Navigating the Buy-in October 1, 2009. Situation #1 Nancy Nancy is turning 65 next month. She will...

Navigating the Buy-in

October 1, 2009

Situation #1 Nancy

Nancy is turning 65 next month. She will receive $867.00 in RSDI starting next month.

Should this recipient Buy-in for Part A?

No Yes If yes what date? __________

Should this recipient Buy-in for Part B?


Answer: Situation #1 Nancy

Nancy is turning 65 next month. She will receive $867.00 in RSDI starting next month.


No, it is free.


Yes, 11/01/09.

Situation #2 Carl

Carl is 58 years old and receives SSI of $674.00 for disability and MSA of $81.00.





Answer: Situation #2 Carl

Carl is 58 years old and receives SSI of $674.00 for disability and MSA of $81.00.


No, he does not have Medicare eligibility.


No, he does not have Medicare eligibility.

Situation #3 Lenny

Lenny is 32 and receives RSDI of $400.00 and SSI of $294.00. His Medicare began 9/1/09.





Answer: Situation #3 Lenny

Lenny is 32 and receives RSDI of $400.00 and SSI of $294.00. His Medicare began 9/1/09.

Should this recipient Buy-in for Part A? No, it is free.

Should this recipient Buy-in for Part B? Yes, 9/01/09. Lenny is categorically eligible

for the buy-in due to SSI and MA even if the worker does not open QMB.

What is the Buy-in?

The Buy-in is a 2-part data exchange between DHS and CMS that pays Medicare premiums for eligible individuals.

Part 1: DHS sends data via MMIS to CMS, to communicate which MHCP recipients appear eligible, or have lost eligibility, to have their Medicare A or B premiums paid by the State of Minnesota.

Part 2: CMS responds. They will either accept, reject, or modify the DHS request.

MAXIS and the Buy-in

MAXIS has to have the correct information before the buy-in process can work correctly in MMIS.

STAT UNEA must have the income start date STAT MEDI must be entered including the

Medicare claim number Be approved on a Medicare Savings Program

(MSP) in Health Care Eligibility

Buy-in Eligibility

To be eligible for the Buy-in a person must qualify for Medicare and:

Be enrolled in an MSP Be enrolled in MA, entitled to premium-free Medicare

Part A, and be enrolled in one of the following programs: Minnesota Supplemental Aid (MSA) Minnesota Family Investment Program (MFIP) 1619(a) or 1619(b) SSI status IV-E Adoption Assistance IV-E Foster Care Group Residential Housing (GRH)

Buy-in Referral

Refer people not enrolled in Medicare who are eligible for the buy-in to SSA.

Check TPQY in MAXIS to ensure there are no discrepancies in the person’s name or DOB

Complete and send DHS-3439 Medicare Buy-in Referral Letter

Allow 60 days to apply for Medicare and return confirmation portion of the referral letter

Update STAT PBEN in MAXIS and track return of letter on DAIL/TIKL

Process MSP eligibility upon receipt of the letter

Previous Medicare Entitlement

Do not refer people who have Part A only or Part B only or who have had Medicare previously. They are already known to SSA and do not need to reapply for Medicare to have entitlement reestablished.

Not Entitled to Premium-Free Part A

People who qualify for Medicare, but are not entitled to premium-free Medicare Part A, including people who receive SSI only who are age 65 or older, must be enrolled in QMB to participate in the buy-in. QMB will pay the Medicare Part A premium, the Medicare Part B premium, and other Parts A and B cost sharing.

Do not approve retroactive SLMB eligibility for any enrollee who must pay a premium to get Medicare Part A, even if the referral form shows a Medicare begin date in a past or current month. Approve prospective QMB eligibility only for these enrollees.

Accrete/Delete

The communication from DHS (via MMIS) to CMS is called Accrete/Delete.

This process runs 8 working days from the end of the month

Everyone who has active MHCP is evaluated to see if they have become eligible, remain eligible, or have lost eligibility for the buy-in

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Accrete/Delete – October 2009

The MAXIS/MEC2/MMIS Production calendar is available on SIR.

Buy-in Apply

The CMS response to Accrete/Delete is called Buy-in Apply

Buy-in Apply runs on the 6th working day of the month (roughly 3 weeks after Accrete/Delete).

Buy-in Apply may also contain CMS-initiated data that can impact buy-in such as: SSI participation Medicare begin or end dates Medicare ID number changes

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Buy-in Apply for November 2009

The MAXIS/MEC2/MMIS Production calendar is available on SIR.

Buy-in for Part A

Must have Medicare ID# and Part A participation dates on RMCR, which can be interfaced from STAT/MEDI.

Requires program eligibility of QMB or QWD. Must not have an entitlement/non-entitlement

code of “E” on RBUY. The Part A calculated accrete request date

will be the later of RELG or RMCR dates.

Part A Information on

RMCR and RBUY NEXT: RSVL 10/20/08 10:49:16 MMIS RECIP MEDICARE-RMCR TILMM02 10/16/08 PWMW134

01234567 12/18/1933 *

BUYIN BETTY X * MEDICARE ID: 333224444M

********************************** RSN: *

- - - - - - - - - - - - M E D I C A R E P A R T A - - - - - - - - - - - -

MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE:

BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP (Y/N)

07/01/08 99/99/99 M *

NEXT: RBYB 10/20/08 11:16:44 MMIS RECIP BUYIN-RBUY TILMM02 10/16/08 PWMW133

01234567 12/18/1933 *

BUYIN BETTY X * MEDICARE ID: 333224444M

********************************** ENTITLE/NON-ENTITLE: Y

PART (A) ACCRETE REQUEST DATE: ACCRETE DATE:

PART (A) DELETE REQUEST DATE: DELETE DATE:

--------------------------BUYIN MONTHLY TRANSACTIONS---------------------------

TXN TXN SUB ACCRETE DELETE ----- PREMIUM ------

DATE CODE CODE DATE DATE AMOUNT DATE

Buy-in for Part B

Must have Medicare ID# and Part B participation dates on RMCR, which can be interfaced from STAT/MEDI

Program eligibility under QMB or SLMB (including QI-1) or

Categorical eligibility of MA with eligibility types 09, 15, 16, 25 or Other MA with “M” indicator (MFIP) or Other MA with MSA/GRH or SSI start dates

on RMSC

Part B Information onRMCR and RMSC

NEXT: RSVL 10/20/08 10:49:16 MMIS RECIP MEDICARE-RMCR TILMM02 10/16/08 PWMW13401234567 12/18/1933 * BUYIN BETTY X * MEDICARE ID: 333224444M ********************************** RSN: * - - - - - - - - - - - - M E D I C A R E P A R T B - - - - - - - - - - - - BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP (Y/N) 07/01/08 99/99/99 M * ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12 PAGE S/EXT N/EXT OOPS HELP

NEXT: RHCI 10/20/08 11:34:48 MMIS RECIPIENT INFO-RMSC TILMM02 10/16/08 PWMW12M01234567 12/18/1933 * BUYIN BETTY X * ********************************** - - - - M I S C E L L A N E O U S - - - - SSI BEGIN DATE: 08/01/2005 SSI END DATE: 99/99/9999 RSDI INCOME (Y/N): RAILROAD INCOME(Y/N): RSDI BEGIN DATE: RSDI END DATE: MSA/GRH GRANT BEG DATE: 12/01/2007 MSA/GRH GRANT END DATE: 99/99/9999 MFIP BEGIN DATE: MFIP END DATE: PREGNANCY BEGIN DATE: PREGNANCY END DATE:

Determining the Part B Accrete Request Date

The Medicare begin date is compared to RELG begin date and the later of the 2 dates is remembered as DATE 1.

For categorical buy-in, further date checking is required. The MSA/GRH date is compared to SSI date on RMSC and the earlier date is remembered as DATE 2.

The Part B calculated accrete request date will be the later of DATES 1 and 2.

Calculating DATE 1

In this example DATE 1 would be 06/01/08

NEXT: RIDS 06/16/08 09:26:24 MMIS ELIGIBILITY-RELG TILSN83 04/24/05 PWMW127 00000000 00/00/0000 * SMITH SAM S * ********************************** - - - - - - - - - - - - - - E L I G I B I L I T Y - - - - - - - - - - - - - - 01 PRG: MA ELIG TY: EX CASE: 00000000 ELIG BEGIN: 01/01/08 ELIG END: 99/99/99 CFR: 018 STATUS: A REASON: 99 STATUS DATE: 01/03/08 DATE ADDED: 01/03/08 INDICATOR: N APPL DT: 01/01/08

NEXT: RSVL 06/16/08 09:26:52 MMIS RECIP MEDICARE-RMCR TILSN83 4/24/05PWMW13400000000 00/00/0000 * SMITH SAM S * MEDICARE ID: 123456789A ********************************** RSN: * - - - - - - - - - - - - M E D I C A R E P A R T B - - - - - - - - - - - - MEDICARE PART B BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP (Y/N) 06/01/08 99/99/99 F

Calculating DATE 2

In this example DATE 2 would be 01/01/08

NEXT: RHCI 06/16/08 09:43:50 MMIS RECIPIENT INFO-RMSC TILSN83 04/24/05 PWMW12M

00000000 00/00/0000 *

SMITH SAM S *

********************************** - - - - M I S C E L L A N E O U S - - - -

SSI BEGIN DATE: 03/01/08 SSI END DATE: 99/99/99

RSDI INCOME (Y/N): RAILROAD INCOME(Y/N):

RSDI BEGIN DATE: RSDI END DATE:

MSA/GRH GRANT BEG DATE: 01/01/08 MSA/GRH GRANT END DATE:

MFIP BEGIN DATE: MFIP END DATE:

PREGNANCY BEGIN DATE: PREGNANCY END DATE:

Determining the Part B Accrete Request Date

DATE 1 and DATE 2 are now compared to determine the accrete request date

In this example: DATE 1 is 06/01/08 (Medicare begin date) DATE 2 is 01/01/08 (SSI begin date)

DATE 1 is the later of those 2 dates, so the Part B accrete request date is calculated to be 06/01/08.

Determining the Accrete Request Date – Part A or B

The next step in determining the accretion date is checking whether buy-in previously existed. If so, the new accrete request date must be after the prior period.

NEXT: RBYD 06/16/08 09:02:16 MMIS RECIP BUYIN-RBYB TILSN83 04/24/05 PWMW13300000000 00/00/0000 * SMITH SAM S * MEDICARE ID: 123456789A

********************************** ENTITLE/NON-ENTITLE: * PART (B) ACCRETE REQUEST DATE: ACCRETE DATE: 06/01/05 PART (B) DELETE REQUEST DATE: DELETE DATE: 06/30/08 --------------------------BUYIN MONTHLY TRANSACTIONS------------------------ TXN TXN MCARE ACCRETE DELETE ----- PREMIUM --- DATE CODE PART DATE DATE AMOUNT DATE

The calculated accrete request date was 06/01/08. In this situation the actual accrete request date sent to CMS would be 07/01/08.

Determining the Accrete Request Date – Part A or B

The accrete request date is systematically limited to 6 months retroactive to the current month.

For example, if there is a delayed eligibility determination and the begin date is more than 6 months in the past, the buy-in start date would be limited to 6 months ago.

Manual requests allow for buy-in to cover the period earlier than 6 months ago. MMIS User Services can key these requests.

Situation #4 Trisha

Trisha is 39 years old and receives RSDI of $1000.00 per month for disability starting 11/1/06. She has Medicare Part A that began 11/1/08 and she refused Medicare Part B when it was offered in 11/1/08. She came in today to apply for Health Care programs and is eligible for MA with a Spenddown effective 9/1/09. She has opted not to apply her Medicare premium to her Spenddown.

Should this recipient Buy-in for Part A? No Yes If yes what date? __________

Should this recipient Buy-in for Part B? No Yes If yes what date? __________

Answer: Situation #4 Trisha

Trisha is 39 years old and receives RSDI of $1000.00 per month for disability starting 11/1/06. She has Medicare Part A that began 11/1/08 and she refused Medicare Part B when it was offered in 11/1/08. She came in today to apply for Health Care programs and is eligible for MA with a Spenddown effective 9/1/09. She has opted not to apply her Medicare premium to her Spenddown.


Should this recipient Buy-in for Part B? Technically Yes she should buy-in for Part B 9/1/09, however

there are no Part B begin dates on RMCR so she will not be picked up on the buy-in until there are dates. This panel interfaces from the STAT MEDI panel.

Situation #5 Joe

Joe is 32 and receives RSDI in the amount of $420.00 that began 9/1/07 and SSI in the amount of $274.00 that began 8/1/07 for disability. He is Medicare eligible beginning 9/1/09. He applied for Health Care programs on 10/1/09. He is eligible for MA 10/1/09 as he did not request retroactive coverage.



Answer: Situation #5 Joe

Joe is 32 and receives RSDI in the amount of $420.00 that began 9/1/07 and SSI in the amount of $274.00 that began 8/1/07 for disability. He is Medicare eligible beginning 9/1/09. He applied for Health Care programs on 10/1/09. He is eligible for MA 10/1/09 as he did not request retroactive coverage.


Should this recipient Buy-in for Part B? Yes 10/01/09 if picked up by the Categorical Buy-in due to the

receipt of SSI with MA. 09/01/09 if opened on a MSP in MAXIS and coded on RELG in MMIS.

Determining Part A Delete Date

Medicare end date is populated on RMCRor

Program eligibility has ended on RELG or Entitle/Non-entitle code of “E” for Part A

received

The delete date will be the eligibility or Medicare end date or the end of the previous month in the case of the “E” coding.

Determining Part B Delete Date

Medicare end date is populated on RMCR

or Program eligibility has ended on RELG

or Categorical eligibility has ended on RELG or

RMSC (elig type, “M” Indicator, SSI, MSA/GRH)

The delete date will be the eligibility/Medicare end date, or the end of last month.

Accrete/Delete Request Dates

RBUY and RBYB each have accrete and delete request date fields to indicate whether Accrete/Delete has determined a change in buy-in status or whether a manual request has been keyed:

NEXT: RBYB 06/19/08 08:31:37 MMIS RECIP BUYIN-RBUY WMW1740 06/15/06 PWMW133

00000000 03/08/1937 *

SMITH SAM R * MEDICARE ID: 123456789A

********************************** ENTITLE/NON-ENTITLE: Y

PART (A) ACCRETE REQUEST DATE: 06/01/08 ACCRETE DATE:

PART (A) DELETE REQUEST DATE: DELETE DATE:

RBUY after Buy-in Apply

NEXT: RBYD 06/16/08 09:02:16 MMIS RECIP BUYIN-RBUY TILSN8300000000 00/00/0000 * PIPER PETER R * MEDICARE ID: 123456789A

********************************** ENTITLE/NON-ENTITLE: * PART (A) ACCRETE REQUEST DATE: ACCRETE DATE: 09/01/08 PART (A) DELETE REQUEST DATE: DELETE DATE: 99/99/99

--------------------------BUYIN MONTHLY TRANSACTIONS---------------------------

TXN TXN SUB ACCRETE DELETE ----- PREMIUM ------

DATE CODE CODE DATE DATE AMOUNT DATE

10/01/08 1161 09/01/08 846.00 09/01/08

Basics of Buy-In TXN Codes

The MMIS User Manual has a complete list of Buy-In related transactions and Worker Messages, along with

guidelines for worker action


Accrete/Delete transaction codes The txn codes we send to CMS do not appear on

RBUY/RBYB but are useful to know in relation to the response codes

51 = delete request 53 = delete request due to death 61 = accrete request 75 = simultaneous accrete/delete request 99 = informational


When an accrete/delete transaction is accepted by CMS we will get these response codes

1161 = CMS accepted an accrete request 1751 = CMS accepted a delete request 1753 = CMS accepted a delete request due to DOD

When an accrete/delete transaction is rejected by CMS we will get these response codes:

2051, 2053 = CMS rejects deletion request 2161, 2175 = CMS rejects an accretion request


CMS-initiated transactions: 41 = ongoing buy-in 14, 15 = CMS reports Medicare entitlement ended 16 = CMS reports a DOD 1728 = CMS reports potential residence outside of

Minnesota 44 = Subsidy for Medicare Part B premium was

received by CMS 45 = Subsidy for Medicare Part B premium has

ended

Navigating the Buy-In

Higher Priority Worker Messages

Buy-In Worker Messages

BUY-IN ACCRETION REJECTED FOR PART (A or B). REASON CODE (A, B, C, D, or E). REVIEW

Txn Code: 2161 Definition: Accrete request was rejected due to

MMIS/CMS discrepancies MMIS: creates buy-in occur span with attempted accrete

date and removes Accrete Request Date Action: depends on reason code Why Important: If enrollee is only Medicare eligible based

on premium payment, enrollment in Medicare A and B is delayed until rejection is resolved.


A: No match to Medicare ID# on the Electronic Data Base (EDB). Check BENDEX or send new TPQY.

B: Name, DOB, or sex code discrepancy between MMIS and EDB. Verify accuracy and update MAXIS/MMIS accordingly.

C for Pt A: Part A is free, or person does not have Part A. Verify Part A dates, and update MAXIS/MMIS accordingly.

C for Pt B: Accrete request is based on QM or SL and EDB shows no Part A coverage. Confirm Pt A eligibility (BENDEX, TPQY). If recipient is not eligible, close QM or SL.


D for Pt A: no record of Pt B buy-in, which is required before Pt A accretion.

D for Pt B: accrete attempt is based on QWD, and QWD does not pay for Part B.

E: no Medicare entitlement. If recipient appears entitled to Medicare, refer to SSA.

For all these worker messages: If data in MMIS has been verified as correct, contact MMIS User Services.

TIP: check the Entitlement/Non-Entitlement code on RBUY and RBYB when this worker message is received.

Entitlement/Non-Entitlement Example

NEXT: RBYB 06/20/08 11:25:30 MMIS RECIP BUYIN-RBYB FMLMMBP00000000 00/00/00000 * BIRD BIG A * MEDICARE ID: 000000000A

********************************** ENTITLE/NON-ENTITLE: C PART (B) ACCRETE REQUEST DATE: ACCRETE DATE: PART (B) DELETE REQUEST DATE: DELETE DATE: --------------------------BUYIN MONTHLY TRANSACTIONS--------------------------- TXN TXN SUB ACCRETE DELETE ----- PREMIUM ------ DATE CODE CODE DATE DATE AMOUNT DATE1 10/01/08 2161 E 06/01/08

Pt B Entitlement/Non-Entitlement codes available via PF12: C NOT ENTITLED NO DISABILITY D COVERAGE DENIED F TERMINATED INVALID VOIDED G ENTITLED GOOD CAUSE N NOT ENTITLED FOREIGN OR DUAL R REFUSED BENEFITS S TERMINATED NO ENTITLE ESRD T TERMINATED NON PAY PREMIUM W VOLUNTARYWITHDRAWAL Y ENTITLED PREMIUM PAYABLE


BUY-IN TERMINATED DUE TO DEATH. VERIFY DATE OF DEATH

Txn: 16 A/B Definition: CMS deleted recipient from buy-in due to

death MMIS: adds delete date on RBUY/RBYB and ends

RMCR span Action: verify recipient’s status. If death is incorrect

refer client to SSA to correct and reopen Medicare. If deceased, add DOD and close case.


NEW MEDICARE CLAIM NBR REPORTED ON BUY-IN FILE

Txn: 23xx Definition: Medicare number changed. MMIS: new claim number added to MMIS, prior

number moves to RIDS Action: update claim number in MAXIS


SSA REPORTS NON MN ADDRESS. VRFY/UPDATE CLIENT ADDRESS

Txn: 1728 Definition: CMS deleted from buy-in because

another state has requested accretion or SSI records indicate residence in another state.

MMIS: delete date added to RBUY/RBYB Action: verify client address. If still a

Minnesota resident, refer to SSA. If not, close case.


CMS REPORTS SSI BEGIN. MMIS UPDATED. Txn: 86 Total txn: 590 (March) Definition: Medicare beneficiary became SSI eligible

(with potential buy-in eligibility). Txn may also include Part A entitlement date

MMIS: SSI start date added to RMSC, and Medicare start date if included. May trigger a categorical accretion if other factors met.

Action: verify SSI amount for effect on other programs


CMS REPORTS SSI ENDED. RMSC UPDATED Txn: 87 Total txn: 443 (March) Definition: SSI eligibility ended (can also end buy-in

unless meets another basis for buy-in) MMIS: deletes SSI Start Date if currently populated ACTION: Verify status of SSI payments for other

programs’ use. This may also indicate a temporary ending of SSI payments.


SSA REPORTS RECIPIENT NO LONGER ELIGIBLE FOR MEDICARE

Txn: 15 Definition: deleted from buy-in because Medicare

ended MMIS: delete date added to RBUY/RBYB and

Medicare end date added on RMCR Action: review client record, particularly entitlement

coding. If Medicare eligibility appears to exist, refer client to SSA. Re-open Medicare if eligibility is re-established.

How to Properly End a MEDI Span

When a 15 txn is received from CMS, STAT/MEDI needs to be updated.

However, it’s not as simple as just adding an end date if Medicare dates were previously verified in MAXIS…

If MAXIS looks like this:

06/19/06 11:17:28 MAXIS FMCGNAM1 CAF Question 44 Medicare (MEDI) 1 Of 1 Ref Last First M * Ref Nbr: 01 SMITH, SAM 01 SMITH SAM* * Medicare Claim Nbr: 999 99 9999 A__ Ver: V * Part A Premium: $ ________ Part B Premium: $ 88.50 * Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __ * Qualified Working Disabled Individual (Y/N): N * Apply Premiums To Spdn/Budgets (Y/N): N * Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __ * Part A Part B * Begin Dt End Date Ver Begin Dt End Date Ver * 04 01 00 __ __ __ V 04 01 00 __ __ __ V * __ __ __ __ __ __ __ __ __ __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * Shift PF7/PF8 To Scroll Part A/B Dates Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __ Sv: 00 PW: X100000 SW: Updated: 11 26 05 User: PWGAP53

And MMIS looks like this: NEXT: RSVL 06/19/06 11:20:36 MMIS RECIP MEDICARE-RMCR WMW1740 06/15/06

PWMW134 00000000 00/00/0000 * SMITH SAM M * MEDICARE ID: 999999999A ********************************** RSN: 1 - - - - - - - - - - - - M E D I C A R E P A R T A - - - - - - - - - - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F * - - - - - - - - - - - - M E D I C A R E P A R T B - - - - - - - - - - - - BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F *

And if you do this in MAXIS… 06/19/06 11:17:28 MAXIS FMCGNAM1 CAF Question 44 Medicare (MEDI) 1 Of 1 Ref Last First M * Ref Nbr: 01 SMITH, SAM 01 SMITH SAM* * Medicare Claim Nbr: 999 99 9999 A__ Ver: V * Part A Premium: $ ________ Part B Premium: $ 88.50 * Buy In Begin Date: 04 01 00 Buy In End Date: __ __ __ * Qualified Working Disabled Individual (Y/N): N * Apply Premiums To Spdn/Budgets (Y/N): N * Apply Premiums To Spdn/Budgets Thru (MM/YY): __ __ * Part A Part B * Begin Dt End Date Ver Begin Dt End Date Ver * 04 01 00 __ __ __ V 04 01 00 __ __ __ V * 04 01 00 05 31 06 04 01 00 05 31 06 * __ __ __ __ __ __ __ __ __ __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * Shift PF7/PF8 To Scroll Part A/B Dates Mode: D Function: STAT Case Nbr: __999999 Month: 06 06 Command: ____ __ __ Sv: 00 PW: X100000 SW: Updated: 11 26 05 User: PWGAP53

…MMIS will look like this: PWMW134 00000000 00/00/0000 * SMITH SAM M * MEDICARE ID: 999999999A ********************************** RSN: 1 - - - - - - - - - - - - M E D I C A R E P A R T A - - - - - - - - - - - - MEDICARE PART A BENEFITS EXHAUSTED (Y/N): DATE: BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F * 04/01/00 05/31/06 M - - - - - - - - - - - - M E D I C A R E P A R T B - - - - - - - - - - - - BEGIN DATE END DATE SRC PPHP (Y/N) BEGIN DATE END DATE SRC PPHP 04/01/00 99/99/99 F *

04/01/00 05/31/06 M

To end a verified Medicare span:

Complete a PF11 on STAT/MEDI. Include the verified end date

Fax the proof of the end date to (651) 431-7419, including the PF11 reference number on the fax.

See TE02.07.453 or QTIP 114 for complete instructions

Navigating the Buy-In

SSI recipient turning 65 scenario

SSI Recipient Turns 65

Federally-funded MA enrollees who receive SSI only and who become age 65 or are older, must enroll in Medicare Part A and Part B if they are eligible.

Failure to enroll is considered non-cooperation with third party liability and results in ineligibility for MA.


These enrollees are required to pay a premium for BOTH Part A and Part B

DHS pays these costs directly to CMS through the buy-in when QMB is approved and entered in MMIS.

Enrollees must apply and be determined eligible for Medicare before these payments can begin through the buy-in.


MMIS User Services generates monthly reports to identify these MA enrollees three months before their 65th birthday and sends MAXIS emails to associated workers.

This contact is designed to help workers initiate the Medicare enrollment process one month earlier than prompted by the current MMIS worker message “Client turns 65. Enter Medicare claim number” that is issued two months in advance for all recipients turning age 65.


When notified by MMIS User Services: Check TPQY in MAXIS for discrepancies in:

Enrollee Name - first, last, middle initial Date of Birth

Send new QURY if TPQY is older than 6 months

CMS data is shown on the BDXP screen

TPQY Screens06/20/06 07:35:14 MAXIS FMLTPAM1 Third Party Query Response (TPQY) MAXIS Data Name: JAMES J CASEY SSN: 569 85 2147 Clm No: Birthdate: 09 10 1930 SVES Response Date: 03 31 06 Unmatched Data Report Date: SSN Ver: V RSDI Record: Y SSI Record: Y ID Discrepancy: Code: V Text: Qualifying Quarters Qualifying Quarters Through 12/96: Qualifying Quarters From 01/97: _ Total Questionable Quarters: Function: SVES Case Nbr: ________ Month: 06 06 Command:

TPQY Screens

Beneficiary Data Response (BDXP)

Name: JIM J CASEY SSN: 569 85 2147 Clm No: 569852147M Dual Entl Nbr: Payment Status: N DISALLOWED CLAIM

Pay Date Gross Amt Net Amt Birthdate: 09 10 1930 $ $ Railroad Ind: $ Lump Payment Date: $ Lump Sum Amt:$ $ Intl Entl Date: 12 90 $ Current Entl Date: 11 03 $ Deferred Payment Date: $ Susp/Term Date: $

Response Date: 03 31 06

TPQY ScreensState Data Response (SDXE) Name: JAMES J CASEY SSN: Clm No: 569852147 Birthdate: 09 10 1930 SSI Appl Date: 11 17 03 Fed Liv Arrange: A Recipient Type: DI DISABLED INDIVIDUAL Payment Status: C01 CURRENT PAY Denial Code: Denial Date: Appeals Code: Onset Date Disa/Blind: 11 01 03 Appeals Date: SSI/Opt SSP Elig Date: 11 01 03 Appeals Decision Code: Appeals Decision Date: Disa Pay Code: F Response Date: 03 31 06


If a discrepancy exists: Advise the enrollee of the specifics of the

discrepancy when sending them the referral to SSA to ensure the error is resolved when he/she goes to the SSA office to apply for Medicare

Advise the enrollee to take original documentation such as a birth certificate or immigration/naturalization papers with them to resolve the error


Complete the County Agency section of the Medicare Buy-in Referral Letter (DHS 3439) and provide it to the enrollee with a county-addressed return envelope. The enrollee must take this form and the county-addressed envelope to the SSA when applying for Medicare. Find DHS 3439 online at:

http://edocs.dhs.state.mn.us/lfserver/Legacy/DHS-3439-ENG

DHS 3439


When referring to SSA, update STAT/PBEN: Benefit type “19” (Other) referral date verification code of “5” (Other document) DISP (disposition) code of “P” (Pending).

Ref Last First M * Ref Nbr: 01 CASEY, JAMES J

01 CASEY JAMES J *

* Referral Appl IAA

* Benefit Type Date Date Ver Date Disp

* 19 Other 07 10 08 __ __ __ 5 __ __ __ P

* __ __ __ __ __ __ __ _ __ __ __ _


Track for return of the letter in 30 days using DAIL/TIKL.

Contact the enrollee if the letter has not been returned at the end of 30 days.

Determine whether he/she complied with the request to apply for Medicare.

Provide a second referral letter if necessary. Track for an additional 30 days.


Upon receipt of the completed referral letter, enter the STAT/MEDI panel: Use the Medicare Claim Number from the referral form

(usually SSN + “M”)

Enter Part A or Part B Premium amounts Enter Buy-in Begin Date as QMB eligibility begin date Enter ‘N’ for Qualified Working Disabled Individual

(Y/N): Enter ‘N’ for Apply Premiums To Spdn/Budgets (Y/N): Enter Medicare Part A and B begin dates from the

referral form

MEDI ScreenCAF Question 44 Medicare (MEDI) 1 Of 1 Ref Last First M * Ref Nbr: 01 CASEY, JAMES 01 CASEY JAMES J * * Medicare Claim Nbr: 569 85 2147 M__ Ver: * Part A Premium: $ 423.00 Part B Premium: $ 96.40 * Buy In Begin Date: 07 01 08 Buy In End Date: __ __ __ * Qualified Working Disabled Individual (Y/N): N * Apply Premiums To Spdn/Budgets (Y/N): N * Apply Prem To Spdn/Bdgt Thru Date Or Medi Reimb Dt: __ __ * Part A Part B * Begin Dt End Date Ver Begin Dt End Date Ver * 07 01 08 __ __ __ 07 01 08 __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * __ __ __ __ __ __ __ __ __ __ __ __ * Shift PF7/PF8 To Scroll Part A/B Dates Mode: D Function: STAT Case Nbr: __408199 Month: 06 08 Command: ____ __ __ Sv: 90 PW: PWSKC35 SW: Updated: 06 16 08 User: PWSKC35 Enter-PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12--- HELP PMI EXIT CNOTE PNOTE PREV NEXT EDIT OOPS TRBL INFO


Update STAT/HCRE if needed to process QMB eligibility in HC ELIG Update Appl/Addendum Request Date with

the date referral form is received Update Coverage Request Date with the

month QM is to begin Approve QMB eligibility and enter in MMIS. Do not provide retroactive SLMB coverage,

even if the referral form shows a Medicare begin date in the past or current month.

HCRE Screen

Ref Last First M * Health Care Application Date: 09/10/05 01 CASEY JAMES J * * Appl Coverage * Addendum Request * Ref Request Date Recv By * Nbr Name Date (MM/YY) Sv Date * 01 CASEY, JAMES 06 10 08 07 08 __ __ __ * * * * * * * * Shift PF7/PF8 To Scroll HC Appl/Add Requests Mode: D Function: STAT Case Nbr: __408199 Month: 06 08 Command: ____ __ __ Sv: 90 PW: PWSKC35 SW: Updated: 06 16 08 User: PWSKC35 Enter-PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10--PF11--PF12--- HELP PMI EXIT CNOTE PREV NEXT EDIT OOPS TRBL INFO


Put in a DAIL/TIKL if the month Medicare begins is not yet available for processing on MAXIS.

Example: Referral letter is received in March stating

Medicare will begin 5-1-09. May is not yet available for processing on

MAXIS. Put in a DAIL/TIKL for April 1st to determine QMB eligibility as May would then be available on MAXIS.


Confirm on RMCR that Medicare participation data has correctly interfaced from MAXIS to MMIS: Claim number Part A participation dates Part B participation dates

If it has not, contact MMIS User Services to complete the interface.


Enter QMB eligibility on RELG. This may be completed no sooner than two months before the effective date of the QMB eligibility.

Review the RBUY and RBYB panels for accretion request dates. These will display on each panel after QMB has been approved AND a buy-in accrete/delete processing has occurred.

Check MAXIS/MEC2/MMIS production region calendar located in SIR for the dates.


Examples: QMB was approved Mar 13 effective for

Apr 1. As this date is PRIOR TO March’s accrete/delete processing date of 3/20, RBUY/RBYB accrete request dates will display on March 23.

QMB was approved Mar 24 effective for Apr 1. As this date is AFTER March’s accrete/delete processing date of 3/20, RBUY/RBYB accrete request dates will display on April 22, after April’s accrete/delete processing date of Apr 21.


REMEMBER:Enrollees who fail to cooperate with applying for

Medicare are ineligible for MA. Cancel MA coverage with 10-day notice for enrollees

who fail to cooperate. Update PBEN disposition field to “N – Not Applied Yet”

Additional Reference points: HCPM §03.35 Medicare Savings Programs HCPM §04.40 Medicare (and many subsections) TEMP §TE02.07.0326 Enrollment in Medicare Part A and Part B TEMP §TE02.07.0327 Medicare Part A/B and the Buy-in (Part 1) TEMP §TE02.07.0328 Medicare Part A/B and the Buy-in (Part 2) TEMP §TE02.13.40 RSDI/SSI Income Start Dates Instructional Bulletin 06-21-04 Medicare Part D Bulletin

Situation #6 Ansarra

Ansarra is a 70 year old LPR who entered the US 7 years ago. She was open on MA and QMB until 8/31/09 when she auto-closed for no Eligibility Review. Her only income is SSI of $674.00 per month. She came into the office today to reapply for all Health Care programs. She is MA eligible 9/1/09.



Answer: Situation #6 Ansarra

Ansarra is a 70 year old LPR who entered the US 7 years ago. She was open on MA and QMB until 8/31/09 when she auto-closed for no Eligibility Review. Her only income is SSI of $674.00 per month. She came into the office today to reapply for Health Care programs. She is MA eligible 9/1/09.

Should this recipient Buy-in for Part A? Yes, 4/01/09.

Should this recipient Buy-in for Part B? Yes, 11/01/09. For this kind of case there must be

an active Part A to be eligible for Part B.

Never The End

Contact MMIS User Services with questions on specific cases.

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