The Medicare and Medicaid Coverage Data Bank.

Included in the Revenue Reconciliation Act of 1993 is a provision for a Medicare and Medicaid Coverage Data Bank, to be set up by the Secretary of the Department of Health and Human Services (HHS). Originally, effective Jan. 1, 1994, a new reporting rule would have required employers to obtain information from employees covered by the employer's group health plans. However, the Health Care Financing Administration has suspended implementation of these rules, at this point indefinitely. At the same time, it is still important to understand these rules and the information required by these requirements. Certain information not usually maintained on employees will be required to be submitted by employers and kept on record. Many employers are unaware of the requirements and even the existence of this data bank and the implications of failure to report. For purposes of this provision, the definition of an employer is any employer that has or contributes to a group health plan under which at least one employee has coverage.

The Secretary has authorization to disclose any information in the data bank to other state agencies, employers or group health plans as necessary to accomplish the goals of the provision. There are two main objectives of this provision. The first is to identify and collect amounts from third parties (i.e., insurance companies) responsible for payment of health care items and services furnished to Medicare beneficiaries. The second objective is to collect or assist in the collection of amounts due from liable third parties for the reimbursement of costs incurred by any state plan under the Medicaid program. By creating the data bank, HHS will be able to exchange information with other state agencies and identify people receiving benefits from Medicare or Medicaid who should be covered by insurance.

The provision is a "sunset provision," meaning that it is only in effect for a limited amount of time. (Originally, employers would have had to provide the required information annually from Jan. 1, 1994 to Jan. 1, 1998; because of the suspension of implementation, the time limits are currently uncertain.) Parties other than employers are not required by law to maintain the information, but if they do so, they may be required to report it. These parties are referred to as "information maintainers" and include plan sponsors, plan administrators and any other persons who, under the plan, maintain the information necessary to enable the employer to comply with the data bank reporting requirements. The data bank will accept information directly from these parties. On the request of the employer, the "information maintainers" must provide the following information to the data bank.

* The employee's name and taxpayer identification number (TIN).

* The type of group health plan coverage (single or family) elected.

* The name, address and identifying number of the group health plan elected by the employee.

* The name and TIN of each other individual covered under the group health plan, including spouses and dependents.

* The period during which the coverage is elected.

* The employer's name, address and TIN.

The format for the reports has not yet been released. There will, however, be at least three methods of reporting, including scannable paper forms, preformatted diskettes and electronic filing. Failure to report could result in the assessment of penalties as provided by Sec. 6721 for failure to comply with information reporting requirements. Penalties are assessed at $50 per instance, not to exceed $250,000. If the information is not available, an explanation must be submitted substantiating the effort made to comply.

At the present time there is legislation pending both to delay and to repeal the provision. Opponents argue that the cost to employers to comply with the provision will exceed the benefit obtained, and that many employers are unfamiliar with and unaware of the requirements. However, the fiscal benefits anticipated from implementing this provision are already built into the Federal budget; repeal would mean the need for finding further revenue elsewhere. Therefore, employers should be cautious and prepare to comply.

It is imperative that clients be aware of this reporting requirement. Many small businesses with high employee turnover or seasonal employees may have difficulty providing the information for employees no longer working at the time of filing; the required information should be obtained when the employees are hired.

There was a notice in the Federal Register in May regarding the data bank. Also, the following people can be contacted for additional information: William Zavoina, Bureau of Program Operations [phone], and John Van Walker, Bureau of Data Management and Strategy [phone].