Social Security

Summary of Changes

Section C:

· Added to Step 7, the Spanish translation of the attestation script.

· Added to Step 8, a PDF to include instructions for changing CMS-40B to a fillable form and to modify signature.

This Emergency Message (EM) provides technicians with instructions for completing form CMS-40B, Application for Enrollment in Medicare Part B (Medical Insurance) telephonically to reduce pen and ink (wet) signatures and mailing of CMS-40B forms. This also allows processing flexibility to technicians when receiving in office CMS-40B requests by accepting either wet signatures or verbal signatures via attestation.

B. Background

The Centers for Medicare & Medicaid Services (CMS) and SSA identified opportunities to improve and increase efficiencies with the Medicare enrollment process. Previously, the enrollment process to add Part B required paper enrollment with a pen and ink (wet) signature and manual staff review, resulting in extra burden on SSA staff and delayed processing of Medicare Part B enrollments. In response to the COVID-19 public health emergency, CMS informed us that a wet signature is not statutorily required for the Form CMS-40B. Now that the public health emergency has ended, CMS advised us that we can continue to accept the CMS-40B without a wet signature. We will accept a verbal signature via attestation of CMS-40B as part of this new efficiency process to Medicare Part B enrollments.

C. Procedures for processing CMS-40B by telephone

1. Verify the caller's identity using normal telephone identification procedures found in GN 00203.020 Identity of Claimants.

2. Technicians should review the MBR to determine if the beneficiary is entitled to Medicare Part A and is not currently enrolled in Medicare Part B.

3. If the beneficiary is not entitled to Medicare Part A, follow normal initial claim application taking procedures to enroll the beneficiary in Medicare Part A and Part B if requested. If the beneficiary is already entitled to Part A and does not have Part B, Proceed to Step 4.

4. Inform the caller that the CMS-40B form no longer requires a pen-and-ink (wet) signature, and we can process their request over the phone.
5. Does the caller agree to verbal signature via attestation?

· If yes, proceed with the verbal signature via attestation and explain that we will confirm the caller’s intent to enroll in Medicare Part B. Proceed to Step 6.
· If no, and the caller prefers a paper copy of the CMS-40B form, give the caller the option to:
o Download and print the CMS-40B form: The CMS-40B is available in both English and Spanish at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-Items/CMS017339.
o Receive an email or text of the CMS-40B form to the caller’s preferred email address, iPhone or Smartphone using SSA’s eMailer program.
o Receive a paper CMS-40B form mailed to the caller’s mailing address with a return envelope to SSA for processing. STOP
6. Access Form CMS-40B. Proceed to Step 7.
7. Read the scripted attestation language to the caller:

· “During this interview, we will ask you questions that will be used to process [your/or name of claimant's] Application for Enrollment in Medicare - Part B (Medical Insurance), Form CMS-40B, for Medicare Part B. At the end of the interview, we will ask you to confirm the truthfulness of your answers under penalty of perjury and we will record your response. You should be aware that you can be held legally responsible for giving us false information.

· For Spanish:

· “Durante esta entrevista, le haremos preguntas que se utilizarán para procesar la Solicitud de inscripción a Medicare Parte B (seguro médico) [suya/o de name of claimant], formulario CMS 40-B, para Medicare Parte B. Al final de la entrevista, le pediremos que confirme la veracidad de sus respuestas bajo pena de perjurio y grabaremos su respuesta. Tenga en cuenta que se le puede considerar legalmente responsable por proporcionarnos información falsa”.




You will receive a notice stating changes to your benefits to retain for your records. Do you understand that you must review all of this information carefully and let us know right away if anything needs to be corrected OR if any of the information changes?



8. Complete applicable fields on Form CMS-40B with the caller. (For instructions on converting CMS-40B to a fillable form or modifying signatures refer to this Verbal Attestation pdf Settings.pdf )

9. Obtain proper caller affirmation of intent to verbally sign their request for enrollment in Medicare Part B via Form CMS-40B and understanding of the penalty clause, by reading the following script:

NOTE: This verbal signature via attestation procedure also applies to face-to-face interviewing.

10. Once the caller agrees to the information, enter the following into the signature block of the form “verbal signature received by, <Technicians Name>, <Office Code>”, record the <Date> in the date section.

11. Complete the enrollment by making a POS input if no outstanding development is in progress (e.g., CMS-L564 or some other proof is needed to verify Group Health Plan (GHP), or Special Enrollment Period (SEP)).

12. Inform the caller that they will receive a notice regarding their enrollment into Medicare Part B.

13. To save the document to the Evidence Portal (EP), click the print icon and under “Printer” select “Microsoft Print to PDF” and then click the “Print” button.

14. Save the document in File Explorer with Complete file name using the following naming convention (e.g., JohnSmith CMS40B); Beneficiary Name CMS40B and select Save.

15. Click the EP shortcut link in iMain to access EP, type SSN and click the “Next” button.

16. Select the document type “CMS 40-B-Medicare Enrollment Application,” add comments if necessary.

17. Select appropriate claim filing type.

18. Select Import then the “Browse” button.

19. Open document in File Explorer and click “Next” to import document.

20. Review for accuracy and click “Import Document”.

21. Receive confirmation message.

22. Review Evidence Portal to ensure the attested CMS-40B is in file by clicking the “View evidence” link.

Reference

GN 00201.015 Alternative Signature Methods