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individual throughout the period in question; • Any relevant information or documentation supporting the requested correction such as a copy of the enrollment request (or evidence of the use of another enrollment mechanism).

CMS approves requests for retroactive enrollments on a case-by-case basis. The request for a retroactive enrollment should be made by the plan within the time frames provided in the SOP for the CMS RPC. The retroactive enrollment request may be denied if CMS determines that the plan did not notify the enrollee that they must use plan services instead of Original Medicare coverage during the period covered by the retroactive enrollment request.

NOTE: Unless an approved capacity limit applies, all MA plans are open for ICEP, IEP for Part D, AEP, and SEP enrollment requests; therefore, all MA plans are open for retroactive enrollments for these types of enrollment requests.

Special note regarding CMS Regional Office Casework actions

When an MA or Part D organization is directed by CMS to submit a retroactive enrollment or disenrollment request to resolve a complaint, the organization must provide the following two items as documentation to CMS (or the RPC):

• A screenshot of the Complaint Tracking Module (CTM) or other documentation showing the CMS authorization to submit the request to the CMS RPC, and,

• A copy of the enrollment or disenrollment request, if one is available—if it is not available, a brief explanation for the missing documentation.

70.5 – Retroactive Disenrollments 42 CFR §§ 422.66(b)(5), 423.36(c), and 423.36(f)

A retroactive disenrollment is a disenrollment with an effective date in the past, which is needed to make the enrollment record consistent with the individual’s election decision or with the effective dates that are reflected in the regulation.

The RPC may grant a retroactive disenrollment if:

• A valid request for disenrollment was properly made by the individual, but not processed or acted upon for the required effective date, by the plan (or CMS);

• An enrollment was not legally valid (§ 50.6); or

• The reason for the disenrollment is related to: o A permanent move out of the plan service area (as outlined in § 60.2.1.2), o The plan’s confirmation of an incarcerated status with a retroactive date (see § 60.2.1.1), o A contract violation (as outlined in 42 CFR §§ 422.62(b)(3) and 423.38(c)(8)), or