461-180-0140    Effective 07/01/04
Effective Dates; Retroactive Medical Benefits

  1. In the MAA, MAF, OSIPM, and SAC programs:

    1. If a benefit group requests and is eligible for retroactive medical benefits, the earliest date they can be eligible is three months before the date of request. For example, if the benefit group requests benefits on July 10th, eligibility may begin as early as April 10.

    2. After the earliest date is established, eligibility is determined on a month-by-month basis. The period starts on the earliest established date and ends on the date the benefit group requests benefits. For example, if the benefit group requests benefits on August 10th, the earliest date is May 10. Eligibility is established separately for May 10 through May 31, June 1 through June 30, July 1 through July 31, and August 1 through August 9.

  2. In the QMB-BAS programs:

    1. If a benefit group currently eligible for QMB-BAS requests and is eligible for retroactive medical benefits under MAA, MAF, OSIPM, or SAC, the earliest date they can be eligible is three months before the effective date for QMB-BAS.

    2. After the earliest date is established, eligibility is determined on a month-by-month basis. The period starts on the earliest established date and ends on the effective date for QMB-BAS. For example, if the benefit group requests benefits on August 10 and the effective date is September 1, the earliest date the group can be eligible for retroactive medical benefits is June 1. Eligibility is established separately for June 1 through June 30, July 1 through July 31, and August 1 through August 31.

  3. If a benefit group currently eligible for QMB-DW requests and is eligible for retroactive medical benefits, the earliest date they can be eligible is three months before the effective date of their initial eligibility.

  4. If a benefit group currently eligible for QMB-SMB requests and is eligible for retroactive payment of Part B Medicare premiums, the earliest date they can be eligible is three months before the effective date of their initial eligibility.

  5. If a benefit group currently eligible for REFM requests and is eligible for retroactive medical benefits, the earliest they can be eligible is the most recent of the following--

    1. The date the benefit group arrived in the United States; or

    2. Three months before the date of request.

Stat. Auth.: ORS 411.060
Stats. Implemented: ORS 411.060

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