Retention Date: 12/30/22
|Intended Audience:||All RCs/ARCs/ADs/FOs/TSCs|
|Originating Office:||Centers for Medicare & Medicaid Services (CMS)|
|Title:||Limited Availability of Equitable Relief - Medicare Enrollment/Disenrollment for Beneficiaries Unable to Contact SSA’s National 800 Network Number (N8NN) or Field Office (FO) General Inquiry (GI) Lines|
|Type:||EM - Emergency Messages|
|Link To Reference:||See References at the end of this EM.|
Recent systemic technical issues surrounding SSA’s National 800 Network Number (N8NN) and Field Office general inquiry phone lines may have caused difficulties for some beneficiaries attempting to contact SSA, including those seeking to submit Medicare enrollment or disenrollment requests. Therefore, anyone who was unable to enroll due to SSA’s telephone issues after January 1, 2022 will be granted additional time, through December 30, 2022, to enroll. SSA is currently working to resolve the phone issues with their vendors.
Given recent technical issues, CMS is providing equitable relief to beneficiaries who could not submit premium-Part A or Part B enrollment or disenrollment requests timely. This relief applies to the 2022 General Enrollment Period (GEP), Initial Enrollment Period (IEP), and Special Enrollment Period (SEP).
B. Limited availability of equitable relief
Typically, the beneficiary must submit a timely request to enroll in Medicare Premium-Part A (Hospital Insurance), Part B (Supplementary Medical Insurance), or both within an applicable enrollment period as outlined in HI 00801.133, HI 00805.010, HI 00805.130, and HI 00805.275.
For beneficiaries who CMS automatically enrolled in Part B, he or she must request to refuse coverage following the rules outlined in HI 00805.055 and HI 00805.080.
Beginning April 1, 2022, consider equitable relief on a case-by-case basis for beneficiaries who allege difficulties submitting timely 2022 GEP, IEP, or SEP enrollment requests via phone and fax.
When making a favorable equitable relief determination, consider the late GEP, IEP, or SEP enrollment filed timely.
This consideration of equitable relief ends December 30, 2022.
C. Processing instructions
Process these cases following the policy for equitable relief cases as outlined in HI 00805.185, HI 00801.138, HI 00805.010, HI 00805.055, HI 00805.080, HI 00805.130, HI 00805.275, HI 00805.277, and TC 24001.040.
We encourage technicians to be as responsive and flexible as possible when a current or new beneficiary affected by telephonic technical issues contacts us for any missed enrollment opportunity due to being impacted by SSA’s telephonic technical issues.
Equitable relief FO/N8NN steps:
1. Consider whether the case meets the requirements in HI 00805.170.
2. Document the beneficiary’s statement identifying him or her as a beneficiary impacted by SSA’s telephonic technical issues. For required documentation, follow policy in HI 00805.175C.
3. Field office (FO) employees prepare a Form SSA-5002 (Report of Contact) with your analysis of the information, and your decision as to whether we should provide relief. Include the reasons for approval or disapproval based on your review.
4. For beneficiaries requesting premium-Part A or Part B enrollment, complete the following steps:
5. Fax the completed CMS-40B or CMS-18-F5, SSA-5002, and if applicable, the CMS-L564, and supporting documentation into CFRMS and add remark “Beneficiary impacted by SSA telephonic technical issues.”
a. If the beneficiary expresses dire need of medical attention, refer the action to the program service center (PSC) of record following existing instructions in GN 01070.228.
b. If the beneficiary wants to enroll in Part B, complete Form CMS-40B (Application for Enrollment in Medicare Part B (Medical Insurance)). If the beneficiary wants to enroll in Premium-Part A, complete Form CMS-18-F5 (Application for Hospital Insurance). For SEP enrollments, obtain evidence of Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage based on current employment via Form CMS-L564 (Request for Employment Information) or written notification (a letter, fax, or email) from the employer, GHP, or LGHP. Beneficiaries enrolling in a GEP or an IEP do not need to complete this form.
c. If the beneficiary wants a retroactive effective date, explain that he or she must pay all premiums for all months of coverage. Explain that the total amount of premiums for all months, including the next coverage month, may be deducted all at once from his or her benefit amount. Be sure the beneficiary understands the implications for a retroactive effective date before processing. Follow normal processing procedures if a beneficiary believes he or she cannot afford to pay retroactive Premium-Part A, Part B or both premiums in a lump sum.
d. Include the beneficiary’s Part B effective date and annotate “Beneficiary impacted by SSA telephonic technical issues” in the remarks section of the CMS-40B. If the beneficiary is enrolling in Premium-Part A, include the beneficiary’s Premium-Part A effective date and annotate “Beneficiary impacted by SSA telephonic technical issues” in the remarks section of the CMS-18-F5.
NOTE: Limit the Premium-Part A and/or Part B effective date to a month granted under normal processing procedures for timely GEP, IEP, or SEP filing.
e. Print the CMS-18-F5 and/or the CMS-40B and, if applicable, the CMS-L564 barcode from NDRED.
6. FO forwards the case to the appropriate PSC via Paperless to review and process. TSC follows routine instructions to send the case to the PSC to review and process.
Equitable relief PSC steps:
1. Review the beneficiary’s statement and available evidence in support of the SSA-5002 determination.
2. Process approved equitable relief cases following equitable relief procedures in HI 00805.185.
Medicare Part B refusal FO steps:
1. Consider whether the case meets the requirements in HI 00805.170. If not, equitable relief does not apply.
2. Obtain a written statement from the claimant requesting SMI refusal as a beneficiary impacted by SSA’s telephonic technical issues during the 2022 GEP.
NOTE: If State Buy-in is currently in effect, the beneficiary cannot refuse or terminate Supplementary Medical Insurance (SMI).
3. Complete the “timely” refusal request by following normal business procedures. Fax the written statement and store in CFRMS. Forward SMI refusals exceeding six months to the PSC of jurisdiction to process via Paperless.
NOTE: When a beneficiary states that he or she wants to refuse SMI, make all reasonable efforts to ensure that the beneficiary understands the effects of their action.
Medicare Part B refusal N8NN steps:
1. Consider whether the case meets the requirements in HI 00805.170 of these instructions. If not, this equitable relief does not apply.
2. Provide a complete explanation of the consequences of terminating SMI.
NOTE: If State Buy-in is currently in effect, the beneficiary cannot refuse or terminate SMI.
3. If the beneficiary still wishes to terminate his or her coverage, fully complete the Form CMS-1763, Request for Termination of Premium Hospital And/Or Supplementary Medicare Insurance.
4. Mail the CMS-1763 to the beneficiary with a courtesy return envelope to the servicing PSC.
· Include the name of the beneficiary, Medicare claim number, and the name of the person (if other than enrollee) who is making this request.
· Indicate that this is a Request for Termination of SMI, and the date SMI ends.
· Annotate that the beneficiary requesting SMI refusal is a “Beneficiary impacted by SSA’s telephonic technical issues”.
1. Review the written statement and available evidence in support of SMI refusal.
2. Process approved SMI refusal by following normal business procedures.
Direct all program-related and technical questions to your RO support staff or to your PC OA staff. RO support staff or PC OA staff may refer questions or problems to their Headquarters contacts.
HI 00801.138 Application for Premium HI
HI 00805.010 Rules on Enrollment Periods
HI 00805.055 Notice of Right to Refuse Deemed Enrollment
HI 00805.080 Withdrawal of Enrollment Before It Goes Into Effect
HI 00805.130 When an Enrollment Received by Mail Is Considered Filed
HI 00805.185 Processing Equitable Relief Cases
HI 00805.275 Special Enrollment Period (SEP) Enrollments
HI 00805.277 Processing SEP Enrollments
TC 24001.040 Initial Enrollment Period (IEP)
TC 24001.050 Special Enrollment Period (SEP) For the Aged and Disabled
EM-22020 REV - Limited Availability of Equitable Relief - Medicare Enrollment/Disenrollment for Beneficiaries Unable to Contact SSA’s National 800 Network Number (N8NN) or Field Office (FO) General Inquiry (GI) Lines - 4/7/2022