[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR408.202]



[Page 287-288]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 408_PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE--Table of Contents

 

 Subpart H_Supplementary Medical Insurance Premium Surcharge Agreements

 

Sec. 408.202  Conditions for participation.



    (a) A State or local government agency may apply to CMS to enter 

into an SMI premium surcharge agreement if the following conditions are 

met:

    (1) Each individual designated for coverage under the premium 

surcharge agreement must be enrolled in Medicare Part B at the time the 

individual is added to the premium surcharge account.

    (2) Each enrollee designated for coverage under the agreement must, 

at the time the individual is added to the premium surcharge account, be 

responsible for paying the base premium and surcharge through direct 

remittance or benefit withholding from Social Security or Railroad 

Retirement benefits or a Civil Service annuity.

    (3) Each enrollee designated for coverage under the agreement must, 

at the time the individual is added to the premium surcharge account, 

not have premiums paid by a State Welfare Agency under a State buy-in 

agreement as described in Sec. 407.40 of this chapter or under a group 

billing arrangement as described in Sec. 408.80.

    (b) The State or local government agency must secure from each 

enrollee a signed, written statement authorizing CMS to send billing 

notices directly to the State or local government agency, and to release 

to the State or local government agency information required under the 

SMI premium surcharge agreement.

    (c) The authorization statement for each enrollee must be retained 

in the State or local government agency files for as long as the 

enrollee is covered by the agreement. These authorization statements 

need not be forwarded to CMS.

    (d) The State or local government agency must certify to CMS, in 

writing, that an authorization statement is



[[Page 288]]



on file for each enrollee covered under the SMI premium surcharge 

agreement. Only one certification is necessary for the entire group of 

covered enrollees.

    (e) A State or local government agency must establish an automated 

data exchange with CMS using the Third Party Premium Collection System, 

in order to transmit electronically an input file that will be used to 

add or remove enrollees from the billing system.