Blue Access for Producers

Creditable Coverage Disclosure to CMS Required for 2009

Creditable Coverage Disclosure to Centers for Medicare and Medicaid (CMS) Required

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 periodically disclose to the Centers for Medicare & Medicaid Services (CMS) whether the prescription drug coverage offered is creditable or non-creditable to Medicare Part D.

When must disclosure be made to CMS?
According to CMS instructions, at a minimum, disclosure to CMS must be made

  1. Within 60 days after the beginning of the plan year for which the entity is providing the disclosure to CMS for plan years ending in 2007 and beyond;
  2. Within 30 days after the termination of the prescription drug plan; and
  3. Within 30 days after any change in the creditable coverage status of the prescription drug plan.


Which entities must make a disclosure?
MMA requires that sponsors of group health plans, including employers, unions, churches, federal, state and local governments, among others, disclose creditability status. This requirement also applies to governmental sponsored plans (e.g., Medicaid, state high risk pools, etc), military coverage (e.g., Veterans Administration, TRICARE, etc), individual coverage, and Medigap plans, among others.

Though the disclosure requirement applies to prescription drug coverage provided to Medicare Part D eligible individuals, group health plan sponsors may want to consider providing the disclosure to CMS even if they’re not aware of Part D-eligible members in their group health 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 CMS.

How is the disclosure made?
Disclosure must be made electronically via the Disclosure Notice form on the CMS Creditable Coverage Web page at 

Where can clients get additional information and instructions?
The current CMS disclosure guidance (Jan. 10, 2006) is posted on the CMS Web site at . Helpful hints also can be found under the title "Disclosure to CMS Guidance and Instructions" on the Web site.

How can HCSC assist clients?
Notification of creditable coverage status is a CMS requirement of sponsors of group health plans, including employers and unions. HCSC will not notify CMS of a client’s creditable coverage status.

The information is 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.