Page 7

Page 7 – State Medicaid Director

Beginning January 1, 2010, for any individual who submits or requests an application for LIS from SSA or who is otherwise identified as potentially eligible for MSP, SSA is required to provide the individual with information about LIS and MSP when providing an application for LIS. Also, with the consent of the applicant, SSA will transmit data from the LIS application to the appropriate State Medicaid agency. The State agency in turn is required to treat the data received from SSA as initiating an application for MSP, for purposes of determining whether the individual is eligible for MSP.

Data Transmission

CMS has consulted extensively with the States and SSA to coordinate the data transmission needs and capability. SSA has agreed to transmit the LIS data, Monday through Friday, excluding Federal holidays, once SSA has adjudicated the LIS application. See Appendix A of this enclosure for the LIS Data Exchange Output Record Layout. This appendix provides a layout of all data being transmitted and a brief description of the information provided in each field.

The LIS data transmission, referred to as an MSP application file, will be sent to the State Medicaid agency that currently receives Bendex data from SSA. The transmission will be sent in either ConnectDirect or Cyberfusion format, depending on the format the State is using, on existing, dedicated lines that are in place for receipt of SSA data. All States have signed new data exchange agreements with SSA which encompass the exchange of the LIS data.

Effective Date of the MSP Application

There currently exists a conflict in the statutory provisions of MIPPA with respect to the definition of the date of application for MSPs. Under section 113 of MIPPA, section 1935(a) of the Act was amended to establish the MSP application date as the date the LIS application was filed with SSA. Under this provision, the State must accept the LIS data transmitted from SSA and act on the data in the same manner, and in accordance with the same deadlines, as if the data were an application submitted directly by the applicant to the State, when applying for MSP. However, section 113 of MIPPA amended section 1144(c) of the Act to establish the date of electronic transmission from SSA to the State as the date of the MSP application.

Notwithstanding this conflict, States may use the date SSA transmits the data from the LIS application as the beginning date. Medicaid regulations (42 CFR 435.911(a)(2)) require that States must process the MSP applications within 45 days of receipt of an application to determine eligibility in a timely manner. Further, States must treat the date the LIS application is filed with SSA as the date of application for MSP for purposes of establishing the effective date of eligibility for MSP benefits. Using the transmission date of the LIS information for processing requirements purposes will give States additional time, if needed, to process MSP applications, while using the filing date for LIS as the MSP application date protects the effective date of MSP eligibility for the beneficiary. Although section 1902(e)(8) of the Act precludes a State from protecting the date of filing for QMBs, a State must protect the LIS filing date for other (non-QMB) MSP applicants.