United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 1995_register executive 2010-09-25 article Rules and Regulations D09002ee1be059e27 D09002ee1be059eb3 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Health Care Financing Administration originator org United States Government Agency or Subagency These regulations establish limits on Medicare payment for services furnished to individuals who are entitled to Medicare on the basis of disability and who are covered under large group health plans (LGHPs) by virtue of their own or a family member's current employment status with an employer; and prohibit LGHPs from taking into account that those individuals are entitled to Medicare on the basis of disability. They also implement certain other provisions of section 1862(b) of the Social Security Act, as amended by the Omnibus Budget Reconciliation Acts of 1986, 1989, 1990, and 1993 and the Social Security Act Amendments of 1994. Those amendments affect the Medicare secondary payer rules for individuals who are entitled to Medicare on the basis of age or who are eligible or entitled on the basis of end stage renal disease and who are also covered under group health plans (GHPs). The provisions that apply to all three groups include-- <bullet> The rules under which HCFA determines that a GHP or LGHP is not in conformance with the requirements and prohibitions of the statute; <bullet> The appeals procedures respecting GHPs and LGHPs that HCFA finds to be nonconforming. <bullet> The referral of nonconforming plans to the Internal Revenue Service; and <bullet> The rules for recovery of conditional or mistaken Medicare payments made by HCFA. The intent of the MSP provisions is to ensure that Medicare does not pay primary benefits for services for which a GHP or LGHP is the proper primary payer and that beneficiaries covered under these plans are not disadvantaged vis-a-vis other individuals who are covered under the plan but are not entitled to Medicare. 60 FR 45344 https://www.govinfo.gov/app/details/FR-1995-08-31/95-21265 95-21265 fr31au95-11 RIN 0938-AD73 4120-01-P BPD-482-FC https://www.govinfo.gov/app/details/FR-1995-08-31/95-21265 https://www.govinfo.gov/content/pkg/FR-1995-08-31/html/95-21265.htm https://www.govinfo.gov/content/pkg/FR-1995-08-31/pdf/95-21265.pdf 29 p. 45344 45372 60 FR 45344 Title 42 Part 400 42 CFR Part 400 Title 42 Part 411 42 CFR Part 411 RIN 0938-AD73 Medicare Program; Medicare Secondary Payer for Individuals Entitled to Medicare and Also Covered Under Group Health Plans; Federal Register Vol. 60, Issue RULE 95-21265 DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration 1995-10-02 BPD-482-FC 4120-01-P 95-21265 Final rule with comment period.

These regulations establish limits on Medicare payment for services furnished to individuals who are entitled to Medicare on the basis of disability and who are covered under large group health plans (LGHPs) by virtue of their own or a family member's current employment status with an employer; and prohibit LGHPs from taking into account that those individuals are entitled to Medicare on the basis of disability. They also implement certain other provisions of section 1862(b) of the Social Security Act, as amended by the Omnibus Budget Reconciliation Acts of 1986, 1989, 1990, and 1993 and the Social Security Act Amendments of 1994. Those amendments affect the Medicare secondary payer rules for individuals who are entitled to Medicare on the basis of age or who are eligible or entitled on the basis of end stage renal disease and who are also covered under group health plans (GHPs). The provisions that apply to all three groups include-- <bullet> The rules under which HCFA determines that a GHP or LGHP is not in conformance with the requirements and prohibitions of the statute; <bullet> The appeals procedures respecting GHPs and LGHPs that HCFA finds to be nonconforming. <bullet> The referral of nonconforming plans to the Internal Revenue Service; and <bullet> The rules for recovery of conditional or mistaken Medicare payments made by HCFA. The intent of the MSP provisions is to ensure that Medicare does not pay primary benefits for services for which a GHP or LGHP is the proper primary payer and that beneficiaries covered under these plans are not disadvantaged vis-a-vis other individuals who are covered under the plan but are not entitled to Medicare.

Effective Dates: These regulations are effective on October 2, 1995. Herbert Pollock, (410) 786-4474. Vol. 60, no. 169 Office of the Federal Register, National Archives and Records Administration 1995-08-31 continuing daily deposited born digital 331 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-1995-08-31 P0b002ee180a90ade 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr31au95 https://www.govinfo.gov/app/details/FR-1995-08-31 https://www.govinfo.gov/content/pkg/FR-1995-08-31/pdf/FR-1995-08-31.pdf fdlp 45325 45646 DGPO 2010-09-25 2023-05-07 FR-1995-08-31 machine generated eng FR FR-1995-08-31 60 169