1. Dual Coverage
  2. QMB Only
    1. End Date Established
    2. End Date Not Established

Some Medicare Part A beneficiaries living in Revised textnursing homes can have HFS pay their Medicare premiums, coinsurance, and deductibles. They must have been found eligible as a Qualified Medicare Beneficiary (QMB). Do not require a screening for QMB eligible persons, during the benefit period in which Medicare covered SNF services are received.

There are 2 types of QMBs:

  • dual coverage who receive Medicaid and QMB; and
  • QMB only.

Dual Coverage

Dual coverage QMBs are eligible for both QMB benefits and cash and/or medical benefits. HFS pays the coinsurance amount, if any, while Medicare-covered SNF services are provided. The income of QMB eligible persons is never applied to Medicare-covered SNF services.

Example: Ms. R is a Medicare Part A beneficiary who is in a Revised textnursing home (NH). She receives Social Security benefits of $670 monthly and Medicaid. Since countable income is less than the one-person QMB income standard, Ms. S is also eligible for QMB benefits.

  1. (FCRC) Figure available income to apply to long term care (see PM 15-06-02 and WAG 15-06-02).
  2. (FCRC) Enter the credit amount in New textthe MMIS LTC subsystem. (Revised textOptional: Enter the credit amount in Section C of either Long Term Care Authorization (Form 2299) or Long Term Care Authorization Update (Form 2449), as appropriate.)
  3. (CO) Sends the facility a monthly prepayment form based on the information in MMIS LTC system. The credit amount shows only the cost of Medicaid payable services.
  4. (Facility) Does not collect the credit amount shown on the Form 2299 or Form 2449 for these persons during a period of Medicare-covered SNF services.

Example: Ms. D is a Medicare Part A beneficiary who is in an Revised textNH. She receives SSA of $670 monthly and Medicaid. Since countable income is less than the one person QMB income standard, Ms. D is also eligible for QMB benefits.

Ms. D is transferred to a Medicare certified bed. The FCRC is notified that full Medicare coverage begins 07/01 and ends 07/20, unless other changes occur. The coinsurance period of up to 80 days starts 07/21.

Ms. D's condition changes and she is transferred to a non-Medicare covered SNF level of care on 08/16. The FCRC is notified that the coinsurance period ends on 08/15.

Enter Ms. D's monthly available income in New textthe MMIS LTC subsystem. This amount if figured to be $640 ($670 - $30 = $640). Enter the effective date of 07/01 and COS 65 in New textthe MMIS LTC subsystem. (Revised textOptional: Enter income in Section C of Form 2449; enter 07/01 effective date and COS 65 in Section D of Form 2449.)

Revised textWhen the coinsurance period begins, enter the effective date of 07/21 and COS 72 in New textthe MMIS LTC subsystem. (Revised textOptional: Revise Form 2449 when the coinsurance period begins by entering the effective date of 07/21 and COS 72 in Section D.)

The facility is sent a prepayment report indicating that Ms. D's credit amount is zero, since the billing period is for only Medicare-covered SNF service days. The facility does not collect the credit shown on the Form 2449. HFS pays the coinsurance amount, if any, for 07/21 through 08/15 when Medicare-covered SNF services were provided.

Treat income remaining after the month of receipt as a Revised textresource. Verify Revised textresources at the end of a period of Medicare-covered SNF services.

Apply Revised textresources that are more than the Revised textresource limits to the customer's monthly countable income when figuring the amount available to apply to long term care costs.

Figure the amount to apply to the August billing period. Enter 08/01 in New textthe MMIS LTC subsystem with the amount figured as a credit. (Revised textOptional: Enter 08/01 and the credit amount in Section C of Form 2449.)

Revised textWhen Medicare-covered SNF services stop, enter the effective date of 08/16 and COS 70 in New textthe MMIS LTC subsystem. (Revised textOptional: Enter the 08/16 effective date and COS 70 in Section D of Form 2449.)

QMB Only

QMB only customers do not receive Medicaid. HFS pays Medicare premiums, deductibles, and coinsurance only for Medicare-covered services. Do not apply the income of QMB only customers to Medicare-covered SNF services.

Example: Mr. J is a Medicare Part A beneficiary living in an Revised textNH. He receives Social Security benefits of $700 per month and has nonexempt Revised textresources of $3500. Mr. J has been found eligible for QMB benefits. HFS will pay for only Medicare premiums, deductibles, and coinsurance charges for all Medicare-covered services.

End Date Established

  1. (FCRC) New textEnter authorization in the MMIS LTC subsystem to start an admit when:
    • a QMB only customer is receiving Medicare-covered SNF services; and
    • benefits are subject to coinsurance; and
    • the end date of the coinsurance is established.
    • Revised textOptional: Complete Long Term Care Authorization (Form 2299) to start an admit.
  2. (FCRC) Enter the date the coinsurance period is effective in New textthe MMIS LTC subsystem. (Revised textOptional: Enter in Sections A, C, and D of Form 2299.)
  3. (FCRC) Enter zero in New textthe MMIS LTC subsystem. (Revised textOptional: Enter in Section C of Form 2299 under "Amount".)
  4. (FCRC) Enter the date following the date that the coinsurance period has been met in New textthe MMIS LTC subsystem. (Revised textOptional: Enter the date in Section D of Form 2299 under "End Date".)

    Example: The coinsurance period is effective for the period 04/01 through 04/08. Enter 04/09 in New textthe MMIS LTC subsystem. (Revised textOptional: Enter 04/09 in Section D of Form 2299 under "End Date".)

  • Deleted text

End Date Not Established

  1. (FCRC) Revised textInitiate an admit in the MMIS LTC subsystem when:
    • a QMB only customer is receiving Medicare-covered SNF services; and
    • benefits are subject to coinsurance; and
    • the end date of the coinsurance is not established.

      Revised textOptional: Complete Form 2299 to initiate admit. 

  2. (FCRC) Enter the date the coinsurance period is effective in New textMMIS LTC subsystem. (Revised textOptional: Enter the date in Sections A, C, and D of Form 2299.)
  3. (FCRC) Enter zero in New textMMIS LTC subsystem. (Revised textOptional: Enter zero in Section C of Form 2299 under "Amount".)
  4. (FCRC) Do not enter an end date in New textMMIS LTC subsystem Revised textor in Section D of Form 2299.
  5. (FCRC) When Medicare-covered SNF services end, process a discharge transaction New textin the MMIS LTC subsystem effective the date following the date that Medicare-covered SNF services end. (Revised textOptional: Complete Form 2449 when Medicare-covered SNF services end.)
    1. Use Code D9, Discharge Destination - Other, for this transaction. No payment is made for the discharge date for Code D9 discharges.