Working Aged Exception for Small Employers in Multi-Employer

10.4 – Working Aged Exception for Small Employers in Multi-Employer Group Health Plans (GHPs) (Rev. 11755, Issued:12-21-2022, Effective: 01-23-2023, Implementation: 01-23-23) A multi-employer GHP having at least one employer participating that has at least one employer with 20 or more employees may prospectively request to except employees (and their spouses) of identified employers with fewer than 20 employees from the working aged provision. The small employer provision of the MSP statute can be found at 42 U.S.C. 1395y(b)(1)(A)(iii) and 42 CFR 411.172(b). Under this provision, multi- employer GHPs may elect Medicare as the primary payer for services provided to working aged Medicare beneficiaries covered through qualified employers participating in the plan that have fewer than 20 employees. These employees and their spouses are not subject to the working aged provision once an exception has been granted as long as the employer continues to meet the requirements for the exception. Be advised that it is the GHP’s responsibility to provide written updates of any information that may affect the original exception request (updates should include identification of any employees not previously identified as well as information on any terminated coverage issues, etc.) to the MSP Contractor as soon as any changes take place. All requests for exceptions from the multi-employer plan/administrator of the small employer shall be submitted to the MSP Contractor. A/B MACs and DME MACs having received a request or an update to a previous request shall forward these requests within 14 calendar days of receipt to the MSP Contractor. Please refer to the following link to identify the appropriate contact: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of- Benefits-and-Recovery-Overview/Contacts/Contacts-page. The MSP contractor shall not make an exception for beneficiaries entitled to Medicare based on permanent kidney failure (End-Stage Renal Disease) or Disability. The MSP Contractor shall only grant requests on a prospective basis. Detailed information regarding the Small Employer Exception and requirements for requesting an exception can be found on the CMS Web site at: https://www.cms.gov/Medicare/Coordination-of- Benefits-and-Recovery/EmployerServices/Small-Employer-Exception