UPDATE: CMS Webinar on Section 111 Reporting Civil Money Penalties

By Barrye Miyagi and Shannon Shelton

Our January 16, 2026, blog on CMS Section 111 Reporting Civil Money Penalties has been updated as follows:

• CMS’s webinar deck has been posted here.

• CMS has clarified that RREs have until July 2025 to implement reporting changes for workers’ compensation TPOCs and assumption of ORM. The first date CMS may issue a notice of CMPs related to workers’ compensation TPOCs and/or assumption of ORM is July 2026. The original blog from January 16 has been updated below to reflect this clarification.

JANUARY 15, 2026 BLOG: CMS WEBINAR ON SECTION 111 REPORTING CIVIL MONEY PENALTIES

On January 15, 2026, the Centers for Medicare & Medicaid Services (CMS) held a webinar on Non-Group Health Plan (NGHP) Section 111 Reporting Civil Money Penalties (CMPs). To learn more about the Final Rule on Civil Money Penalties, click here for an article authored by Taylor Porter’s Medicare Secondary Payer (MSP) Compliance Counsel, Barrye Miyagi.

NOTICE DATES AND NOTICE RECIPIENTS: CMS will begin issuing informal notices on the imposition of CMPs in March 2026. Notices will be sent on official CMS letterhead to the Authorized Representative and Account Manager for the Responsible Reporting Entity (RRE).  Note: Reporting Agents will not receive copies of CMS notices.

CRITICAL DATES FOR LIABILITY AND NO-FAULT CLAIMS

• October 11, 2024: The applicable date for imposing a CMP. If the Total Payment Obligation to Claimant Date (TPOC Date) or assumption of ongoing responsibility for medicals (ORM) is October 11, 2024, or later, the claim could be included in a random audit for potential CMPs. CMS will not retroactively impose CMPs on claims where the TPOC date or assumption of ORM date precedes October 11, 2024. The deadline for the Section 111 report is dependent upon how the RRE is registered to report. In order to avoid potential CMPs, the RRE must submit the mandatory Section 111 report within 365 days of the reportable event. Reportable events include TPOC Dates, Funding Delayed Beyond TPOC Dates, if the Funding Delayed date is included in a Section 111 report, and assumption of ORM.
• October 11, 2025: The first date RREs may be held responsible for a CMP.
• February 2026: CMS will conduct its first random audit of NGHP Section 111 reports.
• March 2026: CMS will issue its first notices concerning potential CMPs.

DELAYED CMPs FOR WORKERS’ COMPENSATION EVENTS

In April 2025, CMS updated its guidance on Section 111 reporting of workers’ compensation TPOCs to include certain data about Medicare Set Asides (MSAs). Due to these updates and in keeping with regulations requiring that RREs be given time to implement changes, RREs have until July 2025 to implement reporting changes for workers’ compensation TPOCs and assumption of ORM. The first date CMS may issue a notice of CMPs related to workers’ compensation TPOCs and/or assumption of ORM is July 2026.

CMS NOTICE AND APPEALS PROCESS

RREs will only receive notice if a noncompliant record is randomly selected during a quarterly audit. A separate notice will be sent for each noncompliant record.

The sole basis for CMPs is failure to timely report.

Informal Notice of Intent to Impose CMP: RREs will have 30 days to respond.

• CMS will issue informal notices to the RRE advising of its intent to impose CMPs and providing instructions for the RRE to submit mitigating evidence. CMS acknowledged there may be numerous reasons why a report may appear to be untimely, and CMS is open to explanations and dialogue with the RRE.

Notice of Proposed Determination to Impose CMP or Favorable Decision Notice

• If the RRE’s mitigating evidence is accepted, the RRE will receive correspondence from CMS confirming that no CMP will issue.
• If the RRE fails to timely respond to the informal notice or CMS rejects the RREs mitigating evidence, CMS will issue Notice of Proposed Determination to Impose CMPs.

Administrative Appeals:  3-step process (ALJ, the Board, Judicial Review)

• The RRE has 60 days from receipt of the Notice of Proposed Determination to appeal the decision to an Administrative Law Judge (ALJ).
• The RRE has 30 calendar days to appeal an unfavorable ALJ decision to the Departmental Appeals Board Appellate Division (the Board).
• The RRE has 60 calendar days from an unfavorable decision from the Board to file a Petition for Judicial Review. A Notice of Final Determination will issue post review.

Payment of CMPs:

• The RRE has 60 days from the receipt of the Notice of Final Determination to submit electronic payments through the pay.gov e-bill process.

SAFE HARBOR FOR GOOD FAITH EFFORTS TO REPORT

CMS provides a safe harbor for instances where an RRE does not have and cannot reasonably obtain the information required to submit a mandatory Section 111 report. Safe harbor compliance requires the RRE to demonstrate three (3) good faith efforts to obtain the required information:

• First 2 attempts in writing (mail or email) to the beneficiary and the beneficiary’s attorney (and other representative, if any).
• 1 attempt by phone, mail, or email.

If the RRE receives a written refusal to provide the requested information, then no further communication is required. The refusal must be in writing to satisfy any evidentiary concerns.

CMS noted that federal law does not prohibit an RRE from contacting a claimant represented by an attorney for purposes of establishing the safe harbor. Per CMS verbal instructions, if the RRE only communicated with the claimant’s representative and the representative did not refuse to provide the requested information, then the RRE must also contact the beneficiary. 

IMPORTANT TAKEAWAYS:

• Self-insurers and insurers should review their Section 111 Reporting Profiles, identify their Section 111 Reporting Account Representatives and Account Managers, and ensure those persons are aware of the need to take immediate action if notices are received.
• RREs should communicate with their Reporting Agents about a procedure to ensure Section 111 reports are successfully submitted. CMS’ determination to send noncompliance letters to RREs and not their Reporting Agents is consistent with CMS guidance that the RRE is ultimately responsible for failure to timely submit a Section 111 report.
• RREs should implement a process to quality check Section 111 submissions. Rejected submissions leave the RRE at risk for potential CMPs.

ABOUT US

Taylor Porter is a full-service law firm with a dedicated Medicare Secondary Payer practice group. If you have questions about Section 111 reporting and/or receive a notice of noncompliance, please reach out to barrye.miyagi@taylorporter.com or shannon.shelton@taylorporter.com.