TN 18 (08-23)

DI 13005.060 Processing Medicare for Qualified Government Employment (MQGE) Cases

A. Background on MQGE cases

Section 278 of Public Law (P.L.) 97-248 provides that effective January 1, 1983 government employees will pay hospital insurance taxes. As a result, government employees (and their spouses, widow(ers), children or dependent parents) may be covered by Medicare on the basis of age, disability or end-stage renal disease.

To be eligible for Medicare coverage based on disability an individual must meet the definition of disability in the Social Security Act. In addition, disabled individuals are subject to all conditions and reviews to which regular Title II beneficiaries are subject (for example, extended period of eligibility (EPE), medical improvement expected (MIE), medical improvement possible (MIP), medical improvement not expected (MINE), and trial work period (TWP) diaries, see HI 00801.400.

B. Policy for processing MQGE cases

To process a continuing disability review (CDR) in a Title II case, apply the same procedures for a MQGE case with the following modifications or exceptions:

  1. 1. 

    Do not extend benefit continuation to a MQGE case, see Section 7 of P.L. 98-460. When processing a concurrent (MQGE and Title XVI) cessation case:

    • do not offer Medicare continuation,

    • cease the MQGE portion of the case as if it were Title II only, and

    • route the case as a normal concurrent (Title II and Title XVI) case.

  2. 2. 

    The FO must modify the forms and letters used to conduct these CDRs (except in a determination notice) and remove any reference to benefit payments. Examples of these forms are:

    • SSA-L1216-U2 (RSDI Notice of Continuing Disability Review), and

    • SSA-L1172-U2 (RSDI Notice of Continued Disability Review).

    SSA developed the form SSA-L270-U2 (Disability Continuance Notice) to use in MQGE cases, see DI 31515.201. This form has paragraphs for cessations, EPE, and devised Medicare notification, see NL 00708.100.

  3. 3. 

    When preparing notices for EPE cases as in DI 13095.140, but submit MQGE numbered paragraphs (for example, decisional paragraph (905), explanation of 36-month reinstatement period (906), impairment-related work expenses paragraph (optional) (907 or 908), Medicare paragraph (911 or 912), paragraph MG10, and paragraph MG20).

  4. 4. 

    MQGE cases are DIBCESS exclusions, therefore when preparing to terminate, suspend, or reinstate benefits follow the procedures in DI 13010.215B.

  5. 5. 

    During the EPE when applying reinstatement, in the notice to the beneficiary state, that we determined that they are no longer performing SGA and that they must notify us if there is a change in work activity.

  6. 6. 

    When the DDS has jurisdiction, the DDS will prepare and release all notices of cessation unless the case is under a Quality Assurance (QA) review.

  7. 7. 

    Complete the SSA-833 in the usual manner, but in remarks add “MQGE Case.”

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DI 13005.060 - Processing Medicare for Qualified Government Employment (MQGE) Cases - 08/03/2023
Batch run: 11/07/2023