Page 53a-1
PRA-OMB # 0938-XXXX
Revision: HCFA-PM-95-3 (MB)
May 1995
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
State/Territory:
“DRAFT”
Limitations on Estate Recovery - Medicare Cost Sharing:
(i) Medical assistance for Medicare cost sharing is protected from estate recovery for the following categories of dual eligibles: QMB, SLMB, QI, QDWI, QMB+, SLMB+. This protection extends to medical assistance for four Medicare cost sharing benefits: (Part A and B premiums, deductibles, coinsurance, co-payments) with dates of service on or after January 1, 2010. The date of service for deductibles, coinsurance, and co-payments is the date the request for payment is received by the State Medicaid Agency. The date of service for premiums is the date the State Medicaid Agency paid the premium.
(ii) In addition to being a qualified dual eligible the individual must also be age 55 or over. The above protection from estate recovery applies to approved mandatory (i.e., nursing facility, home and community-based services, and related prescription drugs and hospital services) as well as optional Medicaid services identified in the State plan, which are applicable to the categories of duals referenced above.
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information, unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-XXXX. The time required to complete this information collection is estimated to average 2 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
CMS-10314
PRA expiration date: MM/YYYY
TN No.:
Supersedes Approval Date: Effective Date:
TN No.:
| File Type | application/msword |
| File Title | MIPPA S-115 Preprint |
| Subject | State Plan Preprint -estate recovery |
| Author | CMS |
| Last Modified By | CMS |
| File Modified | 2010-09-08 |
| File Created | 2010-09-08 |