Creditable Coverage Disclosure to the Centers for Medicare and Medicaid Services (CMS)
February 12, 2024//Comments Off on Creditable Coverage Disclosure to the Centers for Medicare and Medicaid Services (CMS)
| Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), group health plans that currently provide prescription drug coverage to Medicare Part D eligible individuals have two annual disclosure obligations. First, the Centers for Medicare & Medicaid Services (CMS) requires entities to provide a notice to all Medicare Part D eligible individuals disclosing whether the entities’ prescription drug coverage is “creditable,” i.e., whether the prescription drug coverage is equal to or better than the drug coverage offered under Medicare Part D. The deadline for providing the disclosure notices to Part D eligible individuals was October 15, 2023. Second, under the MMA, entities are also obligated to advise CMS as to whether or not the entities’ prescription drug coverage is “creditable.” A. Timing of Disclosure Notice to CMS The deadline for notifying CMS as to whether an entity’s coverage is “creditable prescription drug coverage” is sixty (60) days after the beginning of the plan year. For 2024 calendar year plans, the deadline is March 1, 2024. Disclosure to CMS must also be made within 30 days after any change in the “creditable” coverage status of any prescription drug coverage. B. Manner of Disclosure Notice to CMS A plan is required to provide the Disclosure to CMS Form (“Disclosure Form”) through completion of the form on-line at the CMS Creditable Coverage Disclosure Web Page at: Disclosure to CMS Form This is the sole method for complying with the CMS disclosure requirement. The following plans that provide prescription drug coverage to Medicare Part D eligible individuals are required to go on-line and complete the required Disclosure Form by the deadline indicated above: This is the sole method for complying with the CMS disclosure requirement. The following plans that provide prescription drug coverage to Medicare Part D eligible individuals are required to go on-line and complete the required Disclosure Form by the deadline indicated above: 1. Group health plans offered by employers. 2. Taft-Hartley plans. 3. Church Plans. 4. Federal, State, and Local government plans. IMPORTANT NOTE: If your plan already applied for the Retiree Drug Subsidy Program, you are not required to submit the on-line Disclosure Form to CMS, as CMS has deemed your application as in full compliance with this disclosure obligation. C. Content of Disclosure Notice to CMS CMS requires certain information be made available to it relating to this disclosure obligation, including but not limited to, the name of the entity offering prescription drug coverage; the address, phone number and Federal Tax Identification Number of the entity; type of coverage being offered; the number of Part D eligible Individuals expected to be covered under the plan; the date the Notice of Creditable Coverage was provided to Part D eligible individuals; and the name, title, and email address of the entity’s authorized individual. WHAT YOU NEED TO DO Print the following Helpful Tips When Completing On-Line Disclosure to CMS. Go on-line and complete the Disclosure Form to CMS by March 1, 2024 (for 2024 calendar year plans). Helpful Tips When Completing On-Line Disclosure to CMS – The Name of Entity should be the name of the Employer sponsoring the plan. – Use the Federal Tax ID Number listed in your Plan Document/SPD. – Under “Coverage Type”, choose only one sub-category under the “Group Health Plan” choices. – Under the Section “Creditable/Non-Creditable Offer,” choose one of the three choices available. For many of you, the choice will be “All Options Offered Are Creditable”. After you make your selection, additional information specific to your plan will be requested. You will be asked to provide the following: – The beginning and ending date for your Plan Year. Examples: A plan that runs on a calendar year basis should use 01/01/2024 to 12/31/2024. A Plan Year that begins February 1st should use 02/01/2024 to 01/31/2025. – You will be asked to provide the number of Part D Eligible Individuals expected to have prescription drug coverage under your plan. Please keep in mind that this only needs to be an estimate of the number of individuals covered under your plan that are 65 years of age or older, or disabled individuals under the age of 65. – You will also be asked to provide the number of Retirees covered under your plan who are Part D Eligible Individuals. If you do not provide any retiree coverage, please enter “0”. For those plans providing retiree coverage, you only need to provide an estimate of the number of retirees covered under your plan who are Part D Eligible Individuals. – You need to provide the date that you sent/provided the notice of creditable coverage to all participants or to the participants over the age of 65. For many of you, please note that this date should be prior to October 15, 2023. – Please choose “yes” or “no” when asked whether your creditable coverage status changed from the last plan year. If you choose “yes,” you must provide 1) the effective date of this change, and 2) the date you disclosed to Medicare Part D Eligible Individuals about this change. – Lastly, you will be asked for the name, title and email address of the entity’s Authorized Individual. This means the person employed by the entity that is completing the on-line Disclosure Form. Then fill in the date and click the right arrow. You will then have the opportunity to download a pdf of your responses, as well as view a summary of your responses. Click on the right arrow again at the bottom of the summary of your responses. You will then see a new screen that states: “We thank you for your time spent taking this survey. Your response has been recorded.” Additional information relating to the on-line Disclosure Form can be found at https://www.cms.gov/CreditableCoverage |
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