Effective Dates: 10/27/2022 - Present Previous | Next

TN 12 (10-22)

NL 00722.012 Form CMS-L1617-TR (Notice of Deletion from Part A State Buy-in or Part A Group Payer)

A. POLICY

The Office of Systems prints and releases this notice to a Qualified Medicare Beneficiary (QMB) after the State deletes the QMB from the Part A State buy-in or Part A Group Payer Account.

This notice tells the first month for which the beneficiary is liable for the Part A premium.

B. EXHIBIT — FORM HCFA-L1617-TR

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900722012
NL 00722.012 - Form CMS-L1617-TR (Notice of Deletion from Part A State Buy-in or Part A Group Payer) - 10/27/2022
Batch run: 10/27/2022
Rev:10/27/2022