CMS Releases Section 111 NGHP User Guide Version 7.9

by J. Shymanski

CMS released version 7.9 of the Non-Group Health Plan (NGHP) User Guide yesterday.

The only update in version 7.9 reflects the notice that CMS issues each year regarding the reporting thresholds. For 2025, CMS will maintain the $750 threshold as stated on page 4 of Chapter III (Policy Guidance):

The updates listed below have been made to the Policy Guidance Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary.

As of January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

This minor update is not unexpected since version 7.8 of the User Guide was released less than a month ago. Read our recent blog post for a breakdown of the updates found in version 7.8.

If you have any questions about recent updates to the NGHP User Guide or would like to learn more about our Section 111 Reporting services, please contact our Settlement Consulting team at [email protected].