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60.2.1.3 – Researching and Acting on a Change of Address 42 CFR §§ 422.74(c), 422.74(d)(4), and 423.44(d)(5)

When researching changes of address, plans are encouraged to utilize CMS systems interfaces, internet search tools, address information from provider claims, and other available resources.

Plans may obtain either written or verbal verification of a change in address, as long as the policy applies to all enrollees.

Within 10 calendar days of receipt of a change of address or a possible out-of-area residency notification from the individual, the individual’s authorized representative, CMS, or other reliable sources such as provider claims or the USPS, the plan must: • Attempt to contact the enrollee to confirm the enrollee’s permanent residence; and • Document its efforts to determine an enrollee’s residency status.

NOTE: Plans are not required to attempt to contact enrollees for prospective enrollments with the transaction reply codes: 011 (Enrollment Accepted) or 100 (PBP Change Accepted as Submitted), accompanied by 016 (Enrollment Accepted—Out of Area), that are on the same DTRR. These represent new enrollments for which the organization recently confirmed the individual’s permanent residence in the plan service area.

An individual is considered to be temporarily absent from the plan service area when any one or more of the required materials and content referenced in §§ 422.2267(e) and 423.2267(e), if provided by mail, is returned to the plan sponsor by the U.S. Postal Service as undeliverable and a forwarding address is not provided.

If the plan confirms the member’s out-of-area status is temporary (and does not exceed the applicable time limits described in § 60.2.1.2 above), the plan must retain the individual as an enrollee.

If the individual (or their authorized representative) responded and confirmed the permanent move out of the service area, the plan must send the disenrollment notice (MA Exhibit 36, Part D Exhibit 37) within 10 calendar days of the individual’s confirmation that the move is permanent.

Exception: MAOs will retain an enrollee who has permanently moved into a continuation area and chose the continuation of enrollment option (procedures for electing a continuation of enrollment option are outlined in § 70.7).

If the plan receives notice of a potential move out of the service area from a source other than the individual or the individual’s authorized representative, the plan may not conclude a move is permanent until it has received confirmation of the move from the individual or the individual’s authorized representative, or the period of permissible temporary absence has passed, whichever is earlier. The plan must initiate disenrollment if the individual (or their authorized representative) does not confirm the individual’s permanent address prior to the expiration of the period of permissible temporary absence.