Proposed Rules on LMSAs and Section 111 Penalties Again Delayed

November 25, 2019

US Capitol dome

Almost a year ago the U.S. Office of Management and Budget posted two rulemaking notices from the Centers for Medicare and Medicaid Services (CMS) entitled Civil Money Penalties and Medicare Secondary Payer Reporting Requirements and Miscellaneous Medicare Secondary Payer Clarifications and Updates.  Per our understanding, the purpose of this rulemaking is to provide proposals for how and when penalties will be imposed in Section 111 Mandatory Insurer Reporting and for a Liability Medicare Set-Aside review process.

When issued in December 2018, both notices indicated the proposed rules would be issued in September 2019.  Subsequent notices moved the date to October 2019 and we now have notices moving the date for issuing the proposed rule on penalties to December 2019 and for rules on LMSAs to February 2020.

Practical Implications

The lesson here is these are not hard and fast dates as they have already been moved twice and we assume may be moved again.  At some point we expect the proposed rules to be issued which will be followed by comment periods (likely a 60-day period each).  CMS will take public comments under review and then issue final rules with effective dates.  As such, we are looking at a rulemaking process that will stretch well into 2020 and possibly into 2021.

For more background on these rules please read our prior article, CMS Rulemaking Notices Provide Possible Timeline on LMSAs and Reporting Penalties.

If you have any questions, please contact Dan Anders at (888) 331.4941 or