Identification Number:
EM-17038
Intended Audience:All RCs/ARCsMOS/FOs/TSCs/SPIKES/PSCs/OCO/OCS/OISP
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Disaster Procedure–Disaster Relief for Direct Billing Medicare Beneficiaries affected by Recent Hurricanes—One-Time-Only Instructions---ACTION
Type:EM - Emergency Messages
Program:Medicare
Link To Reference:See References at the end of this EM
 
Retention Date: May 1, 2018

A. Background of disasters
Due to the major disasters associated with the recent hurricanes, CMS is making temporary considerations regarding the billing and payment of Medicare Part A, Part B and/or Part D-IRMAA premiums, for beneficiaries CMS bills directly for their premiums. These considerations are for all CMS-directly billed Medicare beneficiaries who resided in the affected areas at the start of the incidents. (See affected areas under Section B.)

*SPECIAL NOTE regarding Hurricane Maria: For CMS-directly billed beneficiaries in the Commonwealth of Puerto Rico and the Territory of the U.S. Virgin Islands, suspension of termination actions due to non-payment of Medicare premiums has already been provided for under Hurricane Irma relief actions. No separate actions are planned for areas impacted by Hurricane Maria at this time.


B. Policy for suspending termination of Medicare coverage for premium non-payment

To ease the hardships caused by these disasters, CMS will:

1. Hurricane HarveyTemporarily suspend any termination actions resulting from non-payment of premiums for 180 days, for beneficiaries impacted by Hurricane Harvey, effective with the billing date of August 28, 2017. This temporary suspension applies to CMS-directly billed beneficiaries in the following areas:


    a. Texas counties

    030ARANSAS743KLEBERG
    070AUSTIN754LAVACA
    100BASTROP755LEE
    113BEE757LIBERTY
    130BEXAR440 MADISON
    180BRAZORIA790MATAGORDA
    221BURLESON801MONTGOMERY
    224CALHOUN821NEWTON
    280CHAMBERS830NUECES
    312COLORADO840ORANGE
    390DALLAS850POLK
    420DE WITT876REFUGIO
    511FAYETTE882SABINE
    530FORT BEND884SAN JACINTO
    550GALVESTON885SAN PATRICIO
    561GOLIAD910TARRANT
    562GONZALES940TRAVIS
    580GRIMES942TYLER
    600HARDIN948VICTORIA
    610HARRIS949WALKER
    681JACKSON950WALLER
    690JASPER952WASHINGTON
    700JEFFERSON954WHARTON
    722KARNES

    b. ENTIRE State of Louisiana

2. Hurricane IrmaTemporarily suspend any termination actions resulting from non-payment of premiums for 180 days, for beneficiaries impacted by Hurricane Irma, effective with the billing date of August 28, 2017. This temporary suspension applies to CMS-directly billed beneficiaries in the following areas:

    a. ENTIRE State of Florida

    b. ENTIRE State of Alabama

    c. ENTIRE State of Georgia

    d. ENTIRE State of South Carolina

    e. ENTIRE Commonwealth of Puerto Rico

    f. ENTIRE Territory of U.S. Virgin Islands


3. Remove termination dates from delinquent bills mailed to beneficiaries in the affected areas. Beneficiaries will continue to receive a bill reflecting “delinquent” but no termination dates will appear on the bill.

4. Include language in a stuffer for the October, November and December 2017 premium billing notices, assuring beneficiaries affected by the recent hurricanes that their Medicare coverage will not be terminated during the non-termination period.

C. Procedures for extending relief to CMS-directly billed beneficiaries impacted by the recent hurricanes:


    1. SSA should use existing procedures for hardships and inability to pay, and apply the most lenient parameters when a CMS-directly billed individual affected by the recent hurricanes contacts SSA for any of the following reasons:

    a. Inability to pay their Medicare premiums;
    b. Non-receipt of their Medicare premium bill;
    c. A termination notice they may have received.

    2. Field Office (FO) action
    a. Forward premium payments for CMS-directly billed beneficiaries received in the FOs to:

    Medicare Premium Collection Center
    P.O. Box 790355
    St. Louis, MO 63179-0355

    b. If an enrollee visits an office or non-servicing office to request premium notices to be sent to a son, daughter, or other person to ensure continuance of his/her Medicare coverage, follow instructions in.
    c. FOs may contact their respective Program Service Center (PSC) to verify if this non-termination policy applies to an individual.

    3. Program Service Center (PSC) information

    a. PSC Medicare contacts have access to the CMS Enrollment Database (EDB) system. CMS added new “Disaster Codes” to the DB6 screen (DIRECT BILLING – DIRECT BILLING CONTROL).
    b. If a CMS-directly billed individual is eligible for disaster relief for hurricane Harvey, the Disaster Code will reflect “H” and an audit message will display on the AB20 screen (ENROLLMENT SYSTEMS AUDIT TRAIL): “Hurricane Harvey Relief Case effective for 180 days from August 28, 2017.”
    c. If a CMS-directly billed individual is eligible for disaster relief for hurricane Irma, the Disaster Code will reflect “I” and an audit message will display on the AB20 screen (ENROLLMENT SYSTEMS AUDIT TRAIL): “Hurricane Irma Relief Case effective for 180 days from August 28, 2017.”
    d. If an enrollee in an affected area reverts to direct bill status after August 28, 2017, the suspension of termination actions will apply for the same period (for 180 days from August 28, 2017).


NOTE: This section is informational only.

4. National 800 Number Network (N8NN)

If you are contacted by an individual questioning the direct billing of his or her premiums and he or she resides within one of the affected areas, follow these instructions:
    a. Is the individual requesting that his or her premium notices be sent to a son, daughter, or other person to ensure continuance of his/her Medicare coverage?
      • If yes, follow the instructions in HI 01001.225.
      • If no, go to step b.
    b. Advise the caller that he or she will be contacted regarding the billing.
    c. Send a Modernized Development Worksheet to the servicing PSC to verify if the individual is eligible for Disaster Relief for the recent hurricanes.
    5. Other information

    The devastation of the hurricanes has caused many people to relocate temporarily to other states. All states are collaborating to ensure that affected individuals receive the assistance they require. Refer individuals requiring assistance with state administered programs to their state’s social services agency.

    Direct all program related and technical questions to your Regional Office (RO) support staff or to your PSC Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions or problems to their Headquarters contacts.


    References:
    HI 01001.020 Collection of Premiums
    HI 01001.025 Payment by Remittance
    HI 01001.030 Billing Process
    HI 01001.090 Receipt of Premiums in the Field Office (FO)
    HI 01001.225 When Premium Notices May Be Sent to an Individual Other Than An Enrollee
    HI 01001.300 Field Office (FO) Action When Enrollee Protests Determination
    HI 01001.355 Extension of Grace Period for Good Cause
    HI 01001.360 “Good Cause” Defined


    EM-17038 - Disaster Procedure–Disaster Relief for Direct Billing Medicare Beneficiaries affected by Recent Hurricanes—One-Time-Only Instructions---ACTION - 10/31/2017