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Home My WebLink AboutContract 48317 ATY SECRETARY OUNTRACT NO. PART A AGREEMENT Between The Secretary of the Department of Health and Human Services The City of Fort Worth,Texas [Formal Third Party Group Payer] Whereas,The City of Fort Worth, Texas –(hereinafter"Formal Third Party Group Payer") desires to enter into an arrangement with the Secretary of Health and Human Services,to pay the Medicare Part A premiums on behalf of a group of Eligible Individuals,the Secretary and the Formal Third PpM Group Paver hereby agree to the following: A. Definitions For purpose of this agreement— (1) greement(1) "Secretary"means the Secretary of Health and Human Services or his/her delegate. (2) "CMS"means the Centers for Medicare & Medicaid Services.. (3) "Act"means the Social Security Act. (4) "Premium"means money paid out in advance (usually monthly) for insurance coverage. (5) "Formal Third Party Group Payer"means an employer, a lodge,union, or other organization that has entered into a formal agreement with CMS to receive a single bill and pay for the Medicare Part A premiums on behalf of a group of Eligible Individuals. (6) "Eligible Individuals"means those who (1)are currently enrolled under Medicare Part A (Hospital Insurance)and(2)are billed directly by CMS for their Medicare premiums. (7) "Enrollee"means an individual who is enrolled in Medicare Part A. (8) "Late Enrollment Premium Surcharge"or"Premium Surcharge"means the amount Medicare assesses in addition to the monthly Part A premium for individuals who enroll after the expiration of the initial enrollment period, but not in a special enrollment period, or who re-enroll after termination of a coverage period as authorized by section 1839(b)of the Act. (9) "Participant"means an Eligible Individual who has authorized a Formal Third Party Group Payer to pay Part A premiums on the individual's behalf in accordance with regulations at 42 CFR Subpart E. (10) "State Buy-in"means the program under which a State Medicaid Agency may enter into an agreement with the Secretary to enroll and pay Medicare Part A premiums for members of the buy-in group specified in that agreement, as authorized by section 1843 of the Act. (11) "Formal Third Party Group Payer Handbook"means the guide provided to a Formal Third Party Group Payer by CMS that contains the policies and procedures governing the payment of Medicare premiums by a Formal Third Party Group Payer as modified from time to time by CMS. B. Terms of Agreement— (1) greement(1) Formal Third Party Group Payer voluntarily enters into this agreement without expectation of reimbursement from CMS for administrative expenses attributable to carrying out this agreement. (2) Formal Third Party Group Payer may only pay Part A premiums on behalf of Eligible Individuals. (3) Formal Third Party Group Payer may not pay Part A premiums for enrollees who are entitled to Medicare Part A Hospital Insurance without monthly premiums. (4) Formal Third Party Group Payer may not pay premiums for enrollees whose Part A premiums are being paid by a State Medicaid Agency under a buy-in agreement. (5) At the time this agreement is executed,Formal Third Party Group Payer must have a minimum of 20 Participants. (6) Formal Third Party Group Payer must obtain written authorization from the Participant for CMS to send bills and release information to the Formal Third Party Group Payer. (7) Formal Third Party Group Payer must not charge any Participant for any administrative or other expenses incurred by the Formal Third Party Group Payer in carrying out this Agreement. (8) An Eligible Individual will not be billed by CMS for Part A premiums during any month in which the individual is a Participant included in a Formal Third Party Group Payer arrangement. CMS will resume collection of the Part A premiums from the Eligible Individual in accordance with section 1840 of the Act if the Formal Third Party Group Payer agreement is terminated, if the Eligible Individual is no longer included in the Formal Third Party Group Payer arrangement, if the Formal Third Party Group Payer fails to pay, or if the Formal Third Party Group Payer identifies the payment incorrectly. (9) Formal Third Party Group Payer must pay all current Part A premiums, including any Late Enrollment Premium Surcharge, for any Participant included in its Formal Third Party Group Payer arrangement. (10) Formal Third Party Group Payer is responsible for any outstanding premium balance on a Participant's record when a Participant is initially added to the Formal Third Party Group Payer arrangement. (11) Formal Third Party Group Payer must transmit and receive all data electronically. All requirements for electronic data exchange are contained in the Formal Third Party Group Payer Handbook. In the event of a change to the data transmission requirements, CMS will give Formal Third Party Group Payer notice of such revisions. (12) Formal Third Party Group Payer is responsible for supplying CMS with a file that contains records of Participants that it intends to add to the Formal Third Party Group Payer arrangement. Formal Third Party Group Payer may add Participants monthly. CMS' Third Party System will automatically generate an effective date for the addition. In instances where CMS records indicate that there is an outstanding premium balance due from the Participant for a previous month(s), the effective date of the addition will be the earliest month for which a Part A premium is due. In instances where there is no outstanding premium balance, and Formal Third Party Group Payer transmits an addition record to CMS by close of business the next to the last business day of the month, the effective date of the addition will be the next billing month. For example, if Formal Third Party Group Payer transmits an addition record on the 20th of January,the effective date of the addition will be February. If Formal Third Party Group Payer transmits an addition record to CMS after close of business the next to the last business day of the month, and there is no outstanding premium balance,the effective date of the addition will be the month after the next billing month. For example, if Formal Third Party Group Payer transmits an addition record on the 31St of January,the effective date of the addition will be March. If Formal Third Party Group Payer seeks to add as a Participant an enrollee who is not an Eligible Individual, CMS will reject the addition and notify Formal Third Party Group Payer that such enrollee is not eligible to participate in the group. (13) Formal Third Party Group Payer is responsible for supplying CMS with a file that contains records of Participants that it intends to remove from the Formal Third Party Group Payer arrangement. Where Formal Third Party Group Payer is removing a Participant because the Participant died,the removal record must contain the date of death. The effective date of the removal will be the month after the month in which the Participant died. Formal Third Party Group Payer will receive a credit refund for premiums that were paid on the Participant's behalf for any months after the month in which the Participant died. For example, if Formal Third Party Group Payer transmits a removal record in May to remove a Participant who died on January 1 of the same year,the effective date of the removal will be February. No premiums are due for February or beyond and Formal Third Party Group Payer will receive a credit refund for premiums paid on the Participant's behalf for February and beyond. In instances where Formal Third Party Group Payer is removing a Participant for reasons other than death, the removal record should not contain a date. When the removal record is received by CMS by close of business the next to the last business day of the month,the effective date of the removal will be the next month. Therefore,no premium will be due for the next month and Formal Third Party Group Payer will receive a credit refund for premiums that were paid on the Participant's behalf for that month. For example, if Formal Third Party Group Payer transmits a removal record on the 20th of January,the effective date of the removal will be February. No premium will be due for the month of February and Formal Third Party Group Payer will receive a credit refund for premiums paid on the Participant's behalf for February and beyond. When the removal record is received by CMS after close of business the next to the last business day of the month,the effective date of the removal will be two months after the month the removal record is received. Therefore, a premium payment will be due for the next month and Formal Third Party Group Payer will receive a credit refund for premiums that were paid on the Participant's behalf for any months that are 2 months or more after the month in which the notice was received. For example, if Formal Third Party Group Payer transmits a removal record on the 31"of January, the effective date of the removal will be March. A premium will be due for February and Formal Third Party Group Payer will receive a credit refund for premiums that were paid on the Participant's behalf for March or beyond. (14) CMS may remove a Participant when CMS records indicate that the Participant died; is eligible for Medicare Part A without monthly premiums; does not meet all the requirements for Medicare;withdrew or was terminated from Medicare. CMS may also remove a Participant if a State Medicaid Agency is paying the Part A premium under a State Buy-In Agreement. Formal Third Party Group Payer will receive a credit refund for premiums that were paid on the Participant's behalf for any months after the month in which any of these situations occur. (15) Formal Third Party Group Payer must pay Part A premiums through the month the Participant was removed from its Part A premium payment account, or through the month the Participant died, withdrew or was terminated from Medicare. (16) If the Formal Third Party Group Payer discontinues payment of the premium on behalf of a Participant for any reason other than death,the Formal Third Party Group Payer must notify the Participant that he/she is liable for the Part A premiums. (17) Formal Third Party Group Payer will be billed monthly by CMS and must pay the Part A premium amounts, including any Late Enrollment Premium Surcharge and any outstanding premiums due for all Participants identified by Formal Third Party Group Payer. The premium payment is due the first day of the month. If payment is not received by the 30th day after the due date, CMS will notify both the Formal Third Party Group Payer and the Participant that the payment is delinquent. If payment is not received by the 60th day after the due date, CMS will terminate this Agreement. (18) All payments must be paid via electronic funds transfer, utilizing either the U.S. Treasury Department's electronic funds transfer system(Fedwire) or U.S Treasury Department's internet based system known as Pay.gov. Specifications for electronic payments are included in the Formal Third Party Group Payer Handbook. (19) If Formal Third Party Group Payer disputes the amount of the premium bill under the Agreement,the Formal Third Party Group Payer must provide evidence to substantiate its position and CMS will evaluate the evidence presented. Formal Third Party Group Payer must continue to pay its premium bill in full including any disputed amounts. If CMS determines that Formal Third Party Group Payer was billed and paid premiums in error, CMS will reflect any refunds as an adjustment to the subsequent bill. (20) This Agreement may be terminated by Formal Third Party Group Payer or CMS by giving the other party 30 days advance written notice. Premiums continue to accrue during the 30-day notice period. All premiums due on or before the effective date of the termination must be paid within 30 days after the termination date. CMS may terminate this Agreement without notice if it finds that the Formal Third Party Group Payer is not acting in the best interest of the Participants or if the billing arrangement proves to be inconvenient. (21) All documents, data and information provided to the Formal Third Party Group Payer under the Agreement shall be used solely for the purpose of complying with the Agreement. Formal Third Party Group Payer must adopt policies and practices to ensure that information contained in its records and obtained from CMS, or from others in connection with carrying out the Agreement shall be disclosed only as provided in The Privacy Act, section 1106 of the Act and regulations promulgated thereunder. (22) Formal Third Party Group Payer must abide by the terms of this Agreement and instructions associated with this payment arrangement contained in the Formal Third Party Group Payer Handbook as modified from time to time. (23) Formal Third Party Group Payer must comply with CMS' regulations at 42 CFR Section 408, Subpart E, governing group payments. (24) The Agreement is non-transferable and remains in effect until terminated by either party in the manner specified herein. The City of Fort Worth, Texas Name of Formal Third Party Group Payer By a� 1 l0 S an Alanis, Assistant City Manager Date 75-6000528 Employer Identification Number Secretary of Health and Human Services By itlerr�w&, Date APPROVED AS TO FORM AND LEGALITY. F Op Want pity Ativ....; awl 0 . 0 a;U °y ��.X4 � J Ser, ity SecMt%Y