WAG 06-12-04-a: QMB Only

PM 06-12-04-a

  1. Verify continued enrollment in Medicare Part A. Accept client's statement for financial and nonfinancial factors of eligibility other than Part A enrollment.
  2. Complete Form 2382M.
  3. AABD Medical Review (Form 643C) is sent centrally to cases listed on the PAL with message "REDE FORM 643C CENTRALLY MAILED. DUE BY MM/DD/YY". The mail date printed on the REDE form is the 20th day of the calendar month in which it is printed, or the first work day following the 20th. The REDE due date is the 21st calendar day following the mail date, or the first work day following the 21st day.
  4. Complete Form 157 if cancellation is needed. The notice must give the reason the action is being taken and include a policy reference.
  5. Complete Form 552:
    1. Enter the REDE date.
    2. Enter any changes in social data and/or eligibility.
    3. Complete Item 44.
    4. Complete Items 50 and 51 if blank, or if there is a change.
    5. Complete Item 52 if there is a follow-up review initiated by criteria code. See WAG 19-06-00 for Priority Action List.