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HomeMy WebLinkAboutContract 48942 CITY SECRETARY CONTRACT NO. CO PART B tO` PREMIUM SURCHARGE AGREEMENT Between The Secretary of the Department of Health&Human Services And The City of Fort Worth, TX (Surcharge Payer) Whereas; the City of Fort Worth, TX desires to enter into an arrangement with the Secretary of Health&Human Services,to pay the late enrollment premium surcharge portion of the monthly Medicare Part B premiums on behalf of a group of eligible Individuals. The Secretary and the City of Fort Worth, TX hereby agree to the following: A. Definitions For purpose of this agreement-- (1) "Secretary"means the Secretary of Health&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) "Surcharge Payer"means a State or local government that has entered into a formal agreement with CMS to receive a single bill and pay for the premium surcharge portion of the monthly Part B premium on behalf of a group of eligible individuals. (6) "Eligible Individuals"means individuals who (1) are currently enrolled under Supplementary Medical Insurance (Medicare Part B) and (2) are billed directly by CMS for their Medicare premiums, or are eligible for Part B premium deduction from a Social Security or Railroad Retirement benefit or a Civil Service annuity. (7) `Enrollee"means an individual who is enrolled in Medicare Part B. (8) "Late Enrollment Premium Surcharge" or"Premium Surcharge"or "Surcharge"means the amount Medicare assesses in addition to the monthly Part B 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. OFFICIAL RECORD CITY SECRETARY I FT.WORTH,TX L—.—. - (9) "Participant"means an Eligible Individual who has authorized a Surcharge Payer to pay the surcharge portion of the monthly Part B premium on the individual's behalf in accordance with section 1839(e) of the Social Security Act regulations and at 42 C.F.R., section 408.202. (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 B 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"means an employer, lodge, union or other organization that has entered into an agreement with the Secretary to receive a single bill and pay Medicare premiums on behalf of a group of eligible individuals that are billed directly by CMS for Medicare premiums. (12) "Part B Premium Surcharge Group Payer Handbook"means the guide provided to Surcharge Payer by CMS that contains the policies and procedures governing the payment of Medicare Part B premium surcharges by a Surcharge Payer as modified from time to time by CMS. B. Terms of Agreement-- (1) The Surcharge Payer voluntarily enters into this agreement without expectation of reimbursement from CMS for administrative expenses attributable to carrying out this agreement. (2) The Surcharge Payer may only pay Part B premium surcharges on behalf of eligible individuals. (3) The Surcharge Payer may not pay premium surcharges for enrollees whose Part B premiums are being paid by a State Medicaid Agency under a buy-in agreement or a Formal Third Party Group Payer under a Formal Third Party Group Payer Agreement. (4) The Surcharge Payer may not add an enrollee who does not owe a Part B surcharge. (5) The Surcharge Payer must obtain written authorization from the Participant for CMS to send bills and release information to the Surcharge Payer. (6) The Surcharge Payer must not charge any Participant for any administrative or other expenses incurred by the Surcharge Payer in carrying out this Agreement. (7) An Eligible Individual will not be billed by CMS for Part B premium surcharges during any month in which the individual is a Participant included in a Surcharge Payer arrangement. CMS will resume collection of the Part B premium surcharges from the eligible individual in accordance with section 1840 of the Act if the Surcharge Payer agreement is terminated, if the eligible individual is no longer included in the Surcharge Payer arrangement, if the Surcharge Payer fails to pay, or if the Surcharge Payer identifies the payment incorrectly. (8) The Surcharge Payer must pay all current Part B premium surcharges for any Participant included in its Surcharge Payer arrangement. (9) The Surcharge Payer must transmit and receive all data electronically. All requirements for electronic data exchange are contained in the Part B Premium Surcharge Group Payer Handbook. In the event of a change to the data transmission requirements, CMS will give the Surcharge Payer notice of such revisions. (10) The Surcharge Payer is responsible for supplying CMS with a file that contains records of Participants that it intends to add to the Surcharge Payer arrangement. The Surcharge Payer may add Participants monthly. CMS' Third Party System will automatically generate an effective date for the addition. Where the Surcharge 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 the Surcharge Payer transmits an addition record on the 201h of January,the effective date of the addition will be February. If the Surcharge Payer transmits an addition record to CMS after the next to the last business day of the month, the effective date of the addition will be the month after the next billing month. For example, if the Surcharge Payer transmits an addition record on the 31 st of January,the effective date of the addition will be March. If Surcharge Payer seeks to add as a Participant an enrollee who is not an Eligible Individual, CMS will reject the addition and notify the Surcharge Payer that such enrollee is not eligible to participate in the group. (11) The Surcharge Payer is responsible for supplying CMS with a file that contains records of Participants that it intends to remove from the Part B Premium Surcharge Group Payer arrangement. Where the Surcharge 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. The Surcharge Payer will receive a credit refund for surcharges that were paid on the Participant's behalf for any months after the month in which the Participant died. For example, if Surcharge 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 surcharges are due for February or beyond and the Surcharge Payer will receive a credit refund for surcharges paid on the Participant's behalf for February and beyond. In instances where the Surcharge Payer is removing a Participant for reasons other than death,the removal record should not contain a date. When the non-death 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 surcharge will be due for the next month and the Surcharge Payer will receive a credit refund for surcharges that were paid on the Participant's behalf for that month. For example, if the Surcharge Payer transmits a removal record on the 20th of January, the effective date of the removal will be February. No surcharge will be due for the month of February and the Surcharge Payer will receive a credit refund for the surcharge paid on the Participant's behalf for February. 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 surcharge payment will be due for the next month and Surcharge Payer will receive a credit refund for surcharges that were paid on the Participant's behalf for any months immediately after the month after the month in which the notice was received. For example, if the Surcharge Payer transmits a removal record on the 31 st of January, the effective date of the removal will be March. A surcharge will be due for February and Surcharge Payer will receive a credit refund for surcharges that were paid on the Participant's behalf for March or beyond. (12) CMS will remove a Participant when CMS records indicate that the Participant died; does not meet all the requirements for Medicare; withdrew or was terminated from Medicare. CMS may also remove a Participant if a Formal Third Parry Group Payer or State Medicaid Agency is paying the Part B premium under a Formal Third Parry Group or State Buy-In Agreement. (13) The Surcharge Payer must pay surcharges through the month the Participant was removed from its Part B surcharge payment account, or through the month the Participant died,withdrew or was terminated from Medicare. (14) If the Surcharge Payer discontinues payment of the surcharge on behalf of a Participant for any reason other than death, the Surcharge Payer must notify the Participant that he/she is liable for Part B premium surcharges. (15) The Surcharge Payer will be billed monthly by CMS and must pay the Part B premium surcharge amounts due for all Participants identified by the Surcharge Payer. The surcharge 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 the Surcharge Payer that the payment is delinquent. If payment is delinquent 30 days or more, CMS may terminate the agreement with 30 days advance notice. (16) All payments must be paid via electronic funds transfer utilizing either the U.S. Department of the Treasury's internet-based system known as Pay.gov or the U.S. Department of the Treasury's bank-to bank electronic funds transfer system called the FEDWIRE Deposit System. Specifications for electronic payments are included in the Part B Premium Surcharge Group Payer Handbook. (17) If the Surcharge Payer disputes the amount of the surcharge bill under the Agreement,the Surcharge Payer must provide evidence to substantiate its position and CMS will evaluate the evidence presented. The Surcharge Payer must continue to pay its full payment, including any disputed amounts while CMS evaluates the evidence provided. If CMS determines that the Surcharge Payer was billed and paid surcharges in error, CMS will reflect any refunds as an adjustment to the subsequent bill. (18) The Surcharge Payer may voluntarily terminate this Agreement if the Surcharge Payer notifies CMS, in writing, at least 30 days before the effective date of the termination. Surcharges continue to accrue during the 30-day notice period. All surcharges and interest must be paid within 30 days after the effective date of the termination. Interest will continue to accrue until all amounts due are paid in full. (19) CMS may terminate this Agreement by giving the Surcharge Payer 30 days advance notice if a Surcharge Payer's payments are delinquent 30 days or more. (20) CMS may terminate this Agreement by giving the Surcharge Payer 30 days advance notice if the Surcharge Payer fails to comply with the terms of this Agreement (21) CMS may terminate this Agreement without notice if it finds that the Surcharge Payer is not acting in the best interest of the Participant or for any other reason not listed above. (22) If an agreement is terminated by CMS, the Surcharge Payer must wait 3 years from the effective date of the termination before it can request to enter into another Part B Premium Surcharge Agreement. (23) All documents, data and information provided to the Surcharge Payer under tho, greement shall be used solely for the purpose of complying With the Agreement. The Surcharge Payer must adopt policies and prac'ticesto ensure that information contained in its records and obtained from CMS, or from others in connection with carrying out the Agreement s -shall be;4flsiclosed only as provided in The Privacy Act, section 1106 of the Act and regulations promulgated thereunder. (24) The Surcharge Payer must abide by the terms of this Agreement and instructions associated with this payment'arrangement contained in the Part B Premium Surcharge,Group Payer Handbook as modified from time to time. (25) The Surcharge Payer must comply with CMS'regulations at 42 CFR Section 408, Subpart H, governing surcharge payments. (26) 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 Surcharge Payer By S an Alanis Date TitleAssistant City. Manager 75-6000528, APG UMc, A Employer Identification NumberM ® LE19ALt7° �� �► ( e ( M cry c ME 0 o $(STr CITY AT�'C��M W-�'rP —o :alb P.Gonzales,A Secwtary Secretary of Health&Human SjF Date Title: Director, Division of Premium Billing & Collection OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX Contract Compliance Manager: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. r N me of Employee / /< Title