DI 45010.040 Preparation for R-HI/R-SMI Systems Terminations

Terminations of ESRD Medicare eligibility will be processed via the Post-Entitlement Premium Payment and Enrollment (PEPPER), the Miscellaneous Correction Program (MISCOR), or the Manual Adjustment, Credit and Award Processes Programs (MADCAP).

Generally the PEPPER program will be utilized to:

1. A. 

   annotate a future HI/SMI termination date,

2. B. 

   initiate immediate termination processing if the ESRD cessation is equal to or earlier than the current operating month (COM).

The MISCOR facility will be used in situations in which HI/SMI eligibility will continue, subsequent to ESRD Medicare termination, under the disability or aged provisions of the law.

In those instances where PEPPER or MISCOR in unable to process the ESRD Medicare termination, the MADCAP program will be utilized to terminate HI/ SMI entitlement.

In addition to preparation of determination Form SSA-892-U3 (see DI 45010.030) and notice assignment Form SSA-865 (or SSA-573 if more appropriate), prepare (in duplicate), HIB/SMIB Data Enrollment Card Coding Sheet, Form SSA-1598 (see DI 45001.109) (except in equitable relief or closed periods). This form is the PEPPER input vehicle for coding ESRD Medicare terminations. It should be prepared even though processing may ultimately be necessary through MISCOR or MADCAP. Complete only the following items of the SSA-1598:

1. 1. 

   CAN—Account number

2. 2. 

   BIC—All BIC's are valid

3. 3. 

   TOA—Type of Action Code will be “F” in all situations

4. 4. 

   Decision Code will be “S” for a termination

5. 5. 

   DOF—Date of filing. This date represents the ESRD Medicare termination date and will be shown as six characters (MM/01/YY). When the ESRD Medicare termination date is in the future, the input DOF will be annotated to the Future Withdrawal or Termination Date (FWTD) field of the MBR. When the ESRD Medicare termination date is equal to or earlier than COM, the input DOF will initiate an immediate PEPPER debit-credit to terminate the ESRD Medicare coverage. When coding the DOF, the date may be COM or earlier for immediate termination action; or COM +1 month or later for future termination actions. However, the date may never exceed COM +37.

6. 6. 

   Reintroduction Code—If an existing FWTD must be changed to an earlier date, and X should be annotated in the Reintroduction Code block of the SSA-1598. When this code is present, and the input DOF is earlier than the MBR FWTD, but not earlier than COM +1, the MBR FWTD will be changed to reflect the input DOF. If the input DOF is earlier than COM +1 and earlier than the MBR FWTD, immediate credit/debit processing will ensue to terminate renal HI /SMI.