Program Operations Manual System (POMS)
HI 00815.036 State Response to PW Accretion
States are responsible for verifying all “PW” accretions by matching against the State Medicaid Eligibility File and/or the State Data Exchange (SDX) File produced by SSA. The State should follow the procedures in the State Buy-in Manual. If the State determines that a PW accretion is erroneous, the State may protest the action. The State must react to the PW accretion before the end of the fourth month following the month in which it received notification of the PW accretion on its billing file. If the State does not react timely, the State becomes responsible for the premium liability until it submits a deletion action to the Third Party System. In that situation, the Commissioner"s Decision (see HI 00815.063.D) which limits the retroactivity of deletions to processing month minus two, is applicable and the State is liable for all premiums from the month of accretion to the month of deletion.
The State Agency will direct its protest to the CMS RO/CO except in the following situation. If the individual for whom the State received the PW accretion resides in an auto-accrete State and is on the SDX in current pay status but the individual"s claim number is missing from the unearned income field, the State will ask the DO/BO to use the force finder procedure SM 02001.040; SM 01301.325). If the claim number is not established within 90 days, the State will follow up with the DO/BO. NOTE: The CMS RO in the course of it"s PW investigation also may ask the DO/BO to establish the claim number in the unearned income field via the force finder mechanism.