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Potential At-risk Beneficiary – A Part D eligible individual who is identified using clinical guidelines, and not an exempted beneficiary, as being potentially at-risk for misuse or abuse of a frequently abused drug in accordance with the requirements for drug management programs at 42 CFR § 423.153(f).

Program of All-Inclusive Care for the Elderly (PACE) – A program of all-inclusive care for the elderly that is operated by an approved PACE organization and that provides comprehensive healthcare services to PACE enrollees in accordance with a PACE program agreement.

Receipt of Enrollment Request – Generally refers to the date in which the plan first gets the enrollment request. Plans may receive enrollment requests through various means, as described in § 40.1.

Reinstatement – An action that may be taken to correct a disenrollment that was made in error or when the enrollee has demonstrated good cause for a disenrollment based on failure to pay to be reversed. When a reinstatement occurs, the individual’s enrollment record will only show the enrollment start date in the plan and coverage in that plan will be active and unbroken.

Rejection of Enrollment Request – A CMS action to not permit an enrollment transaction submitted by a plan. The rejection could be due to the plan incorrectly submitting the transactions, system error, or an individual’s ineligibility to elect the MA/Part D plan.

Service Area – The CMS-approved geographic area where the plan provides coverage and the geographic area in which all plan enrollees generally must reside (exceptions may apply, for example in continuation areas). Facilities in which individuals are incarcerated are not included in the service area. For local MA plans, the service area is a county or multiple counties, and for MA regional plans is a region approved by CMS within which an MA-eligible individual may enroll in a particular MA plan offered by an MAO. To the extent practicable, PDP regions are the same as MA regions.

Special Needs Plan – A specific type of MA plan offered to certain groups of individuals: • Institutionalized or institutionalized-equivalent individuals; • Those entitled to Medical Assistance under a State Plan under Title XIX; and • Individuals with severe or disabling chronic conditions, as defined at 42 CFR § 422.2 “Severe or disabling chronic condition.”

State Pharmaceutical Assistance Program (SPAP) – A state program that provides financial assistance for the purchase or provision of supplemental prescription drug coverage or benefits on behalf of Part D eligible individuals and meets the requirements described under 42 CFR § 423.464(e)(1).

System Error – An unintended error or delay in enrollment request processing that is clearly attributable to a specific federal government system (e.g., SSA system, Railroad Retirement Board (RRB) system), and is related to Medicare entitlement information or other information required to process an enrollment request.