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The SEP for an individual who disenrolls from an MA or Part D plan to enroll in a PACE organization begins on the effective date of the disenrollment from the MA or Part D plan. The SEP ends two calendar months after the effective date of the disenrollment from the MA or Part D plan.

30.6.13 – SEP for individuals who lose special needs status 42 CFR §§ 422.62(b)(11) and 423.38(c)(27)

This SEP allows individuals enrolled in a special needs plan (SNP) (see § 10) to enroll in an MA plan, when they no longer meet the applicable special needs status to remain enrolled in the SNP.

The SEP for an individual who loses special needs status begins the month the individual’s special needs status changes and ends three calendar months after the effective date of the involuntary disenrollment from the SNP.

Coordinating Part D SEP:

In addition, CMS will provide an SEP to enroll in a Part D plan for those individuals who are no longer eligible for a SNP because they no longer meet special needs status.

30.6.14 – SEP for individuals who are eligible or are found ineligible to enroll in a C- SNP 42 CFR §§ 422.62(b)(13) and 423.38(c)(28)

This SEP allows individuals with severe or disabling chronic conditions to: • Enroll in a Chronic Care special needs plan (C-SNP) (see § 10) designed to serve individuals with those conditions. • Enroll in a different C-SNP that focuses on an individual’s severe or disabling chronic condition, which is not a focus of their current C-SNP.

The SEP for either of the above scenarios is available while the individual has the qualifying condition(s) and ends upon enrollment in the C-SNP.

After enrollment into a C-SNP, an individual who is determined to not have the qualifying condition necessary to be eligible for the C-SNP may use this SEP to enroll in another MA-PD or MA-only plan (e.g., when the required post-enrollment verification with a provider did not confirm the information provided on the pre-enrollment assessment tool).

The SEP begins the month the MAO notifies the individual of the lack of eligibility for the C- SNP.

The SEP ends two calendar months following the month in which the MAO notifies the individual of the lack of eligibility.