TN 19 (12-18)

HI 00815.036 State Response to Public Welfare (PW) Accretion

A. States' responsibilities for verifying all PW accretions

  • States are responsible for verifying all PW accretions by matching the data they receive from the Social Security Administration (SSA) via the State Data Exchange (SDX) file against their data in the State Medicaid Eligibility File.

  • If the State determines that a PW accretion is erroneous, the State may protest the action.

  • A State has two months following the month in which it received notification of the PW accretion on its billing file to annul the accretion or establish a closed period of State Buy-in coverage, in accordance with Chapter 4, Section 480 of the State Buy-in Manual.

  • 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 (TPS). In this situation, the Commissioner’s Decision is applicable and limits the retroactivity of deletions to processing month minus two. The State is liable for all premiums from the month of accretion to the month of deletion, see HI 00815.063.D Systems Processing of State Responsibility Items.

B. State directs protest to the Centers for Medicare & Medicaid Services (CMS)

The State Agency must direct its protest to the CMS Regional Office (RO) and CMS Central Office (CO).

EXCEPTION: If the beneficiary for whom the State received the PW accretion resides in an auto-accrete State and is in current pay status on the SDX, but the Medicare Number is missing from the unearned income field, the State must ask the SSA Field Office (FO) to use the following force finder procedures: SM 02001.040 MBR/SSR Interface Edits, Alerts and Diaries; and SM 01301.325 Query.

The State should follow up with the FO if the Medicare Number is not established within 90 days.

NOTE: The CMS RO, in the course of the PW investigation, may also ask the FO to establish the Medicare Number in the unearned income field via the force finder procedure.

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HI 00815.036 - State Response to Public Welfare (PW) Accretion - 12/18/2018
Batch run: 12/18/2018