1. Survey - The Centers for Medicare & Medicaid Services (CMS) requests Plan Sponsors that have received reimbursement under the Early Retiree Reinsurance Program (ERRP) to complete a survey located at https://www.research.net/s/CMS-ERRP-Survey. The purpose of such survey is to determine how a Plan Sponsor has used or intends to use ERRP reimbursements.

2. Claims File - Health and Human Services (HHS) is requiring Plan Sponsors that have been reimbursed with ERRP funds to submit a full-replacement Claims List that passes the automated edits introduced on October 1, 2011 and an associated reimbursement request by March 30, 2012 for each plan year.

More details on each action item are outlined below:

Survey

Background

In early December 2011, CMS contacted Authorized Representatives of Plan Sponsors that have received reimbursement under the ERRP, requesting them to complete a survey that is primarily related to determining how a Plan Sponsor has used or intends to use ERRP reimbursements. On January 6, 2012, CMS contacted Authorized Representatives and Account Managers of such plans that have yet to complete the survey. CMS is requesting that the survey be completed by January 13, 2012. Plan Sponsors that have already completed the survey or have not received any ERRP funds should disregard this communication.

The ERRP statute at 42 U.S.C. §18002(c)(4) defines the permissible uses of ERRP proceeds as such:

• Reduce premium costs for a plan sponsor.
• Reduce premium contributions, copayments, deductibles, coinsurance, or other out-of-pocket costs for plan participants.
• Cannot be used as general revenues for a plan sponsor.

It also states that "the Secretary shall develop a mechanism to monitor the appropriate use of such payments by such entities."

Completing the Survey

The survey consists of 17 questions grouped into four sections, and is accessible online at https://www.research.net/s/CMS-ERRP-Survey.

Some questions may be harder than others to address. More specifically, Section II (Use of ERRP Reimbursements) questions pertain to the use and allocation of the ERRP proceeds. CMS stated that it recognizes that not all answers to the survey are or will prove to be 100% accurate. However, CMS expects Sponsors to answer all questions as accurately and completely as possible.

You might want to consult with your Plan's legal counsel prior to completing the survey. ERRP is stating that the responses will not be used to determine compliance; however, there is some concern that the survey response will be used in an audit.

Claims List

Background

From the ERRP Website: For each plan year for which a Plan Sponsor has been reimbursed with ERRP funds, the requirement to submit a full-replacement Claims List that passes the automated edits and an associated reimbursement request by March 30, 2012 remains. Absent the submission of such an error-free Claims List and a corresponding reimbursement request, CMS will initiate procedures for recoupment of the funds paid to the Plan Sponsors. As a result of such collection, any funds returned to the program will be used to pay outstanding reimbursement requests in the order in which they were received.

Replacement Claims List Practical Matters

All reimbursements that were submitted using only the summary methodology during the first three quarters of the ERRP program (i.e., through March 31, 2011) must be resubmitted using ERRP's individual claims system. The ineligible procedure codes for professional claims were provided July 18, 2011. The ineligible revenue codes for hospital claims were provided November 11, 2011. No updated ineligible NDC for pharmacy claims are available. The methodology for adjusting for price concession, e.g., rebates, was clarified on December 16, 2011. There are five (really six if the initial format checking is counted) levels of testing that a Claims List must pass in the automated system. If an error occurs, then processing stops at that level and a new Claims List must be submitted. Each submission takes up to five business days to get a response filed. The eligibility file submission that occurs prior to any Claims List being submitted also takes ERRP up to five business days to be processed.

Cheiron recommends that Plans that have submitted a Claims List prior to the implementation of the automated system, i.e., October 1, 2011, file a new claims list in the first quarter of 2012 to ensure compliance with an "error-free Claims List." We also suggest that Plans start the filing process for each Plan Year no later than February 20, 2012 and preferably sooner. Remember even after a Claims List is submitted and approved by ERRP, the Claims List can still be modified, as long as Reimbursement is not requested and there is enough time to get the new list approved before March 30, 2012.

References:

ERRP Help Center:

The ERRP Center is available from Monday through Friday between 9:00 am and 7:00 pm Eastern Time. You can contact the ERRP Center via email or phone at:

help@errp.gov

Toll free: (877) 574-3777

ERRP website address:

http://www.errp.gov

Cheiron is an actuarial consulting firm that provides actuarial and consulting advice. However, we are neither attorneys nor accountants. Therefore, we do not provide legal services or tax advice.