As Medicare Part B premiums for SLMB eligibles are paid through the regular Buy-In procedure, the initial process takes 60-90 days to complete. It is then necessary to ensure the continuity of SLMB eligibility to avoid breaks in the Part B premium payment. Thus, as in the QMB program, SLMB cases are automatically opened and closed to accommodate this continuity. Use the procedures in the following sections to ensure that breaks in SLMB coverage do not occur in these situations::
When an individual who is receiving as a SLMB only applies for and is determined eligible for another type of assistance, do not close the SLMB only case. Approve the new type of assistance and enter SLMB eligibility as “L” in Field 13M1, and the original date of SLMB eligibility in Field 13M2 of IMU5. On the same date that this action is processed, the system will automatically close the SLMB only case. SLMB eligibility continues uninterrupted on the new type of assistance. This transaction produces an “L” TOA turnaround IM-5 with a case action code of “29C” and a reason for closing of “39”. Additionally, the action will be listed on the “Daily Transaction” report.
When a SLMB recipient is determined ineligible for SLMB at the same time you determine eligibility for another type of assistance, approve the other type of assistance and enter “N” in Field 13M1. No entry is required in Field 13M2. The system will automatically close the SLMB only case with case action code “29C” and reason for closing of “39”. When taking this type of action, remember that regular IM-80 procedure apply.
NOTE: Individuals receiving SLMB group 2 or 3 must be closed prior to approving for another TOA providing Medicaid.
NOTE: Groups 2 and 3 are not eligible with another type of assistance.
When an individual receiving another type of assistance and SLMB group 1 coverage, reports a change, re-determine eligibility for both programs. If the change results in ineligibility for the other type of assistance, but SLMB eligibility continues, close the other type of assistance using regular IMU5 procedures, and enter an “L”, “2” or “3” in Field 13M1 and the original date of SLMB eligibility for that group in Field 13M2. This is a required entry. Failure to make an entry in this field will result in an on-line edit, which states “QMB/SLMB INDICATOR AND BEGIN DATE ENTRY REQUIRED”.
Enter SLMB budget figures in Fields 33-35. Failure to enter appropriate SLMB budget figures in these fields will result in an edit stating “SLMB EXPENSE INVALID”.
On the same date the above action is processed, the system automatically opens a SLMB only case. This transaction appears on the Daily Transaction report and generates an “L” type of assistance turnaround IM-5 with a case action of “08C”.
NOTE: Do not make a re-entry in Field 13M1 and 13M2 without determining continued eligibility for SLMB. An “L” “2” or “3” entry is, in effect, an approval of SLMB eligibility.
Additionally, when closing another type of assistance and continuing SLMB coverage, use transaction IMU5. As the system must automatically open another case, an overnight function is required. The system will not allow the closing of these cases using the transaction ICLS. An attempt to close these cases, using ICLS will produce the error message “QMB/SLMB INDIVIDUAL ON CASE. USE IMU5 TO CLOSE.”
If a claimant reports a change that establishes ineligibility for both SLMB and another type of assistance, close both cases using regular IMU5 procedures. Additionally, the system requires an entry on “N” in Field 13M1 to close the SLMB case. Failure to make an entry in this field results in the on-line edit as above.
NOTE: Do not make an entry of “N” in Field 13M1 without redetermining eligibility for SLMB “2”. An entry of “N” effectively closes a SLMB case.
Use IM-80 procedures when taking any adverse action. Field staff must follow IM-33 instructions when closing a case.