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This SEP begins the first day of the month in which the individual requests disenrollment from the MA plan and ends two calendar months after the month the MA enrollment ended.

NOTE: The effective date of an election made during this SEP is the first day of the month following the month in which the enrollment/disenrollment request is received, but not prior to the month residency begins.

30.6.7 – SEP for dual- or other LIS-eligible individuals 42 CFR §§ 423.38(c)(4) and 423.153(f)

The SEP for low-income subsidy eligible individuals is a Part D SEP that allows a “full-benefit dual eligible individual” or “partial-benefit dual eligible or other low-income subsidy (LIS) eligible individual” (see § 10) to enroll once per month into any standalone prescription drug plan but does not permit enrollment into MA-PD plans or changes between MA-PD plans.

The SEP may be used once per month with an effective date of the first of the following month.

NOTE: An individual is not eligible for this SEP if the individual has been identified as an “at-risk beneficiary” or “potential at-risk beneficiary” (see § 10). This SEP limitation starts when the individual receives the initial notice from the Part D plan that they are an at-risk beneficiary or a potential at-risk beneficiary and ends when one of the following situations occur:

Situation SEP Limitation Ends The plan determines the individual is not an at-risk beneficiary 60 days after the date on the initial notice or the date the beneficiary receives notice of the plan’s determination, whichever occurs first The plan determines the individual is an at- risk beneficiary 12 months from the date the individual is determined to be at-risk The plan extends the individual’s at-risk identification beyond the initial 12 months 24 months from the date the individual is determined to be “at-risk”

NOTE: This is the maximum consecutive time the SEP limitation can be imposed for each “at-risk” limitation a sponsor implements The individual’s identification as an at-risk beneficiary or potential at-risk beneficiary is removed by the plan or by a favorable appeal The date the identification is removed by the plan or upon effectuation of a favorable appeal

Additional information regarding this limitation for at-risk and potential at-risk beneficiaries is available on the CMS.gov website: https://www.cms.gov/medicare/coverage/prescription-drug- coverage-contracting/improving-drug-utilization-review-controls-part-d.

30.6.8 – SEP for individuals who gain, lose, or have a change in their dual- or LIS- eligible status 42 CFR § 423.38(c)(9)