Ametros Response to CMS Request for Feedback on ORM Termination
On May 26, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a notice indicating that the Division of Medicare Secondary Payer Program Operations (DMPO) is soliciting feedback from the industry relative to voluntarily terminating Ongoing Responsibility for Medicals (ORM) via Sec. 111 Mandatory Insurer Reporting.
Quick Background on Section 111
Section 111 Mandatory Insurer Reporting requires applicable plans—such as insurance carriers and self-insured entities, collectively known as Responsible Reporting Entities (RREs)—to submit electronic reports to CMS. At a high level, RREs must:
- Determine whether a claimant is a Medicare beneficiary (via the query process)
- Report the assumption and termination of Ongoing Responsibility for Medicals (ORM), most commonly in workers’ compensation and no-fault claims
- Report any settlements, judgments, or other payments unrelated to ORM—referred to as Total Payment Obligation to Claimant (TPOC)
See 42 U.S.C. § 1395y(b)(8)(B)(ii) for additional detail. Sec. 6.3.2 in Chapter 3 of the Non-Group Health Plan User Guide outlines instances where it’s permissible to terminate ORM.
Understanding ORM Termination
Ongoing Responsibility for Medicals (ORM) refers to an RRE’s obligation to pay for an injured party’s claim-related medical care on an ongoing basis. This most commonly arises in workers’ compensation claims. The requirement to report ORM is triggered when the RRE determines it has assumed this responsibility—meaning it has learned, through normal due diligence, that the Medicare beneficiary has received or is receiving treatment related to the injury or illness. See NGHP Sec 111 User Guide, Chap 3, Sec. 6.3.
ORM Termination
ORM termination occurs when an RRE reports the permanent end of its responsibility for ongoing medical care. In other words, it is the Section 111 indicator that notifies Medicare the RRE is no longer responsible for future treatment, allowing Medicare to properly coordinate benefits. Section 6.3.2 of Chapter 3 in the NGHP User Guide outlines scenarios in which an RRE may report ORM termination, including:
- Where there is no practical likelihood of associated future medical treatment (includes related situational conditions such as total amounts paid being less than $25,000 and no claims paid within five years)
- Where responsibility has been terminated under state law associated with a contract of insurance
- When ORM has been terminated per the terms of a particular contract – think applicable benefits exhaustion or time period
- Where there’s no practical likelihood of future treatment as indicated by a written statement of a treatment physician
- A full and final settlement that relieves responsibility to continue to pay for medicals
The above is not meant to be exhaustive and do not contain all technical requirements. For specific questions, it’s important for an RRE to consult their reporting agent.
Industry Call to Action
Ametros is not a Section 111 reporting agent but recognizes the importance of accurately reporting both the assumption and termination of Ongoing Responsibility for Medicals (ORM). The latter has a meaningful impact on post-settlement administration of Medicare Set-Asides (MSAs).
CMS’s notice specifically seeks feedback on “whether the current parameters for ORM termination are appropriate, reasonable, and sufficient” in guiding when a Responsible Reporting Entity (RRE) such as an insurance carrier or self-insured organization may terminate ORM status. Ametros will continue to monitor developments, including any published feedback, and will provide updates as they become available.
