TN 49 (11-22)

HI 01001.215 Retroactive, Simultaneous Accretions/Deletions

Whenever a State submits a simultaneous report of an accretion and deletion, and the date of the deletion is more than 2 months prior to the month in which the report is submitted, only the inclusive period of buy-in as reported by the State is annotated to the MBR. This buy-in coverage period will establish SMI coverage for the period of the buy-in, but will have no effect on the individual's current enrollment status. However, for the purpose of determining the effects on the individual's current premium rate for determining the effects on reenrollment rights and future premium amounts, the State buy-in enrollment will be deemed to have occurred in the month in which SSA is first notified.

In consideration of the current and ongoing premium rate, effective with the first month of the buy-in, premium rate will be established at the base rate in effect at that time. If the individual's current premium rate is subject to a premium increase, it will be reduced to the base rate effective with the first month of buy-in. For months following the deletion month, the individual will continue to receive the advantage of the State buy-in. That is, the premium rate will continue at the base amount. The individual will be credited with “whole month” amounts at the rate previously paid for months of SMI coverage now covered by the buy-in, and for months following the deletion month, the individual will be credited with the difference between the penalty rate and the base premium amount. Credit for this period will be refunded or applied toward future premium liability if the individual is in current billing status.