Master Core Curriculum

1. Master Core Curriculum Part A Intermediate Module 5 Medicare Secondary Payer (MSP)

2. Acronyms • ADEA • The Age Discrimination in Employment Act • COBRA • Consolidated Omnibus Budget Reconciliation Act • ESRD • End Stage Renal Disease • GHP • Group Health Plan • MSP • Medicare Secondary Payer

3. Learning Outcomes At the end of the module, participants will be able to: • define COBRA regulations and applicability • identify documentation requirements • describe dual entitlement situations • file the claim to the correct entity

4. Working Aged • The Age Discrimination in Employment Act (ADEA) • Group Health Plan (GHP) for individuals age 65 or over • ADEA administered by the Equal Employment Opportunity Commission (EEOC)

5. End Stage Renal Disease (ESRD) • Medicare is secondary for individuals eligible or entitled to Medicare benefits based on ESRD • Medicare is secondary during a coordination period • ESRD requirements apply • Regardless of the number of employees • Regardless of the individual’s current employment status

6. End Stage Renal Disease (ESRD) • Medicare is secondary payer to GHPs during a period of up to 30 consecutive months which begins with the earlier of: • The month in which a regular course of renal dialysis is initiated, or • If the beneficiary undergoes a course of self-dialysis training the first day of the month in which the training occurred, or • If an individual who received a kidney transplant, the first month in which the individual became entitled • For more information on the ESRD Coordination Period visit • www.cms.hhs.gov/manuals/105_msp105index.asp

7. End Stage Renal Disease (ESRD) • Dual Eligibility/Entitlement Situations • Individual also becomes entitled to Medicare based on age 65 • Individual also becomes entitled to Medicare based on disability • Coordination of Benefits (COB) period for beneficiaries with dual entitlement

8. Review • The ADEA requires employers to offer coverage to their employees age 65 and over • Medicare is secondary payer to GHPs during a period of up to 30 months for individuals entitled to Medicare based on ESRD • Individual also becomes entitled to Medicare based on age or disability coordination period may continue

9. COBRA • What is COBRA? • It is the acronym for Consolidated Omnibus Budget Reconciliation Act • COBRA requires that certain Group Health Plans (GHP) offer continuation of plan coverage for 18 to 36 months after the occurrence of certain qualifying events

10. Dual Entitlement: Examples • Is Medicare primary or secondary? • Mrs. L, who is 67 years old and entitled to Medicare on the basis of age, has GHP coverage by virtue of current employment status • Mrs. L is diagnosed as having ESRD and begins a course of maintenance dialysis on June 27, 2000 • Effective September 1, 2000, Mrs. L is eligible for Medicare on the basis of ESRD

11. MSP laws and regulations • CMS On Line Manual (IOM) • www.cms.hhs.gov/manuals/105_msp105index.asp • Medicare Secondary Payer (MSP) Manual • Chapter 1 – Background and Overview • Chapter 2 – MSP Provisions