Navigating the Buy-in October 1, 2009
Situation #1 Nancy is turning 65 next month. She will receive $867. 00 in RSDI starting next month. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #1 Nancy is turning 65 next month. She will receive $867. 00 in RSDI starting next month. Should this recipient Buy-in for Part A? No, it is free. Should this recipient Buy-in for Part B? Yes, 11/01/09.
Situation #2 Carl is 58 years old and receives SSI of $674. 00 for disability and MSA of $81. 00. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #2 Carl is 58 years old and receives SSI of $674. 00 for disability and MSA of $81. 00. Should this recipient Buy-in for Part A? No, he does not have Medicare eligibility. Should this recipient Buy-in for Part B? No, he does not have Medicare eligibility.
Situation #3 Lenny is 32 and receives RSDI of $400. 00 and SSI of $294. 00. His Medicare began 9/1/09. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #3 Lenny is 32 and receives RSDI of $400. 00 and SSI of $294. 00. His Medicare began 9/1/09. Should this recipient Buy-in for Part A? No, it is free. Should this recipient Buy-in for Part B? Yes, 9/01/09. Lenny is categorically eligible for the buy-in due to SSI and MA even if the worker does not open QMB.
What is the Buy-in? The Buy-in is a 2 -part data exchange between DHS and CMS that pays Medicare premiums for eligible individuals. n Part 1: DHS sends data via MMIS to CMS, to communicate which MHCP recipients appear eligible, or have lost eligibility, to have their Medicare A or B premiums paid by the State of Minnesota. n Part 2: CMS responds. They will either accept, reject, or modify the DHS request.
MAXIS and the Buy-in MAXIS has to have the correct information before the buy-in process can work correctly in MMIS. n STAT UNEA must have the income start date n STAT MEDI must be entered including the Medicare claim number n Be approved on a Medicare Savings Program (MSP) in Health Care Eligibility
Buy-in Eligibility To be eligible for the Buy-in a person must qualify for Medicare and: n Be enrolled in an MSP n Be enrolled in MA, entitled to premium-free Medicare Part A, and be enrolled in one of the following programs: n n n Minnesota Supplemental Aid (MSA) Minnesota Family Investment Program (MFIP) 1619(a) or 1619(b) SSI status IV-E Adoption Assistance IV-E Foster Care Group Residential Housing (GRH)
Buy-in Referral Refer people not enrolled in Medicare who are eligible for the buy-in to SSA. n Check TPQY in MAXIS to ensure there are no discrepancies in the person’s name or DOB n Complete and send DHS-3439 Medicare Buy-in Referral Letter n Allow 60 days to apply for Medicare and return confirmation portion of the referral letter n Update STAT PBEN in MAXIS and track return of letter on DAIL/TIKL n Process MSP eligibility upon receipt of the letter
Previous Medicare Entitlement Do not refer people who have Part A only or Part B only or who have had Medicare previously. They are already known to SSA and do not need to reapply for Medicare to have entitlement reestablished.
Not Entitled to Premium-Free Part A n People who qualify for Medicare, but are not entitled to premium-free Medicare Part A, including people who receive SSI only who are age 65 or older, must be enrolled in QMB to participate in the buy-in. QMB will pay the Medicare Part A premium, the Medicare Part B premium, and other Parts A and B cost sharing. n Do not approve retroactive SLMB eligibility for any enrollee who must pay a premium to get Medicare Part A, even if the referral form shows a Medicare begin date in a past or current month. Approve prospective QMB eligibility only for these enrollees.
Accrete/Delete The communication from DHS (via MMIS) to CMS is called Accrete/Delete. n n This process runs 8 working days from the end of the month Everyone who has active MHCP is evaluated to see if they have become eligible, remain eligible, or have lost eligibility for the buy-in
Accrete/Delete – October 2009 Sun Mon Tues Wed Thur Fri Sat 2 9 16 3 10 17 23 6 30 1 24 4 11 5 12 6 13 7 14 1 8 15 18 19 20 25 26 5 27 4 21 8 28 3 22 7 29 2 31 The MAXIS/MEC 2/MMIS Production calendar is available on SIR.
Buy-in Apply The CMS response to Accrete/Delete is called Buy-in Apply n Buy-in Apply runs on the 6 th working day of the month (roughly 3 weeks after Accrete/Delete). § Buy-in Apply may also contain CMS-initiated data that can impact buy-in such as: § § § SSI participation Medicare begin or end dates Medicare ID number changes
Buy-in Apply for November 2009 Sun Mon Tue Wed Thu Fri Sat 1 2 1 3 2 4 3 5 4 6 5 7 8 9 6 10 11 12 13 14 15 16 17 18 19 20 21 22 29 23 30 24 25 26 27 28 The MAXIS/MEC 2/MMIS Production calendar is available on SIR.
Buy-in for Part A n Must have Medicare ID# and Part A participation dates on RMCR, which can be interfaced from STAT/MEDI. n Requires program eligibility of QMB or QWD. n Must not have an entitlement/non-entitlement code of “E” on RBUY. n The Part A calculated accrete request date will be the later of RELG or RMCR dates.
Part A Information on RMCR and RBUY NEXT: RSVL 10/20/08 10: 49: 16 MMIS RECIP MEDICARE-RMCR TILMM 02 10/16/08 PWMW 134 01234567 12/18/1933 * BUYIN BETTY X * MEDICARE ID: 333224444 M ***************** RSN: * - - - M E D I C A R E P A R T A - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) 07/01/08 99/99/99 M * NEXT: RBYB 10/20/08 11: 16: 44 MMIS RECIP BUYIN-RBUY TILMM 02 10/16/08 PWMW 133 01234567 12/18/1933 * BUYIN BETTY X * MEDICARE ID: 333224444 M ***************** ENTITLE/NON-ENTITLE: Y PART (A) ACCRETE REQUEST DATE: ACCRETE DATE: PART (A) DELETE REQUEST DATE: DELETE DATE: -------------BUYIN MONTHLY TRANSACTIONS-------------TXN SUB ACCRETE DELETE ----- PREMIUM -----DATE CODE DATE AMOUNT DATE
Buy-in for Part B n Must have Medicare ID# and Part B participation dates on RMCR, which can be interfaced from STAT/MEDI n Program eligibility under QMB or SLMB (including QI-1) or n Categorical eligibility of MA with eligibility types 09, 15, 16, 25 or n Other MA with “M” indicator (MFIP) or n Other MA with MSA/GRH or SSI start dates on RMSC n
Part B Information on RMCR and RMSC NEXT: RSVL 10/20/08 10: 49: 16 MMIS RECIP MEDICARE-RMCR TILMM 02 10/16/08 PWMW 134 01234567 12/18/1933 * BUYIN BETTY X * MEDICARE ID: 333224444 M ***************** RSN: * - - - M E D I C A R E BEGIN DATE END DATE SRC PPHP (Y/N) 07/01/08 99/99/99 M P A R T B - - - BEGIN DATE END DATE SRC PPHP (Y/N) * ENTER---PF 1 ---PF 2 ---PF 3 ---PF 4 ---PF 5 ---PF 6 ---PF 7 ---PF 8 ---PF 9 ---PF 10 ---PF 11 --PF 12 PAGE S/EXT N/EXT OOPS HELP NEXT: RHCI 10/20/08 11: 34: 48 MMIS RECIPIENT INFO-RMSC TILMM 02 10/16/08 PWMW 12 M 01234567 12/18/1933 * BUYIN BETTY X * ***************** - - M I S C E L L A N E O U S - - - SSI BEGIN DATE: 08/01/2005 SSI END DATE: 99/99/9999 RSDI INCOME (Y/N): RAILROAD INCOME(Y/N): RSDI BEGIN DATE: RSDI END DATE: MSA/GRH GRANT BEG DATE: 12/01/2007 MSA/GRH GRANT END DATE: 99/99/9999 MFIP BEGIN DATE: MFIP END DATE: PREGNANCY BEGIN DATE: PREGNANCY END DATE:
Determining the Part B Accrete Request Date The Medicare begin date is compared to RELG begin date and the later of the 2 dates is remembered as DATE 1. For categorical buy-in, further date checking is required. The MSA/GRH date is compared to SSI date on RMSC and the earlier date is remembered as DATE 2. The Part B calculated accrete request date will be the later of DATES 1 and 2.
Calculating DATE 1 In this example DATE 1 would be 06/01/08 NEXT: RIDS 06/16/08 09: 26: 24 MMIS ELIGIBILITY-RELG TILSN 83 04/24/05 PWMW 127 0000 00/00/0000 * SMITH SAM S * ***************** - - - - E L I G I B I L I T Y - - - - 01 PRG: MA ELIG TY: EX CASE: 0000 ELIG BEGIN: 01/01/08 ELIG END: 99/99/99 CFR: 018 STATUS: A REASON: 99 STATUS DATE: 01/03/08 DATE ADDED: 01/03/08 INDICATOR: N APPL DT: 01/01/08 NEXT: RSVL 06/16/08 09: 26: 52 MMIS RECIP MEDICARE-RMCR TILSN 83 4/24/05 PWMW 134 0000 00/00/0000 * SMITH SAM S * MEDICARE ID: 123456789 A ***************** RSN: * - - - M E D I C A R E P A R T B - - - MEDICARE PART B BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) 06/01/08 99/99/99 F
Calculating DATE 2 In this example DATE 2 would be 01/01/08 NEXT: RHCI 06/16/08 09: 43: 50 MMIS RECIPIENT INFO-RMSC TILSN 83 04/24/05 PWMW 12 M 0000 00/00/0000 * SMITH SAM S* ***************** - - M I S C E L L A N E O U S - - - SSI BEGIN DATE: 03/01/08 SSI END DATE: 99/99/99 RSDI INCOME (Y/N): RAILROAD INCOME(Y/N): RSDI BEGIN DATE: RSDI END DATE: MSA/GRH GRANT BEG DATE: 01/01/08 MSA/GRH GRANT END DATE: MFIP BEGIN DATE: MFIP END DATE: PREGNANCY BEGIN DATE: PREGNANCY END DATE:
Determining the Part B Accrete Request Date DATE 1 and DATE 2 are now compared to determine the accrete request date In this example: DATE 1 is 06/01/08 (Medicare begin date) n DATE 2 is 01/01/08 (SSI begin date) n DATE 1 is the later of those 2 dates, so the Part B accrete request date is calculated to be 06/01/08.
Determining the Accrete Request Date – Part A or B The next step in determining the accretion date is checking whether buy-in previously existed. If so, the new accrete request date must be after the prior period. NEXT: RBYD 06/16/08 09: 02: 16 MMIS RECIP BUYIN-RBYB TILSN 83 04/24/05 PWMW 133 0000 00/00/0000 * SMITH SAM S * MEDICARE ID: 123456789 A ***************** ENTITLE/NON-ENTITLE: * PART (B) ACCRETE REQUEST DATE: ACCRETE DATE: 06/01/05 PART (B) DELETE REQUEST DATE: DELETE DATE: 06/30/08 -------------BUYIN MONTHLY TRANSACTIONS------------TXN MCARE ACCRETE DELETE ----- PREMIUM --DATE CODE PART DATE AMOUNT DATE The calculated accrete request date was 06/01/08. In this situation the actual accrete request date sent to CMS would be 07/01/08.
Determining the Accrete Request Date – Part A or B n The accrete request date is systematically limited to 6 months retroactive to the current month. n For example, if there is a delayed eligibility determination and the begin date is more than 6 months in the past, the buy-in start date would be limited to 6 months ago. n Manual requests allow for buy-in to cover the period earlier than 6 months ago. MMIS User Services can key these requests.
Situation #4 Trisha is 39 years old and receives RSDI of $1000. 00 per month for disability starting 11/1/06. She has Medicare Part A that began 11/1/08 and she refused Medicare Part B when it was offered in 11/1/08. She came in today to apply for Health Care programs and is eligible for MA with a Spenddown effective 9/1/09. She has opted not to apply her Medicare premium to her Spenddown. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #4 Trisha is 39 years old and receives RSDI of $1000. 00 per month for disability starting 11/1/06. She has Medicare Part A that began 11/1/08 and she refused Medicare Part B when it was offered in 11/1/08. She came in today to apply for Health Care programs and is eligible for MA with a Spenddown effective 9/1/09. She has opted not to apply her Medicare premium to her Spenddown. Should this recipient Buy-in for Part A? No, it is free. Should this recipient Buy-in for Part B? Technically Yes she should buy-in for Part B 9/1/09, however there are no Part B begin dates on RMCR so she will not be picked up on the buy-in until there are dates. This panel interfaces from the STAT MEDI panel.
Situation #5 Joe is 32 and receives RSDI in the amount of $420. 00 that began 9/1/07 and SSI in the amount of $274. 00 that began 8/1/07 for disability. He is Medicare eligible beginning 9/1/09. He applied for Health Care programs on 10/1/09. He is eligible for MA 10/1/09 as he did not request retroactive coverage. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #5 Joe is 32 and receives RSDI in the amount of $420. 00 that began 9/1/07 and SSI in the amount of $274. 00 that began 8/1/07 for disability. He is Medicare eligible beginning 9/1/09. He applied for Health Care programs on 10/1/09. He is eligible for MA 10/1/09 as he did not request retroactive coverage. Should this recipient Buy-in for Part A? No, it is free. Should this recipient Buy-in for Part B? Yes 10/01/09 if picked up by the Categorical Buy-in due to the receipt of SSI with MA. 09/01/09 if opened on a MSP in MAXIS and coded on RELG in MMIS.
Determining Part A Delete Date n Medicare end date is populated on RMCR or n Program eligibility has ended on RELG or n Entitle/Non-entitle code of “E” for Part A received The delete date will be the eligibility or Medicare end date or the end of the previous month in the case of the “E” coding.
Determining Part B Delete Date n Medicare end date is populated on RMCR or n Program eligibility has ended on RELG or n Categorical eligibility has ended on RELG or RMSC (elig type, “M” Indicator, SSI, MSA/GRH) The delete date will be the eligibility/Medicare end date, or the end of last month.
Accrete/Delete Request Dates RBUY and RBYB each have accrete and delete request date fields to indicate whether Accrete/Delete has determined a change in buy-in status or whether a manual request has been keyed: NEXT: RBYB 06/19/08 08: 31: 37 MMIS RECIP BUYIN-RBUY WMW 1740 06/15/06 PWMW 133 0000 03/08/1937 * SMITH SAM R * MEDICARE ID: 123456789 A ***************** ENTITLE/NON-ENTITLE: Y PART (A) ACCRETE REQUEST DATE: 06/01/08 ACCRETE DATE: PART (A) DELETE REQUEST DATE: DELETE DATE:
RBUY after Buy-in Apply NEXT: RBYD 06/16/08 09: 02: 16 MMIS RECIP BUYIN-RBUY TILSN 83 0000 00/00/0000 * PIPER PETER R * MEDICARE ID: 123456789 A ***************** ENTITLE/NON-ENTITLE: * PART (A) ACCRETE REQUEST DATE: ACCRETE DATE : 09/01/08 PART (A) DELETE REQUEST DATE: DELETE DATE: 99/99/99 -------------BUYIN MONTHLY TRANSACTIONS-------------TXN SUB ACCRETE DELETE ----- PREMIUM -----DATE CODE DATE AMOUNT DATE 10/01/08 1161 09/01/08 846. 00 09/01/08
Basics of Buy-In TXN Codes The MMIS User Manual has a complete list of Buy-In related transactions and Worker Messages, along with guidelines for worker action
Basics of Buy-In TXN Codes Accrete/Delete transaction codes The txn codes we send to CMS do not appear on RBUY/RBYB but are useful to know in relation to the response codes n 51 = delete request n 53 = delete request due to death n 61 = accrete request n 75 = simultaneous accrete/delete request n 99 = informational
Basics of Buy-In TXN Codes When an accrete/delete transaction is accepted by CMS we will get these response codes n 1161 = CMS accepted an accrete request n 1751 = CMS accepted a delete request n 1753 = CMS accepted a delete request due to DOD When an accrete/delete transaction is rejected by CMS we will get these response codes: n 2051, 2053 = CMS rejects deletion request n 2161, 2175 = CMS rejects an accretion request
Basics of Buy-In TXN Codes CMS-initiated transactions: n 41 = ongoing buy-in n 14, 15 = CMS reports Medicare entitlement ended n 16 = CMS reports a DOD n 1728 = CMS reports potential residence outside of Minnesota n 44 = Subsidy for Medicare Part B premium was received by CMS n 45 = Subsidy for Medicare Part B premium has ended
Navigating the Buy-In Higher Priority Worker Messages
Buy-In Worker Messages BUY-IN ACCRETION REJECTED FOR PART (A or B). REASON CODE (A, B, C, D, or E). REVIEW n Txn Code: 2161 n Definition: Accrete request was rejected due to MMIS/CMS discrepancies n MMIS: creates buy-in occur span with attempted accrete date and removes Accrete Request Date n Action: depends on reason code n Why Important: If enrollee is only Medicare eligible based on premium payment, enrollment in Medicare A and B is delayed until rejection is resolved.
Buy-In Worker Messages n A: No match to Medicare ID# on the Electronic Data Base (EDB). Check BENDEX or send new TPQY. n B: Name, DOB, or sex code discrepancy between MMIS and EDB. Verify accuracy and update MAXIS/MMIS accordingly. n C for Pt A: Part A is free, or person does not have Part A. Verify Part A dates, and update MAXIS/MMIS accordingly. n C for Pt B: Accrete request is based on QM or SL and EDB shows no Part A coverage. Confirm Pt A eligibility (BENDEX, TPQY). If recipient is not eligible, close QM or SL.
Buy-In Worker Messages n D for Pt A: no record of Pt B buy-in, which is required before Pt A accretion. n D for Pt B: accrete attempt is based on QWD, and QWD does not pay for Part B. n E: no Medicare entitlement. If recipient appears entitled to Medicare, refer to SSA. For all these worker messages: If data in MMIS has been verified as correct, contact MMIS User Services. TIP: check the Entitlement/Non-Entitlement code on RBUY and RBYB when this worker message is received.
Entitlement/Non-Entitlement Example NEXT: RBYB 06/20/08 11: 25: 30 MMIS RECIP BUYIN-RBYB FMLMMBP 0000 00/00/00000 * BIRD BIG A * MEDICARE ID: 00000 A ***************** ENTITLE/NON-ENTITLE: C PART (B) ACCRETE REQUEST DATE: ACCRETE DATE: PART (B) DELETE REQUEST DATE: DELETE DATE: -------------BUYIN MONTHLY TRANSACTIONS-------------TXN SUB ACCRETE DELETE ----- PREMIUM -----DATE CODE DATE AMOUNT DATE 1 10/01/08 2161 E 06/01/08 Pt B Entitlement/Non-Entitlement codes available via PF 12: n n n n n C D F G N R S T W Y NOT ENTITLED NO DISABILITY COVERAGE DENIED TERMINATED INVALID VOIDED ENTITLED GOOD CAUSE NOT ENTITLED FOREIGN OR DUAL REFUSED BENEFITS TERMINATED NO ENTITLE ESRD TERMINATED NON PAY PREMIUM VOLUNTARYWITHDRAWAL ENTITLED PREMIUM PAYABLE
Buy-In Worker Messages BUY-IN TERMINATED DUE TO DEATH. VERIFY DATE OF DEATH n Txn: 16 A/B n Definition: CMS deleted recipient from buy-in due to death n MMIS: adds delete date on RBUY/RBYB and ends RMCR span n Action: verify recipient’s status. If death is incorrect refer client to SSA to correct and reopen Medicare. If deceased, add DOD and close case.
Buy-In Worker Messages NEW MEDICARE CLAIM NBR REPORTED ON BUYIN FILE n Txn: 23 xx n Definition: Medicare number changed. n MMIS: new claim number added to MMIS, prior number moves to RIDS n Action: update claim number in MAXIS
Buy-In Worker Messages SSA REPORTS NON MN ADDRESS. VRFY/UPDATE CLIENT ADDRESS n Txn: 1728 n Definition: CMS deleted from buy-in because another state has requested accretion or SSI records indicate residence in another state. n MMIS: delete date added to RBUY/RBYB n Action: verify client address. If still a Minnesota resident, refer to SSA. If not, close case.
Buy-In Worker Messages CMS REPORTS SSI BEGIN. MMIS UPDATED. n Txn: 86 n Total txn: 590 (March) n Definition: Medicare beneficiary became SSI eligible (with potential buy-in eligibility). Txn may also include Part A entitlement date n MMIS: SSI start date added to RMSC, and Medicare start date if included. May trigger a categorical accretion if other factors met. n Action: verify SSI amount for effect on other programs
Buy-In Worker Messages CMS REPORTS SSI ENDED. RMSC UPDATED n Txn: 87 n Total txn: 443 (March) n Definition: SSI eligibility ended (can also end buy-in unless meets another basis for buy-in) n MMIS: deletes SSI Start Date if currently populated n ACTION: Verify status of SSI payments for other programs’ use. This may also indicate a temporary ending of SSI payments.
Buy-In Worker Messages SSA REPORTS RECIPIENT NO LONGER ELIGIBLE FOR MEDICARE n Txn: 15 n Definition: deleted from buy-in because Medicare ended n MMIS: delete date added to RBUY/RBYB and Medicare end date added on RMCR n Action: review client record, particularly entitlement coding. If Medicare eligibility appears to exist, refer client to SSA. Re-open Medicare if eligibility is reestablished.
How to Properly End a MEDI Span n When a 15 txn is received from CMS, STAT/MEDI needs to be updated. However, it’s not as simple as just adding an end date if Medicare dates were previously verified in MAXIS…
If MAXIS looks like this: n n n n n n 06/19/06 11: 17: 28 CAF Question 44 MAXIS Medicare (MEDI) FMCGNAM 1 1 Of 1 Ref Last First M * Ref Nbr: 01 SMITH, SAM 01 SMITH SAM* * Medicare Claim Nbr: 999 99 9999 A__ Ver: V * Part A Premium: $ ____ Part B Premium: $ 88. 50 * Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __ * Qualified Working Disabled Individual (Y/N): N * Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __ * Part A Part B * Begin Dt End Date Ver * 04 01 00 __ __ __ V * __ __ __ __ __ __ * __ __ __ * Shift PF 7/PF 8 To Scroll Part A/B Dates Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __ Sv: 00 PW: X 100000 SW: Updated: 11 26 05 User: PWGAP 53
And MMIS looks like this: n n n n NEXT: RSVL 06/19/06 11: 20: 36 MMIS RECIP MEDICARE-RMCR WMW 1740 06/15/06 PWMW 134 0000 00/00/0000 * SMITH SAM M* MEDICARE ID: 99999 A ***************** RSN: 1 ------MEDICARE PART A------MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F * ------MEDICARE PART B------BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F *
And if you do this in MAXIS… n n n n n n 06/19/06 11: 17: 28 CAF Question 44 MAXIS Medicare (MEDI) FMCGNAM 1 1 Of 1 Ref Last First M * Ref Nbr: 01 SMITH, SAM 01 SMITH SAM* * Medicare Claim Nbr: 999 99 9999 A__ Ver: V * Part A Premium: $ ____ Part B Premium: $ 88. 50 * Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __ * Qualified Working Disabled Individual (Y/N): N * Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __ * Part A Part B * Begin Dt End Date Ver * 04 01 00 __ __ __ V * 04 01 00 05 31 06 * __ __ __ __ __ __ * Shift PF 7/PF 8 To Scroll Part A/B Dates Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __ Sv: 00 PW: X 100000 SW: Updated: 11 26 05 User: PWGAP 53
…MMIS will look like this: n n n n PWMW 134 0000 00/00/0000 * SMITH SAM M* MEDICARE ID: 99999 A ***************** RSN: 1 ------MEDICARE PART A------MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F * 04/01/00 05/31/06 M ------MEDICARE PART B------BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F * 04/01/00 05/31/06 M
To end a verified Medicare span: Complete a PF 11 on STAT/MEDI. Include the verified end date Fax the proof of the end date to (651) 431 -7419, including the PF 11 reference number on the fax. See TE 02. 07. 453 or QTIP 114 for complete instructions
Navigating the Buy-In SSI recipient turning 65 scenario
SSI Recipient Turns 65 Federally-funded MA enrollees who receive SSI only and who become age 65 or are older, must enroll in Medicare Part A and Part B if they are eligible. Failure to enroll is considered non-cooperation with third party liability and results in ineligibility for MA.
SSI Recipient Turns 65 n These enrollees are required to pay a premium for BOTH Part A and Part B n DHS pays these costs directly to CMS through the buy-in when QMB is approved and entered in MMIS. n Enrollees must apply and be determined eligible for Medicare before these payments can begin through the buy-in.
SSI Recipient Turns 65 MMIS User Services generates monthly reports to identify these MA enrollees three months before their 65 th birthday and sends MAXIS emails to associated workers. This contact is designed to help workers initiate the Medicare enrollment process one month earlier than prompted by the current MMIS worker message “Client turns 65. Enter Medicare claim number” that is issued two months in advance for all recipients turning age 65.
SSI Recipient Turns 65 When notified by MMIS User Services: n Check TPQY in MAXIS for discrepancies in: Enrollee Name - first, last, middle initial n Date of Birth n n Send new QURY if TPQY is older than 6 months n CMS data is shown on the BDXP screen
TPQY Screens 06/20/06 07: 35: 14 FMLTPAM 1 MAXIS Third Party Query Response (TPQY) MAXIS Data Name: JAMES J CASEY SSN: 569 85 2147 Clm No: Birthdate: 09 10 1930 SVES Response Date: 03 31 06 Unmatched Data Report Date: SSN Ver: V RSDI Record: Y SSI Record: Y ID Discrepancy: Code: V Text: Qualifying Quarters Through 12/96: Qualifying Quarters From 01/97: _ Total Questionable Quarters: Function: SVES Case Nbr: ____ Month: 06 06 Command:
TPQY Screens Beneficiary Data Response (BDXP) Name: JIM J CASEY SSN: 569 85 2147 Clm No: 569852147 M Dual Entl Nbr: Payment Status: N DISALLOWED CLAIM Pay Date Gross Amt Net Amt Birthdate: 09 10 1930 $ $ Railroad Ind: $ Lump Payment Date: $ Lump Sum Amt: $ $ Intl Entl Date: 12 90 $ Current Entl Date: 11 03 $ Deferred Payment Date: $ Susp/Term Date: $ Response Date: 03 31 06
TPQY Screens State Data Response (SDXE) Name: JAMES J CASEY SSN: Clm No: 569852147 SSI Appl Date: 11 17 03 Recipient Type: DI DISABLED INDIVIDUAL Payment Status: C 01 CURRENT PAY Denial Code: Denial Date: Onset Date Disa/Blind: 11 01 03 SSI/Opt SSP Elig Date: 11 01 03 Response Date: 03 31 06 Birthdate: 09 10 1930 Fed Liv Arrange: A Appeals Decision Disa Pay Code: Date: Code: F
SSI Recipient Turns 65 n If a discrepancy exists: n Advise the enrollee of the specifics of the discrepancy when sending them the referral to SSA to ensure the error is resolved when he/she goes to the SSA office to apply for Medicare n Advise the enrollee to take original documentation such as a birth certificate or immigration/naturalization papers with them to resolve the error
SSI Recipient Turns 65 Complete the County Agency section of the Medicare Buy-in Referral Letter (DHS 3439) and provide it to the enrollee with a countyaddressed return envelope. The enrollee must take this form and the county-addressed envelope to the SSA when applying for Medicare. Find DHS 3439 online at: http: //edocs. dhs. state. mn. us/lfserver/Legacy/DHS-3439 -ENG
DHS 3439
SSI Recipient Turns 65 When referring to SSA, update STAT/PBEN: § Benefit type “ 19” (Other) § referral date § verification code of “ 5” (Other document) § DISP (disposition) code of “P” (Pending). Ref Last First M * Ref Nbr: 01 CASEY, JAMES J 01 CASEY JAMES J * * Referral Appl * Benefit Type Date * 19 Other 07 10 08 __ __ __ * __ __ IAA Ver Date 5 __ __ Disp P _
SSI Recipient Turns 65 n Track for return of the letter in 30 days using DAIL/TIKL. n Contact the enrollee if the letter has not been returned at the end of 30 days. n Determine whether he/she complied with the request to apply for Medicare. n Provide a second referral letter if necessary. Track for an additional 30 days.
SSI Recipient Turns 65 Upon receipt of the completed referral letter, enter the STAT/MEDI panel: n Use the Medicare Claim Number from the referral form (usually SSN + “M”) n n n Enter Part A or Part B Premium amounts Enter Buy-in Begin Date as QMB eligibility begin date Enter ‘N’ for Qualified Working Disabled Individual (Y/N): Enter ‘N’ for Apply Premiums To Spdn/Budgets (Y/N): Enter Medicare Part A and B begin dates from the referral form
MEDI Screen CAF Question 44 Ref Last First M * 01 CASEY JAMES J * * * * Medicare (MEDI) Ref Nbr: 01 1 Of 1 CASEY, JAMES Medicare Claim Nbr: 569 85 2147 M__ Ver: Part A Premium: $ 423. 00 Part B Premium: $ Buy In Begin Date: 07 01 08 Buy In End Date: __ __ Qualified Working Disabled Individual (Y/N): N Apply Premiums To Spdn/Budgets (Y/N): N Apply Prem To Spdn/Bdgt Thru Date Or Medi Reimb Dt: Part A Part B Begin Dt End Date Ver Begin Dt End Date 07 01 08 __ __ __ __ __ __ __ __ __ __ __ Shift PF 7/PF 8 To Scroll Part A/B Dates 96. 40 __ __ __ Ver Mode: D Function: STAT Case Nbr: __408199 Month: 06 08 Command: ____ __ __ Sv: 90 PW: PWSKC 35 SW: Updated: 06 16 08 User: PWSKC 35 Enter-PF 1 ---PF 2 ---PF 3 ---PF 4 ---PF 5 ---PF 6 ---PF 7 ---PF 8 ---PF 9 ---PF 10 --PF 11 --PF 12 --HELP PMI EXIT CNOTE PREV NEXT EDIT OOPS TRBL INFO
SSI Recipient Turns 65 n Update STAT/HCRE if needed to process QMB eligibility in HC ELIG Update Appl/Addendum Request Date with the date referral form is received n Update Coverage Request Date with the month QM is to begin n n Approve QMB eligibility and enter in MMIS. n Do not provide retroactive SLMB coverage, even if the referral form shows a Medicare begin date in the past or current month.
HCRE Screen Ref Last First M * 01 CASEY JAMES J * * * * Health Care Application Date: 09/10/05 Ref Nbr Name 01 CASEY, JAMES Appl Addendum Request Date 06 10 08 Coverage Request Date Recv By (MM/YY) Sv Date 07 08 __ __ __ Shift PF 7/PF 8 To Scroll HC Appl/Add Requests Mode: D Function: STAT Case Nbr: __408199 Month: 06 08 Command: ____ __ __ Sv: 90 PW: PWSKC 35 SW: Updated: 06 16 08 User: PWSKC 35 Enter-PF 1 ---PF 2 ---PF 3 ---PF 4 ---PF 5 ---PF 6 ---PF 7 ---PF 8 ---PF 9 ---PF 10 --PF 11 --PF 12 --HELP PMI EXIT CNOTE PREV NEXT EDIT OOPS TRBL INFO
SSI Recipient Turns 65 Put in a DAIL/TIKL if the month Medicare begins is not yet available for processing on MAXIS. Example: n Referral letter is received in March stating Medicare will begin 5 -1 -09. n May is not yet available for processing on MAXIS. Put in a DAIL/TIKL for April 1 st to determine QMB eligibility as May would then be available on MAXIS.
SSI Recipient Turns 65 n Confirm on RMCR that Medicare participation data has correctly interfaced from MAXIS to MMIS: Claim number n Part A participation dates n Part B participation dates n n If it has not, contact MMIS User Services to complete the interface.
SSI Recipient Turns 65 n Enter QMB eligibility on RELG. This may be completed no sooner than two months before the effective date of the QMB eligibility. n Review the RBUY and RBYB panels for accretion request dates. These will display on each panel after QMB has been approved AND a buy-in accrete/delete processing has occurred. n Check MAXIS/MEC 2/MMIS production region calendar located in SIR for the dates.
SSI Recipient Turns 65 Examples: n QMB was approved Mar 13 effective for Apr 1. As this date is PRIOR TO March’s accrete/delete processing date of 3/20, RBUY/RBYB accrete request dates will display on March 23. n QMB was approved Mar 24 effective for Apr 1. As this date is AFTER March’s accrete/delete processing date of 3/20, RBUY/RBYB accrete request dates will display on April 22, after April’s accrete/delete processing date of Apr 21.
SSI Recipient Turns 65 REMEMBER: Enrollees who fail to cooperate with applying for Medicare ineligible for MA. Cancel MA coverage with 10 -day notice for enrollees who fail to cooperate. Update PBEN disposition field to “N – Not Applied Yet” Additional Reference points: n HCPM § 03. 35 Medicare Savings Programs n HCPM § 04. 40 Medicare (and many subsections) n TEMP §TE 02. 07. 0326 Enrollment in Medicare Part A and Part B n TEMP §TE 02. 07. 0327 Medicare Part A/B and the Buy-in (Part 1) n TEMP §TE 02. 07. 0328 Medicare Part A/B and the Buy-in (Part 2) n TEMP §TE 02. 13. 40 RSDI/SSI Income Start Dates n Instructional Bulletin 06 -21 -04 Medicare Part D Bulletin
Situation #6 Ansarra is a 70 year old LPR who entered the US 7 years ago. She was open on MA and QMB until 8/31/09 when she auto-closed for no Eligibility Review. Her only income is SSI of $674. 00 per month. She came into the office today to reapply for all Health Care programs. She is MA eligible 9/1/09. Should this recipient Buy-in for Part A? No Yes If yes what date? _____ Should this recipient Buy-in for Part B? No Yes If yes what date? _____
Answer: Situation #6 Ansarra is a 70 year old LPR who entered the US 7 years ago. She was open on MA and QMB until 8/31/09 when she auto-closed for no Eligibility Review. Her only income is SSI of $674. 00 per month. She came into the office today to reapply for Health Care programs. She is MA eligible 9/1/09. Should this recipient Buy-in for Part A? Yes, 4/01/09. Should this recipient Buy-in for Part B? Yes, 11/01/09. For this kind of case there must be an active Part A to be eligible for Part B.
Never The End Contact MMIS User Services with questions on specific cases.
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