HI 00803.040 Developing Presence in Lincoln County, Montana, for Entitlement to EHH Medicare
A. Presence requirement for EHH Medicare entitlement
An individual exposed to Environmental Health Hazards (EHH) in Lincoln County, Montana, must meet a presence requirement for entitlement to EHH Medicare. He or she must have been present in Lincoln County, Montana, for a total of at least 6 months during a period ending:
10 years or more before the date of the diagnosis, and
prior to the implementation of all the remedial and removal actions specified by the Environmental Protection Agency in the Records of Decision for Libby and Troy, Montana.
NOTE: Since all remedial and removal actions have not been completed, there is no end date to establishing presence at this time.
Residency is not a requirement, and the 6-month period does not have to be consecutive (i.e., an individual can meet the presence requirement by having lived, worked, or vacationed in Lincoln County, Montana, for short periods over several years).
EXAMPLE: Mr. Smith applied for Medicare under the EHH provision in May 2010. He received a diagnosis of a qualifying medical condition in April 2010. To meet the presence requirement, he must have been present in Lincoln County, Montana, for a total of 6 months during a period ending 10 years or more before the date of the diagnosis. Since he received the diagnosis in April 2010, he must have been present in Lincoln County, Montana, for a total of 6 months during a period prior to April 2000.
B. Developing proof of presence in Lincoln County, Montana
Field Office (FO) 872 in Kalispell, Montana is responsible for developing proof of presence in Lincoln County, Montana.
A claimant states on his or her application for EHH Medicare, “I was present at least a total of 6 months in Lincoln County, Montana, from MM/CCYY to MM/CCYY.” If the claimant cannot make this statement, enter the appropriate statement based on his or her allegation.
The claimant must provide evidence to prove he or she meets the presence requirement for EHH Medicare. The evidence does not have to document every month in the 6-month period, but it must support the period in which the claimant can meet the presence requirement. Identifying the period(s) of presence that meets the presence requirement and acceptable evidence requires discussion with the claimant and guidance from the interviewer.
Primary evidence is preferred and considered convincing. For additional information on primary evidence, see HI 00803.040C in this section. Since the claimant must establish his or her presence 10 or more years in the past, it may be difficult to obtain primary evidence. If primary evidence is unavailable, the CR must develop secondary evidence and prepare a special determination.
NOTE: A single document (e.g., an EHH Checklist from the Center for Asbestos Related Disease (CARD)) may provide evidence of both presence and diagnosis.
To store evidence, follow instructions in GN 00301.286, Electronic Evidence Documentation and Retention.
C. Primary evidence of presence in Lincoln County, Montana
Accept the following from the Lincoln County, Montana, area during the appropriate time as primary evidence:
medical records dated prior to March 23, 2010 (e.g., a CARD Exposure Questionnaire completed prior to March 23, 2010),
title or deed to real estate,
rent receipts, rental lease,
Montana driver’s license or ID,
mail addressed to the claimant at an address in Lincoln County, Montana,
telephone directory listing,
tax assessment notice,
summer camp or campground registration,
fishing, hunting, or boating license purchased in designated area of the environmental health hazard,
birth certificate of the claimant’s child,
records that show participation in a social program,
local bank record or check-cashing card,
record of volunteer activity, and
religious, fraternal, or social organization records.
D. Secondary evidence of presence in Lincoln County, Montana
1. Ask questions to develop secondary evidence of presence in Lincoln County, Montana
Ask open-ended questions that a claimant who was present in Lincoln County, Montana, should be able to answer. Accept the answers as secondary evidence when primary evidence is unavailable. The following are examples of questions you can ask:
How long did you live at the Lincoln County, Montana, address?
Can you describe the rooms in your residence?
Where did you live previously, and when did you move to Lincoln County, Montana?
How much time did you spend at your address?
Where did you keep your household and personal goods?
Can you describe your neighbors? What were their names?
What was your daily routine?
Where did you shop?
What were the names of businesses near your residence?
Were you married? Where did your spouse or family live? How often did you see family members?
Did you periodically visit friends or family outside Lincoln, County, Montana? If so, where and with whom did you stay? Did you store personal or household items there? How long did you usually stay?
Did you work in Lincoln County, Montana? If so, where did you work and who was your employer? When did you work for this employer? What was your work schedule? What were your job duties?
Did your children attend school in Lincoln County, Montana? If so, what school(s) did they attend? When did they attend school there? Who was (were) their teacher(s)?
Did you or a family member have a general physician when you lived in Lincoln County, Montana? If so, who was the physician and where was his or her office? When did you or family member seek medical care from this physician?
Did you vacation in Lincoln County, Montana? If so, how often and for how long? Where did you vacation, and what did you do?
Did you participate in activities in Lincoln County, Montana? If so, what were the activities, and when did you participate in them?
2. Obtain two statements to acknowledge claimant’s presence
If you cannot obtain primary evidence, consider obtaining statements from two reliable, disinterested individuals who have firsthand knowledge of the claimant’s presence in Lincoln County, Montana. Solicit these statements only after you exhaust all attempts to secure evidence. The individuals may include, but are not limited to, the following:
An employer who states that the claimant worked several days a week or who can provide evidence that the claimant worked 1 or 2 hours several days per week;
An official of a religious or other organization who can confirm that the claimant attended services or functions sponsored by the organization;
A landlord who provided lodging for the claimant;
A neighbor of the claimant (a crisscross directory may help locate a likely individual);
A school official who can confirm the attendance of the claimant’s child(ren) in a local school; or
A social services provider.
3. Prepare a presence determination
If a claimant cannot provide convincing evidence to establish presence in Lincoln County, Montana, the CR must prepare a special presence determination on the RPOC screen in MCS to document a presence determination based on secondary evidence. If you cannot establish the claim in MCS, use a paper form SSA-5002 (Report of Contact) to document a presence determination based on secondary evidence. Fax the paper SSA-5002 into the Non-Disability Repository for Evidentiary Documents (NDRed). Include the following documentation to support a finding that the claimant does or does not meet the presence criteria:
the reason the claimant could not provide convincing evidence of presence in Lincoln County, Montana; and
the claimant’s responses to open-ended questions asked; or
a minimum of two statements from knowledgeable, disinterested persons; and
any additional information gained in the application process, including interviewer observations that have an impact on the presence determination.
If presence appears questionable, document the file with your rationale to support the decision that the claimant was or was not present in Lincoln County, Montana.
GN 00301.286, Electronic Evidence Documentation and Retention