HI 00815.066 Systems Processing of CMS Responsibility Items

The following paragraphs provide an overview of CMS processing of accretion and deletion actions for auto-accrete States.

A. CMS-Initiated Accretions for SSI Recipients

CMS is responsible for accreting SSI recipients to the buy-in rolls for accrete States. Individuals who are potentially eligible for buy-in are identified by internal processes developed by CMS and SSA. Each month the Third Party System receives from SSA a file of records that indicate potential buy-in. The Third Party System examines the data fields and prepares an accretion action if:

  1. 1. 

    The individual is receiving SSI.

  2. 2. 

    The individual is a resident of an accrete State.

  3. 3. 

    Medicare entitlement is contained in the individual"s MBR record.

The Third Party System determines the effective buy-in date based on the individual"s SSI entitlement date, Medicare entitlement date and date of residency in the State. CMS-initiated SSI accretion records will be sent to the States in the regular monthly buy-in data exchange file.

B. CMS-Initiated Deletions

All SSI records which appear on the buy-in files in accrete States are the result of an accretion action taken by CMS for SSI recipients. It is CMS responsibility to delete these individuals if they lose SSI payment status or move to another State regardless of SSI eligibility. Additionally, CMS will transfer buy-in responsibility to the State in several situations where SSI payments have terminated but the individual"s Medicaid eligibility is retained for one of several reasons. (The States have been provided with instructions regarding these individuals.) Accrete States cannot delete SSI records. If the State submits a deletion action, it will be rejected. The States have been provided with specific procedures to follow when there is a discrepancy with an SSI record.

SSI termination events are conveyed to the Third Party System within the same framework as accretion actions. Each month the Third Party System receives SSI termination events and deletes the items from the accrete State"s account. CMS will generate a deletion record to the State in the billing file. The deletion date will be the last month that the individual received an SSI payment.

When an SSI recipient moves to another State, SSA will correct the SSI record to reflect the new State. When this change of State residency is entered in the SSI record, the SSI system will generate a change record to the Third Party System for appropriate action. The Third Party System, upon receipt of the State residency change record, will delete the individual from the accrete State"s account. The deletion date will be the individual"s last month of residency in that State. The new State of residency, which can be an alert State or accrete State, will receive the appropriate CMS-initiated transaction record if SSI entitlement continues.

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HI 00815.066 - Systems Processing of CMS Responsibility Items - 11/20/2001
Batch run: 11/20/2001