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Creditable Coverage Disclosure to Centers for Medicare and Medicaid (CMS) Required
Centers for Medicare and Medicaid (CMS) publishes disclosure instructions
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) requires that all entities providing prescription drug coverage to Medicare Part D-eligible individuals must periodically disclose to the Centers for Medicare and Medicaid Services (CMS) whether the prescription drug coverage offered is creditable or non-creditable to Medicare Part D. On January 10, 2006, CMS published instructions for making these periodic disclosures. These instructions remain current.
When must disclosure be made to Centers for Medicare and Medicaid (CMS)?
According to CMS instructions, at a minimum, disclosure to CMS must be made by the following deadlines:
- For plan years ending in 2007 and beyond, disclosure must be provided within 60 days after the beginning of the plan year for which the entity is providing the disclosure to Centers for Medicare and Medicaid (CMS);
- Within 30 days after the termination of the prescription drug plan; and
- Within 30 days after any change in the creditable coverage status of the prescription drug plan.
Who must make the disclosure to Centers for Medicare and Medicaid (CMS)?
- The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) requires that sponsors of group health insurance plans, including employers, unions, churches, Federal, State and local government, among others, that provide prescription drug coverage to Medicare Part D-eligible individuals must disclose creditability status to Centers for Medicare and Medicaid (CMS). This requirement also applies to governmental-sponsored health insurance plans (e.g., VA Plans, TRICARE, etc.), individual coverage, Medigap Plans, and Indian Health Service, tribal and urban Indian organization plans, among others.
- Though the disclosure requirement applies to prescription drug coverage provided to Medicare Part D-eligible individuals, group health insurance plan sponsors may want to consider providing the disclosure to CMS even if they are not aware of Part D-eligible members in their group health insurance plan. This is because of the difficulty in determining whether employees' spouses or dependents are Medicare-eligible.
- Plan sponsors that have applied for and anticipate receiving payment for the retiree drug subsidy (RDS) are not required to make this disclosure to Centers for Medicare and Medicaid (CMS).
How is the disclosure made?
Where can clients get additional information and instructions?
- Centers for Medicare and Medicaid’s (CMS) January 10, 2006 disclosure guidance is posted on the CMS Web site.
- Information, guidance, and questions and answers about creditable coverage can be found on the CMS Web site.
How can Blue Cross and Blue Shield of Texas assist clients?
Notification of creditable coverage status is a CMS requirement specifically for sponsors of group health insurance plans, including employers and unions. Therefore, HCSC cannot notify CMS of a client's creditable coverage status.
In October 2007, BCBSTX provided guidance documents for clients' use in determining the Medicare Part D creditable coverage status of their prescription drug plans. These guidance documents are available from the client's Account Executive.
The information in this article should not be construed as legal advice or as a legal opinion on any specific facts or circumstances, and is not intended to replace advice of independent legal counsel.
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