CMS Updates Section 111 Reporting Guide: Expands definition of "Spouse" to include same-sex marriages

In the updated User Guide released on October 6th, 2014, with regards to Medicare Secondary Payer (“MSP”) policies, CMS redefines "spouse" to include partners in a same-sex marriage. The result of this redefinition is that any legal same-sex marriages entered into in a U.S. jurisdiction that recognizes same-sex marriages, the District of Columbia, or a U.S. territory or a foreign country will be recognized for MSP purposes.  Although the provision will not be effective until January 1, 2015, if an employer, insurer, third party administrator or other plan sponsors so chooses, they may currently use the broader definition of spouse.                                                          
Due to this change, if an individual, based on the Social Security Administration's rules, is entitled to Medicare as a spouse, that individual is a "spouse" for purposes of the MSP Working Aged provisions. Similarly, if a marriage is valid in the jurisdiction in which it was performed as noted above, both parties to the marriage are "spouses" for purposes of the MSP Working Aged provisions. Additionally, if a plan sponsor (employer, insurer, etc.) has a more expansive definition of spouse, it may take over primary payment responsibility for the "spouse". If the "spouse" is reported as such pursuant to Medicare, Medicare, & SCHIP Extension Act of 2007 ("MMSEA") Section 111, Medicare will both pay and pursue recovery accordingly.

For more information please visit the CMS website here.