ACA Reporting
ACA Compliance Lessons Learned From Recent Reporting Seasons
Common themes emerge when reflecting on recent ACA reporting seasons that can help employers reduce administrative burdens and improve accuracy.
Employers
MSP Reporting Requirement Effective Now
The Centers for Medicare and Medicaid Services (CMS) issued final rules imposing civil money penalties on Medicare Secondary Payer (MSP) reporting violations.
The Centers for Medicare and Medicaid Services (CMS) issued final rules imposing civil money penalties on Medicare Secondary Payer (MSP) reporting violations. The final rules were effective December 11, 2023, but penalties are not imposed until October 10, 2024.
The Medicare Secondary Payer rules are applicable to group health plans provided by employers with at least 20 employees, including those in both the private and public sectors. These provisions help establish whether the employer-sponsored health plan or Medicare should serve as the primary payer for healthcare expenses of individuals who are eligible for Medicare.
Group health plans covered under MSP include not only traditional employee health plans but also dental, vision, and health reimbursement arrangements (HRAs) with annual benefits exceeding $5,000. MSP mandates that responsible reporting entities submit information to the Centers for Medicare & Medicaid Services, identifying Medicare beneficiaries who are covered by these group health plans.
The penalties for not complying with the reporting requirements are as follows:
- Group health plans: $1,000 per day of noncompliance, adjusted annually
- Non-group health plan required reporting entities: A tiered penalty approach
The maximum penalty for noncompliance for any one individual is $365,000, adjusted for inflation.
Plans should plan to comply with the reporting requirements immediately.
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This article is for informational purposes only and is not intended as legal, tax, or benefits advice. Readers should not rely on this information for taking (or not taking) any action relating to employment, compliance, or benefits. Always consult with a qualified professional before making decisions based on this content.