Retention Date: January 30, 2020
|Intended Audience:||All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/ODAR|
|Originating Office:||Centers for Medicare & Medicaid Services (CMS)|
|Title:||Medicare Enrollment for Individuals Affected by a Weather-Related Emergency or Major Disaster|
|Type:||EM - Emergency Messages|
|Link To Reference:||See Reference at the end of this EM.|
Recent weather events, which included evacuation and caused major devastation in certain areas, may have affected many individuals’ ability to submit timely Medicare enrollment choices.
B. Enrollment and refusal requests for individuals affected by a Weather-Related Emergency or Major Disaster
Under normal circumstances, individuals 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.
Individuals automatically enrolled in Part B, but who don’t want the coverage, must refuse coverage as outlined in HI 00805.055 and HI 00805.080.
Individuals impacted by mail disruptions and SSA office closings caused by a weather-related emergency or major disaster, may need extra time to enroll in premium-Part A and/or Part B, or refuse automatic Part B enrollment. As such, CMS is providing equitable relief to certain individuals who could not submit their premium-Part A and/or Part B enrollment, or Part B refusal requests timely.
C. Limited Availability of Equitable Relief
Beginning December 1, 2018, consider equitable relief on a case-by-case basis for individuals who, due to a weather-related emergency or major disaster, had difficulties submitting timely IEP or SEP enrollment requests, or IEP Part B refusal requests.
Where weather-related events affected U.S. mail delivery and/or operations at local field offices, consider equitable relief for individuals who:
· At the start of a weather-related incident period, were in their IEP or SEP, and
· Resided in areas for which the Federal Emergency Management Agency (FEMA) declared a weather-related emergency or major disaster.
When you make a favorable equitable relief determination, consider the late premium-Part A and/or Part B IEP or SEP enrollment request as filed timely.
This consideration of equitable relief ends June 30, 2019.
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 potential beneficiary affected by a weather-related emergency or major disaster contacts SSA for any of the following reasons:
1. Non-receipt of their Medicare award notice or Initial Enrollment Period package; or
2. Inability to file an enrollment request or refusal timely.
Equitable Relief FO/N8NN steps:
1. Consider whether the requirements in Section C of these instructions are met.
2. Document the individual’s statement identifying him or her as a resident of an area affected by a weather-related emergency or major disaster.
3. For individuals requesting premium-Part A or Part B enrollment, complete the following steps:
• 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.
• If the individual wants to enroll in Part B, complete Form CMS-40B (Application for Enrollment in Medicare Part B (Medical Insurance)). If the individual 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). Completion of this form is not required for SEP enrollment.
• If the individual 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 individual understands the implications for a retroactive effective date before processing. Follow normal processing procedures if an individual believes he or she cannot afford to pay retroactive Premium-Part A, Part B, or both premiums in a lump sum.
• Include the individual’s Part B effective date and annotate “Resident of the Federal Emergency Management Agency (FEMA) declared disaster areas” in the Remarks section of the CMS-40B. If the individual 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.
• Print the CMS-18-F5 and/or the CMS-40B and, if applicable, the CMS-L564 barcode from NDRED.
4. Prepare a Form SSA-5002 (Report of Contact) giving 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.
5. Fax the completed CMS-40B, 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. Forward the case to the appropriate PSC via Paperless to review and process. TSC should follow routine instructions for sending the case to the PSC.
Equitable Relief PSC steps:
1. Review the individual’s statement and any available evidence in support of the SSA-5002 determination.
2. Process approved equitable relief case following normal equitable relief procedures.
Part B refusal FO steps:
1. Consider whether the requirements in Section C of these instructions are met. If not, equitable relief does not apply.
NOTE: If State Buy-in is currently in effect, the individual cannot refuse or terminate Supplementary Medical Insurance (SMI).
2. Obtain a written statement from the claimant requesting SMI refusal as a resident of the Federal Emergency Management Agency (FEMA) declared disaster areas.
· When an individual 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.
3. Complete the “timely” refusal request by following normal business procedure. Fax the written statement and store in CFRMS.
Forward SMI refusals exceeding six months to the PSC of jurisdiction to process via Paperless.
Part B refusal N8NN steps:
1. Consider whether the case meets the requirements in Section C of these instructions. If not, this equitable relief does not apply.
NOTE: If State Buy-in is currently in effect, the individual cannot refuse or terminate SMI.
2. After providing a complete explanation of the consequences of terminating SMI, if the caller still wishes to terminate his or her coverage:
- Indicate that this is a Request for Termination of SMI, and the date SMI will end,
- Annotate that the claimant requesting SMI refusal is a resident of the Federal Emergency Management Agency (FEMA) declared disaster areas.
1. Review the written statement and available evidence in support of SMI refusal.
4. Mail the CMS-1763 to the individual with a courtesy return envelope to the servicing PSC.
2. Process approved SMI refusal by following normal business procedure.
Direct all program-related and technical questions to your Regional Office (RO) support staff or to your Program Service Center, Operation Analysis (PSC OA) staff. RO support staff or PSC OA staff may refer questions or problems to their Headquarters contacts.
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 00801.133 Enrollment and Coverage Periods
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-18059 - Medicare Enrollment for Individuals Affected by a Weather-Related Emergency or Major Disaster - 11/29/2018