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to SSA. Plans are not required to provide coverage to such individuals while the issue is reviewed by the plan or SSA.

In these instances, plans: (1) Check CMS’ systems to see if the incarceration or unlawful presence status has been removed (via MARx), and

(2) Ensure that the individual is otherwise eligible to remain enrolled as of the disenrollment effective date.

If CMS systems show that the erroneous incarceration or unlawful presence information has been corrected, the reinstatement request may be sent to the CMS RPC instead of referring the individual to SSA. However, if CMS systems continue to reflect an incarcerated or unlawful presence status, the plan should refer the individual to SSA so that they may review their records and make corrections, as appropriate. If SSA determines the information or status to be erroneous, CMS systems will be updated. The plan will receive notification of the individual’s reinstatement from CMS via the DTRR. At that time, services should resume and coverage should be seamless, as though the individual was never disenrolled.

CMS suggests that the plan send the enrollee notification of the reinstatement (MA Exhibit 25a; Part D Exhibit 22a) within 10 days of receipt of DTRR confirmation of the individual’s reinstatement.

70.3.3 – Reinstatements Based on Individual Cancellation of New Enrollment 42 CFR §§ 422.60 and 423.32

As stated in § 60.1.4 deliberate individual-initiated disenrollments imply intent to disenroll. Therefore, reinstatements generally will not be allowed if the individual intentionally initiated a disenrollment. An exception is made for those individuals who were automatically disenrolled because they enrolled in another plan but subsequently cancelled the enrollment in the new plan before the effective date.

If an individual changes their mind and does not want to change to a different plan, the individual must request to cancel the enrollment into the new plan prior to the effective date, as described in § 70.2.1.

When a cancellation of enrollment in a new plan is correctly submitted and processed:

1) The associated automatic disenrollment from the previous MA or Part D plan becomes invalid;

2) CMS systems will attempt to automatically reinstate enrollment in the previous plan; therefore, a request for reinstatement via the RO or RPC is not needed; and