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first of the month following the date on which the current incarceration was confirmed. If the plan confirms an individual’s current incarceration status as well as the start date of the current incarceration, the plan must disenroll the individual for the first of the month following the start date of the incarceration. If that disenrollment effective date is outside the range of effective dates allowed by MARx, the plan must submit the retroactive disenrollment request to the CMS Retroactive Processing Contractor (see § 70.5).

60.2.1.2 – Required Involuntary Disenrollments Based on Extended Absence 42 CFR §§ 422.74(d)(4)(ii) and 423.44(d)(5)(ii)

An MAO must disenroll an individual if: • The enrollee’s extended absence from the service area (or continuation area, for continuation of enrollment enrollees) exceeds six consecutive months (see § 60.2.1.2.1 for exception); or • The enrollee is an out-of-area member (as defined in § 10), who leaves their residence for more than six months.

For MA plan enrollees, the disenrollment is effective the first day of the calendar month after six months have passed.

A Part D sponsor must disenroll an individual if the enrollee’s extended absence from the service area exceeds 12 consecutive months. For Part D enrollees absent from the service area more than 12 consecutive months, the disenrollment is effective the first day of the 13th month.

60.2.1.2.1 – Exceptions for MA Enrollees Enrolled in Visitor or Traveler Programs 42 CFR § 422.74(d)(4)(iii)

There is an exception to the required involuntary disenrollment requirement for extended absences, as described in § 60.2.1.2 above, for individuals enrolled in MA plans that offer a visitor/traveler benefit, which allows a temporary absence from the plan service area, but within the United States, for up to 12 consecutive months. Such individuals are disenrolled if their absence from the service area exceeds 12 consecutive months (or the length of the visitor/traveler program if less than 12 months). Plans that offer such programs do not have to disenroll individuals in these extended programs who remain out of the service area for more than six months but less than 12 months. Plans may choose to limit this option to enrollees who travel to certain areas, as designated by the MAO, and who receive services from qualified providers.

Where an MA plan offers a visitor/traveler benefit, it must disenroll an individual if the enrollee is temporarily absent from the service area (or continuation area, as applicable) for more than 12 consecutive months (or the length of the visitor/traveler program if less than 12 months).

The disenrollment is effective the first day of the 13th month (or the first day of the month after the length of the visitor/traveler program if less than 12 months) after the individual left the service area (or continuation, as applicable).