SHIIP

Jimmo vs. Sebelius was a nationwide class action lawsuit on behalf of Medicare beneficiaries with chronic conditions who had been incorrectly denied Medicare coverage. The settlement requires the Centers for Medicare and Medicaid (CMS) to confirm that Medicare coverage is determined by a beneficiary’s need for skilled care, not only when the care might result in improvement. This applies to care in home health, skilled nursing facilities, outpatient therapy, and inpatient rehabilitation facilities.

Beneficiaries, caregivers, providers, and advocates continue to encounter problems on occasion where claims are wrongly denied. Such denials can be appealed. You can file the appeal with the Medicare Quality Improvement Organization. For more information, go to https://bit.ly/3rhbt0q.

Social Security Field Offices and Social Security Card Centers will implement a nationwide Express Interview (EXI) process. This process was established to address the challenges the public has faced providing enumeration and documentary proof during the COVID-19 pandemic.

An EXI interview is a brief interview lasting about 5-7 minutes, which allows individuals to apply for an original or replacement Social Security Number (SSN) card and submit necessary evidence in person. EXI interviews are also available for gathering evidence for processing claims and for individuals who meet certain limited, critical situations.

An EXI interviewee must meet existing limited, critical appointment criteria such as: a. Original cards for individuals age 12 or older b. Replacement cards for individuals who need to update or correct their information, such as name, date of birth, or citizenship, or to obtain income, resources, medical care or coverage, or other services or benefits. And the person must be unable to use SSA’s automated services (e.g. enumeration at birth, enumeration at entry or enumeration beyond entry) or online SSN replacement card service.

EXIs are not the primary option offered to callers, and local managers have the discretion to schedule EXIs based on staffing and other office considerations. The scope is limited to obtaining evidence or reviewing the application. If additional questions arise, they will be addressed by mail or telephone. Updates courtesy of monthly SHIIP News, N.C. Dept. of Insurance.

STATE POINT MEDIA PUZZLE ANSWERS Puzzles on page 30