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In the case of MA plan enrollees who fail to respond to the request for address confirmation and are disenrolled because they are absent from the service area for more than six months, the MAO must provide the disenrollment notice within the first 10 calendar days of the sixth month of such absence. Since individuals enrolled in MA plans that offer a visitor/traveler benefit are permitted an absence from the service area for up to 12 months, such individuals are disenrolled if their absence from the service area exceeds 12 months (or the length of the visitor/traveler program if less than 12 months). In this scenario, the MAO must provide notification of the upcoming disenrollment to the enrollee during the first 10 calendar days of the 12th month (or the last month of the allowable absence, per the visitor/traveler program).

For PDP enrollees who fail to respond to the request for address confirmation and are disenrolled because they are absent from the plan service area for more than 12 months the PDP must provide notification of the upcoming disenrollment to the enrollee within the first 10 calendar days of the 12th month of such absence.

MAOs and Part D plan sponsors must document the basis for involuntary disenrollment actions that are based on the residency requirements.

60.2.1.4 – Special Procedures for Auto- and Facilitated Enrollees Whose Address is Outside the PDP Region

CMS assigns most individuals based on data provided by State Medicaid Agencies to identify full-benefit dual eligible individuals, even if that state is different than that in the address in CMS’ systems. When an individual whom CMS had auto/facilitated enrolled or reassigned (see § 40.1.8) has an address outside of the PDP’s region (e.g., via a state and county code change on the DTRR), the PDP sponsor must try to determine the individual’s permanent residence and retain documentation of such efforts.

Additionally, the plan should retain documentation from the enrollee or enrollee’s authorized representative that includes: • Notification of whether the member’s out-of-area status is temporary or permanent.

The PDP sponsor may accept either written or verbal confirmation that an individual has moved out of the service area, as long as the plan applies the policy consistently among all enrollees.

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 plan confirms the member’s out-of-area status is permanent and has a PDP in the new region with a premium at or below the low-income premium subsidy amount for that region, the PDP sponsor may submit an enrollment transaction to enroll the individual in that PDP prospectively (See Part D Exhibit 27).

If the plan confirms the member’s out-of-area status is permanent and does not have a PDP in the new region with a premium at or below the low-income premium subsidy amount for that