TN 7 (07-95)
NL 00722.014 Form CMS-L1900-TR (Notice of Part A State Buy-in/Part A Group Payer Enrollment and Part A State Buy-In/Part A Group Payer Deletion)
The Office of Systems prints and releases this notice to a beneficiary when the State paid the Part A Medicare premiums for a limited period of time.
This notice provides the inclusive dates for which the State was responsible for the Part A premiums.
B. EXHIBIT — FORM CMS-L1900-TR
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