Identification Number:
GN 02602 TN 70
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Continuing Eligibility
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 026 – Posteligibility
Subchapter 02 – Continuing Eligibility
Transmittal No. 70, 03/09/2020

Audience

PSC: BA, CA, CCRE, CS, DS, ICDS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BIES, BTE, CR, CTE, FCR, FDE, PETL, RECONR;
OCO-ODO: BTE, CCE, CR, CST, CTE, CTE TE, DSE, PETE, PETL, RCOVTA, RECOVR;
FO/TSC: CS, CS TII, CSR, CTE, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

 

Summary of Changes

GN 02602.630 Unable to Locate Procedures for the Medicare Non-utilization Project (MNUP)

Replaced e8551 with Allegation Referral Intake System (ARIS) and ARIS and updated “Note” to select “Unable to Locate” under the “Medicare Non-Utilization” program option in Section A.2.d

Replaced e8551 with ARIS and updated “Note” to select “Other” under the “Medicare Non-Utilization” program option in Section B and C

 

GN 02602.640 Death Procedures for the Medicare Non-utilization Project (MNUP)

Under #4, replaced e8551 with Allegation Referral Intake System (ARIS) and ARIS and updated Note to select “Death” under the “Medicare Non-Utilization” program option

GN 02602.630 Unable to Locate Procedures for the Medicare Non-utilization Project (MNUP)

A. Appointment letter returned undeliverable

1. Undeliverable mail

If the appointment letter is undeliverable, follow the instructions in GN 02605.055B.

2. Unable to locate the beneficiary

  1. a. 

    If you are unable to locate the beneficiary, add the following message to the Master Beneficiary Record (MBR):

    “MNUP interview needed. Payments suspended for failure to keep MNUP interview appointments. Immediately remove suspense once MNUP interview is conducted.”

  2. b. 

    Suspend benefits per undeliverable mail procedures in GN 02605.055B.

  3. c. 

    After the MBR shows the ledger account file (LAF) code as suspended for address development (S6), update the LAF code in the “Medicare Non-Utilization Project (MNUP)” section on the MNUP Website to show you suspended the beneficiary’s benefits.

  4. d. 

    When you suspend benefits, immediately refer the case to the Office of the Inspector General (OIG) using the Allegation Referral Intake System (ARIS). Annotate in remarks on the website the date you referred the case to OIG.

    Provide as much information as available in ARIS. For more information on referring a potential violation using ARIS, see GN 04124.001.

    NOTE: When completing ARIS for MNUP, select program option “Medicare Non-Utilization” then select "Unable to Locate."

B. Beneficiary is not available at time of interview

Call the beneficiary at the telephone number shown on the MBR and take the following steps:

  • If the beneficiary answers the telephone, inform him or her you are calling to conduct the scheduled telephone interview. If asked to reschedule the interview, do so and inform the beneficiary that you will send a letter informing him or her of the new time and date. Remind the beneficiary of the importance of being available at the time of the scheduled interview.

  • If you reach a voicemail, leave a detailed message that includes your name, the office you are from, that you called for the scheduled appointment, and your office phone number.

  • If the beneficiary resides in a nursing home, call the nursing home to verify the beneficiary is alive before suspending benefits. If the nursing home alleges the beneficiary is alive, begin representative payee development, if necessary. If the nursing home alleges the beneficiary is deceased, process the report of death. For instructions on how to process a death report, see GN 02602.640.

    Send a new appointment notice to the beneficiary. Allow the beneficiary two rescheduled appointments. Include the following language in the appointment letter when scheduling the final (third) appointment:

    “We have tried to schedule an appointment with you twice. Each time we rescheduled, you were not available. It is very important that you keep this appointment. If you do not keep this appointment, we may suspend your benefits until we speak with you.”

    Add a remark to the MNUP website worksheet stating the beneficiary was not available for the scheduled interview; include any actions taken to contact the beneficiary at the time of the interview. Also, include the date and time of the rescheduled appointment.

    If the beneficiary fails to keep the third appointment, follow instructions in GN 02602.610B.4.

    If you suspend benefits, immediately refer the case to the Office of the Inspector General (OIG) using ARIS. Provide as much information as available in ARIS. Annotate the online worksheet that you referred the case to OIG. For more information on ARIS, see GN 04124.001.

    NOTE: When completing ARIS for MNUP, select program option “Medicare Non-utilization” then select "Other."

C. Beneficiary fails to respond to letters

We will attempt to contact the beneficiary three times.

Send the first letter and allow 2 weeks for the beneficiary to respond before sending a follow-up request.

NOTE: If the beneficiary resides in a nursing home, call the nursing home to verify the beneficiary is alive before suspending benefits.

If the nursing home alleges the:

  • beneficiary is alive, begin representative payee development, if necessary; or

  • beneficiary is deceased, process the report of death. (For instructions on how to process a death report, see GN 02602.640).

Include the following language in the letter when sending the final (third) request:

“We have tried to contact you twice. It is very important that you respond to this letter. If you do not respond within two weeks we may suspend your benefits until we speak with you.”

Add a remark to the MNUP website documenting your attempts to contact the beneficiary. Include the dates of each contact and the method of attempted contact (e.g. telephone or mail).

If the beneficiary fails to respond to the third request, follow procedures in GN 02602.610B.4.

If you suspend benefits, immediately refer the case to OIG using ARIS. Provide as much information as available in ARIS. Annotate the online worksheet that you referred the case to OIG. For more information on ARIS, see GN 04124.001.

NOTE: When completing ARIS for MNUP, select program option “Medicare Non-utilization” then select "Other."

GN 02602.640 Death Procedures for the Medicare Non-utilization Project (MNUP)

Follow these instructions when you receive a report of the beneficiary’s death. These instructions apply regardless of whether the death is prior to or after the field office (FO) initiated contact.

  1. 1. 

    Obtain proof of death following regular policy guidelines. For preferred evidence of death, see GN 00304.005, see GN 02602.050 for reports of death, and see GN 02602.070 for procedures for resolving death alerts and exceptions.

  2. 2. 

    Post the proof of death to the Evidence Screen (EVID) in the Shared Processes menu. (For more information, see MS 01701.003.)

    REMINDER: Proof of death posted on the Master Beneficiary Record (MBR) or Supplemental Security Income Record (SSR) (for concurrent beneficiaries) without proper documentation on the EVID screen is not proof of the beneficiary’s death. However, you can use death data on the Numident as proof of death. For use of Numident death data, see GN 00304.100B.3.

  3. 3. 

    Terminate benefits based on the verified date of death as outlined in GN 02602.051 and, for concurrent beneficiaries, terminate Supplemental Security Income benefits per SM 01301.375 through SM 01301.380.

  4. 4. 

    If the report of death is not timely and we paid at least 2 months of benefits after the date of death, submit a referral to the Office of Inspector General (OIG) via the Allegation Referral Intake System (ARIS). Provide as much information as possible in ARIS. For more information on ARIS, see GN 04124.001.

    NOTE: When completing ARIS for MNUP, select program option “Medicare Non-utilization” then select "Death."

  5. 5. 

    Post the following special message on the MBR and in the remarks field on the SSR (for concurrent beneficiaries):

    “Medicare Non-Utilization Project-(Month and Year)-Beneficiary is deceased- (Field Office Number) and your initials or unit.”

  6. 6. 

    Document the beneficiary’s death on the MNUP website and appropriate worksheet. For information on completing the worksheet, see GN 02602.660. Update the ledger account file codes in the “Medicare Non-Utilization Project (MNUP) Information” section to show we terminated the beneficiary’s benefits.

  7. 7. 

    Update the MNUP website erroneous payment field to reflect any payment made after the date of death that has not been returned within the three-month period after the date of death.


GN 02602 TN 70 - Continuing Eligibility - 3/09/2020