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Prior to receiving an official notification from CMS via the DTRR, plans may, at their discretion, make note of the reported death in internal plan systems in order to suppress premium bills and member notices. The plans are not allowed to disenroll a beneficiary for death unless CMS systems shows that the beneficiary is deceased.

MA plans have the option to send a disenrollment notice (MA Exhibit 13) to the estate of the enrollee, following receipt of a CMS notification, so that any erroneous disenrollment can be promptly corrected.

60.2.4 – Loss of Special Needs Status 42 CFR §§ 422.52(d) and 422.74(b)(2)(iv)

A SNP can continue to provide care for an enrollee who no longer meets the eligibility criteria for the plan (i.e., special needs status) if the individual can reasonably be expected to again meet the special needs criteria within a period of time not to exceed six months. The SNP may choose any length of time from one to six months for deeming continued eligibility, as long as it applies the criteria consistently to all enrollees of the plan and fully informs enrollees of its policy.

A plan should consider its ability to meet the needs of an enrollee that no longer meets the special needs status if and when applying the period of deemed continued eligibility. In the following instances, the SNP is expected to disenroll the individual: • If an enrollee does not requalify within the plan’s period of deemed continued eligibility, with proper notice (see below), at the end of this period. • If the SNP is unable to provide continuity of care to an enrollee who loses eligibility (e.g., the enrollee leaves the institution or long-term care facility when enrolled in an institutional SNP).

The plan should provide the enrollee a notice of disenrollment a minimum of 30 days before the disenrollment regardless of the date of the loss of special needs status. The notice should be: • Provided to the enrollee within 10 days of learning of the loss of special needs status affording the opportunity to prove that they are still eligible to remain in the plan.

The notice must include: • Information regarding deemed continued eligibility; • Duration of the period of deemed continued eligibility; • Description of SEP eligibility (see § 30.6.13); • Consequences of not regaining special needs status within the period of deemed continued eligibility; and • Disenrollment effective date.

If the enrollee fails to regain special needs status during the period of deemed continued eligibility, the SNP is expected to provide the individual a written notice regarding involuntary disenrollment and submit the disenrollment transaction to CMS within three business days following the disenrollment effective date which is either (1) the last day of the period of deemed