GN 03314.095: Disclosure Without Consent to State and Local Agencies to Administer the Medicare Program, the Medicare Savings Program (MSP), and Medicare 1144
Effective Dates: 01/17/2017 - Present
- TN 2 (01-17)
- GN 03314.095 Disclosure Without Consent to State and Local Agencies to Administer the Medicare Program, the Medicare Savings Program (MSP), and Medicare 1144
- A. Disclosure policy
- 1. The Medicare program
- Medicare (Title XVIII of the Social Security Act (Act)) is the national health insurance program for people 65 and older, as well as certain disabled individuals under age 65. We may disclose certain non-tax return information, including verification of Social Security Numbers (SSN), to State or local Medicare providers to administer the Medicare program (including section 1843 of the Act).
- Disclosure is permissible under the health maintenance and income maintenance routine use cited in a number of our systems of records, including, but not limited to the following:
- * 60-0058—Master Files of SSN Holders and SSN Applications System;
- * 60-0089—Claims Folders System;
- * 60-0090—Master Beneficiary Record;
- * 60-0103—Supplemental Security Income Record and Special Veterans Benefits System; and
- * 60-0320—Electronic Disability Claims File.
- In certain circumstances, we may also disclose tax return information when it is relevant and necessary to the purpose of the request. Disclosure of certain tax return information covered under the Earnings Recording and Self-Employment Reporting System (60-0059) system of records is permissible pursuant to Section 6103 of the Internal Revenue Code (IRC).
NOTE: Information may be disclosed without consent only to public providers of medical services under Medicare. Disclosure to private providers requires the consent of the subject individual. For information concerning the verification of SSNs, see GN 03325.003. For information on the disclosure of tax return information, see GN 03314.002 and GN 03320.015A.
- 2. Medicare Savings Program (MSP)
- Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), we are required to work closely with our State partners to improve MSP participation. Our role is to increase participation in these programs through the Extra Help (low income subsidy (LIS)) application process. Under MIPPA, an application for Extra Help filed on or after January 1, 2010 will start the MSP application process, unless the beneficiary objects. The information we send to the States is the same non-tax return data we use in making the beneficiary’s Extra Help determination. We provide this information to the States through the LIS data exchange system. In certain circumstances, we may also disclose tax return information when it is relevant and necessary to the purpose of the request. Disclosure of certain tax return information covered under the Earnings Recording and Self-Employment Reporting System (60-0059) system of records is permissible pursuant to Section 6103(l)(7) of the IRC. For more information on MSP, see HI 00815.024A. For more information on the LIS data exchange system, see GN 03314.155. For information on the disclosure of tax return information, see GN 03314.002 and GN 03320.015A.
- 3. Medicare 1144
- Under section 1144 of the Act, we are required to:
- (1) notify low income Medicare beneficiaries about programs that can assist them with their medical/drug expenses, and
- (2) identify these same individuals to the States.
- SSA secures the individual’s authorization to provide information to the State, thus starting the application process for MSP. We send this non-tax return information to the States through the Medicare 1144 electronic data exchange system.
- For more information on Medicare 1144, see HI 00815.025.
- For more information on the Medicare 1144 (Outreach) data exchange system, see GN 03314.155.
- For information on the disclosure of tax return information, see GN 03314.002 and GN 03320.015A.
- B. Procedure for handling requests
- State agencies that administer Medicare, MSP, and Medicare 1144 receive certain non-tax return information (and, when permissible, tax return information) from us primarily through electronic data exchanges, as authorized under data exchange agreements with us. Consult the regional office Data Exchange Coordinator or Privacy Act Coordinator to determine if we have a data exchange in effect with a particular State agency for its administration of Medicare, MSP, and Medicare 1144. For more information regarding the handling of requests from State and local agencies, see GN 03314.001E.
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