TN 30 (03-02)

DI 39506.240 State Agency Reporting on the Cost of Processing Federal Employee Medicare Only Cases

A. Background

Since January 1, 1983, pursuant to Public Law 97-248, Federal employees who are disabled may establish entitlement to Medicare. The definition of disability for these claims is identical to that used for title II claimants and the law requires the same continuing disability review and appeal steps.

B. Procedure - reporting

1. Workload

Effective January 1, 1983, the disability determination services (DDS) have been instructed to report Federal employee Medicare only (Fed/Med) processed workloads in two different categories--“transitional Federal employee Medicare only claims” and “regular Federal employee Medicare only claims”--on the Disability Operational Data Store (DIODS). The reporting instructions are outlined in the Management Information Manual for the DDS work measurement system (MIM-IV).

2. Workpower

Include the workpower used to process these Fed/Med claims in the totals shown on Form SSA-4514 (Time Report of Personnel Services for Disability Determination Services). No prorated adjustment is needed between the time spent on Fed/Med and other disability claims.

3. Costs

Report costs incurred in the processing of Fed/Med claims in the totals reported on Form SSA-4513 (State Agency Report of Obligations for SSA Disability Programs). Include personnel services and all other costs for Fed/Med claims in the cost categories as used for other disability claims. Medical costs for Fed/Med claims should, however, be included with title II medical costs. Consequently, there is no need to report separately the costs of processing Fed/Med cases. These costs should also be included in the amounts reported on the monthly obligations report and likewise do not need to be reported separately.

SSA central office will use the reported information to obtain reimbursement from the Medicare trust fund for the cost of DDSs processing Fed/Med claims. An average cost per workyear (WY) will be calculated for each State. This average cost will be multiplied by the number of Fed/Med WY's used in that State as derived from the SAOR to determine the cost of processing the Fed/Med claims for reimbursement purposes. Therefore, it is essential that the workload and obligations reports be accurate.


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http://policy.ssa.gov/poms.nsf/lnx/0439506240
DI 39506.240 - State Agency Reporting on the Cost of Processing Federal Employee Medicare Only Cases - 03/11/2013
Batch run: 03/11/2013
Rev:03/11/2013