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BACKGROUND In December 2007, President Bush signed the Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program) Extension Act of 2007 (Medicare Extension Act) which provided a number of Medicare and Medicaid health insurance coverage provisions including the elimination of a scheduled reduction to Medicare physicians and an extension of the SCHIP through March 2009. In addition to the Medicare Extension Act's broad national health benefit related provisions; it creates reporting requirements that will enable Medicare to examine settlements, judgments, and awards impacting Medicare benefits to ensure that related health care expenses are allocated to the appropriate party. As such, the Medicare Extension Act requires any entity serving as an insurer or third part administrator for a group health plan, to: (1) provide information necessary to identify situations where the group health plan is or has been a primary plan to the Medicare program; and (2) submit such information to the federal government's Centers for Medicare and Medicaid Services (CMS). In addition, it requires a determination, and submittal, of information on whether a claimant is Medicare eligible. This information allows CMS to identify those claims where Medicare has a right of recovery against the primary payer of the claim. The bottom line of these requirements is to protect the Medicare system from inheriting medical expenses considered to be the primary obligation of a group health plan, which under the Medicare Extension Act includes insured and self- insured workers compensation, liability and no fault plans. Failure to adhere to the new requirements carries significant penalties of up to $1,000 per day. While the Medicare Extension Act implements a new reporting system, current law required that parties to a settlement protect Medicare's interest as a secondary payor to other available health plans. However, due to lack of available reporting and other administrative responsibilities, it has been difficult to enforce this requirement. As such, while the Medicare Extension Act establishes new reporting responsibilities, it does not establish new responsibilities for payments of medical expenses. It should also be noted, that the medical benefits applicable to the Medicare Extension Act usually come into play with workers compensation claims requiring medical treatment indefinitely. Because Pleasanton administers its worker's compensation plan and is involved with health coverage, and based on a review of the Medicare Extension Act, it is a Responsible Reporting Entity (RRE) subject to the Medicare Extension Act's reporting requirements. The new reporting requirements begin April 1, 2010. DISCUSSION Meeting the reporting requirement of the Medicare Extension Act is expected to be a detailed process that will be addressed in two steps. The initial required step includes the naming of an authorized representative who has ultimate accountability for reporting information to the CMS. In addition to initial registration to the program, the authorized representative will enter into an agreement that mandates Medicare as a secondary provider for those eligible to receive medical treatment. The City, or RRE, must register Page 2 of 3