17011]


[[Page Unknown]]

[Federal Register: July 14, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[BPD-799-GN]

 

Medicare Program; Medicare Secondary Payer (MSP) Amendments

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: General notice.

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SUMMARY: This notice--
    1. Describes the changes made to the MSP for the disabled provision 
by sections 13561(b) and 13561(e) of the Omnibus Budget Reconciliation 
Act of 1993, Public Law 103-66, hereafter referred to as OBRA '93; and
    2. Provides guidance for employers and employer health plans so 
that they can provide to Medicare contractors and beneficiaries the 
information necessary to implement these changes.
    Section 13561(b) changes the sunset date of the MSP for the 
disabled provision from October 1, 1995 to October 1, 1998.
    Section 13561(e) modifies the MSP for the disabled provision to 
conform to the MSP for the working aged provision, so that for both 
groups, the MSP provision applies (and the group health plan is primary 
payer) only when coverage under the plan is based on ``current 
employment status with an employer.''

DATES: This notice is effective August 15, 1994.

FOR FURTHER INFORMATION CONTACT: Eve Fisher, (410) 966-5641.

SUPPLEMENTARY INFORMATION: Under the amendments made by section 
13561(e) of OBRA '93, Medicare is the secondary payer for health 
services provided to disabled individuals who have large group health 
plan coverage based on the individual's own or a family member's 
``current employment status with an employer''. An individual has 
current employment status if the individual is currently employed 
(including as a self-employed person), is the employer, or is 
associated with the employer in a business relationship. Before these 
amendments, Medicare was the secondary payer not only for disabled 
individuals who had coverage based on their own or a family member's 
current employment status but also for individuals who had coverage on 
some other basis, but who were treated as employees by their employers.
    Under present law, Medicare continues to be secondary payer for 
disabled individuals who have LGHP coverage on the basis of their own 
or a family member's current employment. Medicare is now primary payer 
for disabled individuals who are not working and who are not family 
members of workers.
    The statutory changes made by subsections (b) and (e) of section 
13561 can be put into effect without first issuing regulations because 
it is clear on the face of the statute what the Congress intended. 
Moreover, we have already had to apply these provisions because the 
Congress made the changes applicable to services furnished on or after 
August 10, 1993. This notice will help to ensure that all affected 
parties are aware of, and able to comply with, the new provisions.
    Employers that wish to have an evaluation of the Medicare payment 
status of disabled individuals affected by this amendment must send 
beneficiary information to the Medicare carrier (not the intermediary) 
in the State where the employer's home office is located. The 
beneficiary information includes the name, sex, birth date, social 
security number, and health insurance claim (HIC) number. The affected 
individuals are the disabled beneficiaries who are currently covered 
under the employer's LGHP but whose coverage is not based on the 
beneficiary's or a family member's current employment status. The 
employer must give the Medicare carrier written certification that each 
identified beneficiary has LGHP coverage on a basis other than current 
employment status.
    After it receives and evaluates the beneficiary information, the 
Medicare carrier will give the employer written notice of the names and 
HIC numbers of the beneficiaries for whom Medicare will be primary 
payer, and the effective date of the changed payment status.
    Disabled beneficiaries who are identified by the Medicare carrier, 
and who have delayed enrollment in Medicare Part B because their LGHPs 
were primary payers under the previous statutory provision, will have 
the opportunity to enroll in Part B during a special enrollment period. 
That period will cover the 7 months beginning with the month in which 
the employer notifies the beneficiary that it is no longer primary 
payer, or the month following the last month for which the LGHP makes 
primary payment, whichever is later.
    The premium increases that generally apply to delayed enrollment 
will be waived for all months, beginning with January 1987, during 
which the beneficiary was covered under the LGHP. Entitlement to 
Medicare Part B may be established as of the first day of the month of 
filing for Part B, or retroactive to the first month for which the LGHP 
no longer makes primary payment, provided the beneficiary agrees to pay 
all premiums due.
    The employer must provide to each affected beneficiary a written 
notice that includes the following information:
     A statement advising the beneficiary that the plan will no 
longer make primary payment for services furnished on or after a 
specified date no earlier than August 10, 1993.
     A statement advising the beneficiary of the opportunity 
for immediate enrollment in Medicare Part B.
     A statement showing all the months during which the 
beneficiary was covered under the LGHP.
    The employer must also--
     Provide to the beneficiary a copy of the notice from the 
Medicare carrier certifying that Medicare is now the primary payer; and
     Advise the beneficiary to take the employer notice and the 
carrier notice to the Social Security office when he or she goes to 
enroll in Part B.
    The information collection and recordkeeping requirements contained 
in the guidance, above, have been sent to the Office of Management and 
Budget for review under the Paperwork Reduction Act of 1980.
    In accordance with Executive Order 12866, this notice was not 
reviewed by the Office of Management and Budget.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: April 12, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 94-17011 Filed 7-13-94; 8:45 am]
BILLING CODE 4120-01-P