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eligibility verification for the purposes of determining D-SNP eligibility.

The Social Security number may only be requested in the enrollment mechanism if the state Medicaid agency requires it to verify Medicaid status.

FIDE SNP, HIDE SNP, and AIP: Beginning in plan year 2027, where an MAO offers a D-SNP and its parent organization (or any entity that shares a parent organization with the MAO) also contracts with a state as a Medicaid MCO that enrolls full-benefit dual eligible individuals in the same service area, the D-SNP must limit new enrollment to individuals enrolled in (or in the process of enrolling in) the D-SNP’s affiliated Medicaid MCO. This would apply when any part of the D-SNP service area(s) overlaps with any part of the Medicaid MCO service area, even if the two service areas do not perfectly align. Beginning in 2030, such D-SNPs must only enroll (or continue to cover) individuals enrolled in (or in the process of enrolling in) the affiliated Medicaid MCO, except that such D- SNPs may continue to implement deemed continued eligibility requirements as described in 42 CFR §422.52(d). More information about this exception can be found in Chapter 16-B.

Institutional SNP: For enrollments into an institutional SNP (I-SNP), the organization must confirm that the individual meets the definition of “institutionalized” or the definition of “institutionalized- equivalent.”

When an I-SNP opts to enroll individuals prior to a 90-day length-of-stay, the I-SNP may use a number of sources of information to show that the individual’s condition makes it likely that the length-of-stay (or need for an institutional level-of-care) will be at least 90 days. Please refer to 42 CFR § 422.2 definitions of “Institutionalized” and “Institutionalized-equivalent,” for additional information.

Chronic Condition SNP: For enrollments into a chronic condition SNP (C-SNP), the organization must confirm that the individual has the qualifying condition. For more information on verification of eligibility for C- SNPs, see 42 CFR § 422.2 “Severe or disabling chronic condition.”