MSP Program Operations Seeks Industry Feedback on ORM Termination

By Mark Popolizio, J.D., Jeremy Farquhar

May 28, 2026 / 4 min read

The Division of Medicare Secondary Payer Program Operations (DMPO) has released a Non-Group Health Plan Mandatory Insurer Reporting User Guide ORM Termination Request for Feedback regarding Section 111 NGHP reporting.

CMS ORM Questions

Request for Industry Feedback – ORM termination

The DMPO is requesting industry input regarding the voluntary termination of On-Going Responsibility for Medicals (ORM). More specifically, the DMPO states that it seeks “industry feedback on whether the current [ORM termination] parameters are appropriate, reasonable, and sufficient.”
DMPO notes that all feedback must be submitted “no later than June 9, 2026.” However, notwithstanding the referenced June 9^th date, DMPO’s notice states that comments received after the above date will still be considered for future enhancements.
For those interested in submitting feedback, see the DMPO’s notice (link above) for instructions on how to do so.

Current ORM Termination Guidelines

As noted in the DMPO’s notice, currently Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2 (ORM Termination), “provides various scenarios under which an RRE may terminate their ORM status when such status appropriately ends.” The reader may wish to review this section to revisit the current bases to terminate ORM per this section.

In the interim, Section 6.3.2, in general, states that ORM may be terminated as follows:

1. State Law

CMS states: “Where the insurer’s responsibility for ORM has been terminated under applicable state law associated with the insurance contract.”[1]

2. Contract

CMS states: “Where the insurer’s responsibility for ORM has been terminated per the terms of the pertinent insurance contract, such as maximum coverage benefits, or any other reason that is not prohibited by the terms of the insurance contract or applicable state or federal law. Note: An insurer’s refusal to accept ORM, or to continue to accept ORM, is a valid ORM termination reason, provided that the refusal is permitted by applicable state or federal law and the terms of the insurance contract.” [2]

3. No Practical Likelihood of Future Medical

CMS states: “Where there is no practical likelihood of associated future medical treatment, which is reflected by meeting ALL of the following: (a) No claims were paid with any diagnosis codes related to alleged ingestion, implantation, or exposure; and (b) No claims were paid, for any medical item or service related to the case, within five (5) years of the date of service of any such claim; and (c) Treatment did not include, nor were any claims paid related to, a medical implantation or prosthetic device; and (d) The total amount paid by the insurer, for all medical claims related to the case, did not exceed $25,000.”[3]

If this basis to terminate ORM is applicable, CMS notes: “If, at any time, any of the parameters set forth above should no longer be applicable, the insurer must then update the ORM record to reflect that they, once again, have ongoing responsibility for medicals (i.e., update the termination date to all zeroes). Should the case once again fall under these parameters (for example, if five years have elapsed from the last relevant date of service), then ORM for that case may once again be terminated in accordance with the criteria above.”[4]

4. Treating Physician Statement

CMS states: “Where there is no practical likelihood of associated future medical treatment, an RRE may submit a termination date for ORM if it maintains a statement (hard copy or electronic) signed by the beneficiary’s treating physician that no additional medical items and/or services associated with the claimed injuries will be required.”[5] If applicable, CMS has specific rules regarding what should be used as the ORM termination date as outlined in the endnote to this sentence.^[6]

Consideration Points

DMPO’s request for feedback provides a unique opportunity for RREs and other industry stakeholders to provide commentary and suggestions regarding how CMS may consider revising and updating their ORM termination guidelines.

From the authors’ interactions with RREs, one primary focus area will likely be scenarios where there may be no further practical likelihood of future medical care anticipated (Point #3 above). From the authors’ perspective, this basis for ORM termination (since its implementation in June of 2021) has historically been viewed by many RREs as a step in the right direction, although the consensus from many RREs tends to be that these criteria are still much too stringent and restrictive. Specifically, many RREs and industry stakeholders have long argued for a further refining and loosening of the requirements viewed as most restrictive, mainly the 5 years without treatment and no more than $25,000 paid in medicals components. As such, the current DMPO request for industry feedback may be a prime opportunity for the industry to further advocate for these long-requested revisions, along with other potential points and ideas regarding ORM termination, for CMS’s consideration. On a final note, it will be interesting to see what CMS may do next once it receives the requested industry feedback and if it will ultimately make changes to its ORM termination directives based on the feedback it receives.

Questions?

The Verisk policy team is reviewing this request for feedback and will be submitting commentary in response thereto by the noted June 9th date. In the interim, please do not hesitate to contact the authors if you have any questions.

[1] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.

[2] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.

[3] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.

[4] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.

[5] CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.

[6] In this situation, states: “Where an RRE is relying upon a physician’s statement to terminate ORM, the ORM termination date to be submitted should be determined as follows: • Where the physician’s statement specifies a date as to when no further treatment was required, that date should be the reported ORM termination date; or • Where the physician’s statement does not specify a date when no further treatment was required, the date of the statement should be the reported ORM termination date; or • Where the physician’s statement does not specify a date when no further treatment was required, nor is the statement dated, the last date of the related treatment should be used as the ORM termination date.” CMS’s Section 111 NGHP User Guide (Version 8.4, April 13, 2026), Chapter III, Section 6.3.2.