OMB No. 0960-0707
Medicare Quality Review System
Proposed Changes
Below are SSA’s proposed changes to the Medicare Quality Review System, OMB No. 0960-0707.
The Division of Special Studies requests a change to the OMB package, 0960-0707. The change request adds two new Medicare Part D Subsidy review appointment letters, SSA-9311 and SSA-9312. It also includes minor revisions to the SSA-9301, Medicare Subsidy – Quality Review Analysis form; the SSA-9302, Notice of Appointment (Reviewer Will Call); the SSA-9303, Notice of Appointment (Please Call Reviewer) and the SSA-9304, Checklist of Required Information.
Please note that none of these changes will increase the public reporting burden. Additionally, the universe of respondents remains unchanged.
Two new appointment letters added:
SSA-9311, “Notice of Appointment – Denial – Reviewer Will Call”
SSA-9312 “Notice of Appointment – Denial – Please Call Reviewer.”
These letters are not actually new but are existing notices that have been revised slightly to make them more appropriate for a specific population. They are needed to set up telephone appointments for quality reviews of cases in which the applicant has been denied Medicare Part D subsidy benefits.
Previously the SSA-9302, Notice of Appointment (Reviewer Will Call) and SSA-9303 (Please Call Reviewer) were used in establishing the appointments for both awarded and denied applicants. However, it has been brought to our attention that the language in the SSA-9302 and SSA-9303 is not appropriate for use in contacting denied applicants, as it implies the individual is currently receiving a subsidy. As a result, a separate notice with language specific to a denial situation is necessary.
Minor revisions to existing forms SSA-9301, SSA-9302, SSA-9303, and SSA-9304:
The Medicare Part D quality review process has been recently updated requiring minor changes to the case analysis form (SSA-9301). The revised SSA-9301 and a summary of the changes are attached.
The SSA-9302 and SSA-9303 that we have been using indicate that “we may terminate your help with Medicare prescription drug plan costs.” However, it has been brought to our attention that this language is not appropriate for us in contacting beneficiaries as it carries a threatening tone. We have revised these two letters, changing the language to clarify that the beneficiary is not obligated to provide the information OQP requests. We also clarified what the possible consequences associated with either participating or not participating in the quality review are. We feel this will help the beneficiary decide if he or she wants to participate in the quality review.
The SSA-9304 check list information that was originally requested has been revised for clarity and its language changed to make it more user-friendly.
Summary of Changes SSA-9301
SSA-9301 - The proposed changes are instructions for the SSA reviewer and do not place a burden on the beneficiaries. In addition, the universe of respondents is the same.
Page 1
Changed “Sample Period” to “Sample Cycle”
(This designates the month in which the cases were selected for the quality review. This change was made to identify the month the case was selected for review versus the month the subsidy determination was made. This change is necessary to better align the case data with the month in which it was selected for review.)
Added “Study ID” next to “Sample Cycle”
(This form is used to capture data for both awards and denials. Study ID was added to identify the type of case being reviewed. The addition of this information is necessary to distinguish the type of case that has been selected for review and the subsequent required development.)
Removed the word “Explain” below “Living-with Spouse contacted” in the chart :
Prior language:
Living-with Spouse contacted: Yes No, explain
(This is a change of the review instructions for the SSA reviewer. It is no longer necessary to contact both the beneficiary and the living-with spouse and therefore the reviewer does not need to explain why the living-with spouse was not contacted.)
Page 10
Element 6 – Life Insurance Policy SSA Records Column
Reworded question to read: “Have policies with total face value of more than $1,500?”
Prior language: Have policies with total face value of $1500 or more?
(This revision does not change evidence requirements on the part of the beneficiary; it is a clarification of policy to the reviewer. There is only a need to capture policies with a total face value of more than $1500.)
Page 15 - The proposed changes for page 15 are not new information requirements. They are meant to clarify data input instructions for the SSA reviewer.
Total Countable Resources Summary Chart
Added “Subtotal $______”
Added “Minus Burial Fund Exclusion $______”
(If applicable) below Non-Home Real Property
(The addition of “Minus Burial fund Exclusion” on page 15 serves to remind the SSA reviewer to apply the burial fund exclusion to the resource total.)
Page 18
Element 10 – Earned Income SSA Records Column
Added “Computer Match: $______ as last entry below both “Beneficiary” and “Living-with Spouse”.
(This was added to give the reviewer a place to annotate the data obtained from other agencies via computer matching. This information is part of the SSA records available to the reviewer.)
Summary of Changes SSA-9302, SSA-9303 and SSA-9304
The proposed changes do not place an additional burden on the beneficiaries. In addition, the universe of respondents is the same.
SSA-9302 Initial Contact (Awards) – I will call you
Letter
The last sentence in the first paragraph has been revised to add “or to verify that this is an official communication”.
(Previously some of the beneficiaries were told that there was not a study for Medicare Part D. This addition was to reassure the public that this an official study.)
The third paragraph has been moved: it is now the fourth paragraph. This paragraph “How you can get ready for your call” has been revised, adding a third sentence “If you do not have all of the information that I am requesting, I can help you get the information you do not have.”
The fourth paragraph has been moved; it is now the second paragraph. This paragraph “Important Information” has been revised to “You do not have to give us the requested information. If you do provide the information and your subsidy level is correct, we will not have to contact you to review your eligibility for at least a year. However, if the information is incorrect or you do not provide the information, we may contact you to review your eligibility within the next few months. Such a review of your eligibility could result in your subsidy level increasing, decreasing or stopping.
We would also like to remind you that if you (and your spouse if married and living together) have a change in your income, resources or household size you should report this information to Social Security.
(This paragraph was changed because the prior language used stated that “we may terminate the subsidy if the beneficiary did not cooperate.” We have removed this remark and replaced it with non-threatening language.
This revised language clarifies that the beneficiary is not obligated to provide the information OQP requests. We also clarified what the possible consequences associated with either participating or not participating in the quality review are. We feel this will help the beneficiary decide if he or she wants to participate in the quality review.)
Privacy Act and Paper Reduction Act Notice
The last sentence in the second paragraph has been revised to “You do not have to give us the requested information. If you do provide the information and your subsidy level is correct, we will not have to contact you to review your eligibility for at least a year. However, if the information is incorrect or you do not provide the information, we may contact you to review your eligibility within the next few months. Such a review of your eligibility could result in your subsidy level increasing, decreasing or stopping.
We would also like to remind you that if you (and your spouse if married and living together) have a change in your income, resources or household size you should report this information to Social Security.)”
(This sentence was changed because the prior language used stated that “we may terminate the subsidy if the beneficiary did not cooperate.” We have removed this remark and replaced it with non-threatening language.
The revised language clarifies that the beneficiary is not obligated to provide the information OQP requests. We also clarified what the possible consequences associated with either participating or not participating in the quality review are. We feel this will help the beneficiary decide if he or she wants to participate in the quality review.)
Acknowledgement Form
The third item has been revised to “If you will not be available at the time requested, we can reschedule your appointment. If you would like to reschedule, please let us know when you will be available at that number.”
SSA-9303 Initial Contact (Awards) – You call me
Changes on this form letter and attachments are the same as the changes to the SSA-9302.
SSA-9304 Information needed for Review of the Application for Help with Medicare Prescription Drug Plan Costs
The first paragraph has been revised to “Please have the INFORMATION CHECKED BELOW on hand for the telephone review. Even if you do not have all of the information that is checked, I will help you get the information you do not have. We only need information about your spouse if you and your spouse were living together when you filed your application.”
(This change serves to clarify that SSA will require information on the spouse only if the beneficiary and the spouse were living together at the time of the application for benefits. It eliminates the repeated use of the SSA term “living-with spouse” which may be confusing to the public. In addition, it tells the beneficiary that the reviewer will help him or her to obtain any information that he or she may not have. The language was changed to make it more “user-friendly”.)
The bullets A, B, C, D and E have been re-lettered to reflect changes on the list of information that may be needed for this review. The language used to describe the information that may be needed for this review has also been changed.
(These changes are designed to lessen the burden on the public. This revision does not change evidence requirements on the part of the beneficiary; it clarifies that there is not need to have all ID, pay stubs, notices of awards, tax returns, mortgage receipts, lease agreement, etc. on hand for the telephone interview. The language used to list the information that may be needed has also been revised to make it more “user-friendly”.)
Bullet A. Personal Identification Items, has been deleted
(Changed because the personal identification items are no longer needed for the telephone interview.)
Bullet B, Family Size and Household Expenses Information, is now A due to deletion of the old A bullet.
The fourth and fifth items have been revised to:
“If you are living with anyone other than your spouse and/or minor children, have their name and amount they contribute towards the household expenses.”
“The monthly amount you paid for each one of the following items: food, mortgage/rent, property insurance, property tax, heating fuel, electricity, gas, water, garbage removal and sewer for the time period.”
(The second and third items have been deleted because they are no longer a requirement for the telephone interview. The fourth and fifth items have been revised for clarity.)
Bullet C, Income, is now B. The first and third items have been revised to:
“Amount of wages that you or your spouse earned during the period.”
“The monthly amount of any pensions, or other benefit (other than Social Security benefits) you or your spouse receive.”
(The first and third items have been revised for clarity. The second item has been deleted because it is no longer a requirement for the telephone interview. )
Bullet D, Resources, is now C. All five items have been revised to:
“Balance in bank accounts during the period for all accounts on which your name and/or your spouse’s name appear as individual or joint owner, or as a beneficiary.”
“Value of stocks, bonds, promissory notes, etc, owned by you or your spouse.”
“Location of property owned by you or your spouse other than the home you live in.”
“Life insurance and burial insurance policies owned by you or your spouse. (It would be helpful if you have these policies with you when I call, so you can provide the information that I need.)”
“Amount in retirement savings accounts such as 401K, IRA, KEOGH, etc. owned by you or your spouse.”
(All five items have been revised for clarity.)
Bullet E, Other is now D due to removal of A and re-lettering.
0960-0707 Change Sheets
| File Type | application/msword |
| File Title | DMQ requests a change to the OMB package, 0960-0707 |
| Author | 233047 |
| Last Modified By | Faye |
| File Modified | 2007-04-02 |
| File Created | 2007-04-02 |