Retention Date: May 31, 2018
|Intended Audience:||All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/|
|Originating Office:||Centers for Medicare & Medicaid Services (CMS)|
|Title:||Medicare Enrollment for Eligible Beneficiaries Affected by a Weather-Related Emergency or Major Disaster – Instructions Will Follow Shortly|
|Type:||EM - Emergency Messages|
|Link To Reference:||See References at the end of this EM.|
Recent weather events, which included evacuation and caused major devastation in certain areas, may have affected many beneficiaries ability to submit timely Medicare enrollment choices.
B. Enrollment and refusal requests for beneficiaries affected by a weather-related emergency or major disaster
Under normal circumstances, 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 that 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.
Recent weather events caused disruption to mail delivery and affected operations at local field offices. This affected our ability to notify some beneficiaries of their Medicare enrollment or process their enrollment request timely. As a result, some beneficiaries were not able to make their Premium-Part A or Part B enrollment request during their Initial Enrollment Period (IEP) or Special Enrollment Period (SEP).
As such, CMS is providing equitable relief to beneficiaries who could not submit their premium-Part A or Part B enrollment or Part B refusal requests timely.
C. Limited availability of equitable relief
Beginning September 1, 2017, consider equitable relief on a case-by-case basis for beneficiaries who had difficulties submitting timely IEP enrollment requests, IEP refusals, or SEP enrollment requests.
These considerations are for beneficiaries who, at the start of the incident period, were in their IEP or SEP, and who resided in areas for which the Federal Emergency Management Agency (FEMA) declared a weather-related emergency or a major disaster.
When you make a favorable equitable relief determination, consider the late IEP or SEP enrollment request as filed timely.
This consideration of equitable relief ends May 31, 2018.
D. Processing instructions
Process these cases following the normal rules for equitable relief cases as outlined in HI 00805.185. We encourage technicians to be as responsive and flexible as possible when a current or new beneficiary affected by a weather-related emergency or major disaster contacts us for any of the following reasons:
1. Non-receipt of his or her Medicare award notice or Initial Enrollment Period package; or
2. Inability to file an enrollment request or refusal timely.
Equitable relief FO/N8NN steps
Follow these steps:
1. Consider whether the case meets the requirements in Section D of these instructions.
2. Document the beneficiary’s statement identifying him or her as a resident of an area affected by a weather-related emergency or major disaster.
3. For beneficiaries requesting premium-Part A or Part B enrollment, complete the following steps:
4. 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.
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 enrollment, attempt to 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). Beneficiaries enrolling in SEP 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 “Resident of the Federal Emergency Management Agency (FEMA) declared disaster areas” in the remark sections of the CMS-40B. If the beneficiary is enrolling in Premium-Part A, include the beneficiary’s Premium-Part A effective date and annotate “Resident of Federal Emergency Agency (FEMA) declared disaster areas” 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 IEP and SEP filing.
e. Print the CMS-18-F5 and/or the CMS-40B and if applicable the CMS-L564 barcode from NDRED.
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 “Resident of the Federal Emergency Management Agency (FEMA) declared disaster areas.”
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
Follow these steps:
1. Review the beneficiary’s statement and available evidence in support of the SSA-5002 determination.
2. Process approved equitable relief cases following normal Equitable Relief procedures.
Part B refusal FO steps
Follow these steps:
1. Consider whether the case meets the requirements in Section D of these instructions. If not, equitable relief does not apply.
2. Obtain a written statement from the claimant requesting SMI refusal as a resident of the Federal Emergency Management Agency (FEMA) declared disaster areas.
NOTE: If State Buy-in is currently in effect, the beneficiary cannot refuse or terminate Supplemental Medical Insurance (SMI).
3. Complete the “timely” refusal request by following normal business procedure. Fax the written statement and store in CFRMS.
When a beneficiary states that he or she wants to refuse SMI, make all reasonable efforts to ensure that the beneficiary refusing or terminating SMI coverage understands the effect of their action.
Part B refusal N8NN steps
Forward SMI refusals exceeding six months to the PSC of jurisdiction to process via Paperless.
Follow these steps:
1. Consider whether the case meets the requirements in Section D of these instructions. If not, this equitable relief does not apply.
2. Providing 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 caller still wishes to terminate his or her coverage, fully complete the Form CMS-1763, Requests for Termination of Premium Hospital, Supplementary Medicare Insurance, or both.
4. Mail the CMS-1763 to the beneficiary with a courtesy return envelope to the servicing PSC.
· Include the name of beneficiary, Medicare claim number, name of 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 resident of the Federal Emergency Management Agency (FEMA) declared disaster areas.
Follow these steps:
1. Review the written statement and available evidence in support of SMI refusal.
2. Process approved SMI refusal by following normal business procedure.