TN 1 (03-14)

HI 00803.200 Medicare Pilot Program for Asbestos-Related Disease

A. Introduction to the pilot program and its covered services

The Affordable Care Act includes a pilot program to provide additional services for certain Medicare beneficiaries who are entitled to free Medicare Part A (Hospital Insurance, HI) based on exposure to Environmental Health Hazards (EHH), see HI 00803.001. The Medicare Pilot Program for Asbestos Related Disease (Pilot Program) began July 1, 2011, with voluntary participation by EHH Medicare beneficiaries living in certain ZIP codes in Lincoln and Flathead counties, Montana.

The Pilot Program was expanded on March 1, 2014, to include EHH individuals who currently reside in the following Idaho, Montana, and Washington counties as well as a limited group of other individuals, who previously resided in these counties.

Idaho

Montana

Washington

Counties include

  • Benewah

  • Bonner

  • Boundary

  • Clearwater

  • Kootenai

  • Latah

  • Shoshone

Counties include

  • Flathead

  • Glacier

  • Lake

  • Lincoln

  • Mineral

  • Missoula

  • Sanders

Counties include

  • Ferry

  • Lincoln

  • Pend Oreille

  • Spokane

  • Stevens

  • Whitman

The Pilot Program covers items and services beyond what Medicare normally covers such as:

  • special home care service,

  • special medical equipment,

  • help with travel to get care,

  • special counseling, like help quitting smoking,

  • nutritional supplements, and

  • prescription drugs not covered by Medicare (for those enrolled in a Medicare drug plan).

Beneficiaries will also be able to work with a nurse case manager who will help them get the care they need. There is no cost to participate in the Pilot Program.

B. Eligibility policy to participate in the pilot

To participate in the pilot, EHH Medicare beneficiaries must be entitled to Medicare Part A (HI) and Part B (Supplementary Medical Insurance, SMI) and currently reside within one of the following ZIP codes in the states of Idaho, Montana or Washington.

Idaho ZIP codes:

83520

83804

83815

83832

83843

83853

83866

83877

83535

83805

83816

83833

83844

83854

83867

 

83537

83806

83821

83834

83845

83855

83868

 

83541

83808

83822

83835

83846

83856

83869

 

83544

83809

83823

83836

83847

83857

83870

 

83546

83810

83824

83837

83848

83858

83871

 

83553

83811

83825

83839

83849

83860

83872

 

83801

83812

83826

83840

83850

83861

83873

 

83802

83813

83827

83841

83851

83864

83874

 

83803

83814

83830

83842

83852

83865

83876

 

Montana ZIP codes:

59411

59808

59834

59856

59873

59915

59926

59936

59417

59812

59842

59859

59874

59916

59927

59937

59427

59820

59844

59860

59901

59917

59928

59941

59434

59821

59845

59863

59903

59918

59929

 

59801

59823

59846

59864

59904

59919

59930

 

59802

59824

59847

59865

59910

59920

59931

 

59803

59825

59848

59866

59911

59921

59932

 

59804

59826

59851

59867

59912

59922

59933

 

59806

59830

59853

59868

59913

59923

59934

 

59807

59831

59855

59872

59914

59925

59935

 

Washington ZIP codes:

99001

99020

99039

99121

99143

99160

99201

99216

99003

99021

99040

99122

99144

99161

99202

99217

99004

99022

99101

99125

99146

99163

99203

99218

99005

99023

99102

99126

99147

99164

99204

99219

99006

99025

99103

99128

99148

99166

99205

99220

99008

99026

99104

99129

99149

99167

99206

99223

99009

99027

99107

99130

99150

99170

99207

99224

99011

99029

99109

99131

99151

99171

99208

99228

99012

99030

99110

99134

99152

99173

99209

99251

99013

99031

99111

99136

99153

99174

99210

99252

99014

99032

99113

99137

99154

99176

99211

99256

99016

99033

99114

99138

99156

99179

99212

99258

99017

99034

99117

99139

99157

99180

99213

99260

99018

99036

99118

99140

99158

99181

99214

99299

99019

99037

99119

99141

99159

99185

99215

99333

EHH Medicare beneficiaries who do not live in the ZIP codes listed above are eligible to participate in the Pilot Program if they:

  • are entitled to EHH Part A (HI) and Part B (SMI),

  • previously resided in one of the ZIP codes listed on or after July 1, 2011,

  • have since moved out of the Pilot Program area, and

  • apply to participate in the Pilot Program by March 30, 2015.

As part of the enrollment application to participate in the pilot, the beneficiary will need documentation to show proof of current or previous residency in one of the listed ZIP codes.

EHH beneficiaries with HI and SMI, living in the expanded service area, can sign up for the pilot starting March 1, 2014.

EHH beneficiaries with HI only, living in the expanded service area must enroll in SMI prior to signing up for the pilot. Beneficiaries may enroll in SMI during their initial enrollment period, the general enrollment period, or the special enrollment period, as described in HI 00803.220.

NOTE: EHH beneficiaries residing in these ZIP codes will be eligible for the SMI special enrollment period (SEP) described HI 00803.220.

NOTE: Individuals not already enrolled in SMI and not currently residing in the listed ZIP codes are not eligible for the EHH SEP described in HI 00803.220.

C. Procedures for responding to inquiries about the pilot

1. Beneficiary is eligible for, but not yet entitled to, EHH HI

Complete EHH application following HI 00803.030. During the EHH Medicare application interview, advise the individual that the Pilot Program is available only to people who are entitled to HI and SMI based on EHH. Give the individual a Pilot Program brochure, if available. Advise the beneficiary to call Noridian Administrative Services at 1-888-469-9464 to enroll in the Pilot Program. Tell the beneficiary that more information can be found at www.noridianmedicare.com/ard.

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2. Beneficiary already entitled to EHH HI and SMI

Advise the beneficiary to call Noridian Administrative Services at 1-888-469-9464 to enroll in the Pilot Program. Tell the beneficiary that more information can be found at www.noridianmedicare.com/ard.

3. Beneficiary is already entitled to EHH HI (no SMI)

If the beneficiary wants to enroll in SMI, tell him or her that the Pilot Program is available and the requirements to participate in the pilot. Tell the beneficiary about the SEP if they are eligible to participate in the Pilot Program, see HI 00803.220. Tell the beneficiary that more information can be found at www.noridianmedicare.com/ard.

4. Beneficiary not eligible for EHH HI

The Pilot Program and SEP are only available to EHH beneficiaries.

D. References

  • HI 00803.001 Hospital Insurance (HI) Entitlement for Individuals Exposed to Environmental Health Hazards (EHH)

  • HI 00803.030 EHH Medicare Application

  • HI 00803.210 Special Enrollment Period for Medicare Pilot Program for Asbestos Related Disease (July 1, 2011 to June 30, 2012)

  • HI 00803.220 Special Enrollment Period for Expanded Medicare Pilot Program for Asbestos Related Disease (April 1, 2014 to March 31, 2015)


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600803200
HI 00803.200 - Medicare Pilot Program for Asbestos-Related Disease - 04/03/2014
Batch run: 04/03/2014
Rev:04/03/2014