CMS Pub. 100-24, ch. 5, § 5.1

On or before the 10th of each month, CMS sends (via US Postal Service and email) each state a

bill called the Summary Accounting Statement (SAS) that CMS produces at the end of the prior

month (update month). See appendix 5.C for a sample SAS and a detailed explanation of the

SAS.

The SAS reflects the state’s Medicare premium liability for the upcoming month (billing month).

The SAS gives the first of the billing month as the “payable by” date (due date), but CMS grants

states a “grace period” up to the 25th day of that month.1

For example, on or before June 10th, CMS mails the state its SAS created after the end of the

update month of May. The SAS contains the state’s Medicare Part A or Part B premium liability

for the month of July. The SAS gives July 1st as the due date and the grace period lasts up to

July 25.

CMS considers a state’s Medicare premium liability to be satisfied once CMS receives the full

amount due. If outstanding balances remain after the grace period, they are assessed interest

and subject to collection through offset against the state’s Medicaid Grant Award.

A state Medicaid agency may appeal if it disagrees with the amount of their Medicare premium

liability, the amount of interest assessed, or the amount of the offset against the Medicaid Grant

Award. CMS must receive the appeal within 90 days of the billing date on the disputed SAS

billing notice. The state can submit a written request for review along with supporting

documentation to the Director of the Division of Premium Billing and Collections (DPBC)

through:

1 If the 25th day of the month falls on a federal holiday or weekend, states must pay their premium liability no

later than close of business on the last business day prior to the 25 th.

Mail:

CMS, OFM, AMG

Division of Premium Billing and Collections

Mailstop C3-13-08

7500 Security Boulevard

Baltimore, Maryland 21244-1850

Email: DPBCStateBuy-in@cms.hhs.gov

Type ‘Appeal Request’ and <state’s name> in the subject line of the email.

Within 30 days of receipt of the state’s appeal request, the Director of DPBC will send the state

a written acknowledgement confirming receipt. Pending the appeal, the state should pay the

disputed amount to avoid further interest charges and a possible offset.

CMS will send a written response to the state to communicate its decision. If CMS determines

that it owes the state a credit, the credit will appear as an adjustment in a subsequent SAS.

NOTE: If a state disagrees with the premium amount billed for a specific Health Insurance

Claim Number (HICN), the state should submit the record directly to the CMS Division of

Medicare Systems Exceptions and Inquiries (DMSEI) in accordance with procedures in chapter

6. To avoid interest assessment and possible offset, the state should pay the disputed amount

while CMS reviews the state’s request.