Page 63

62 | P a g e

Examples of acceptable state policy documents include but are not limited to a SMAC, state letter, and/or a copy of the state’s completed/signed default enrollment plan application, if applicable.

State data sharing processes and data provisioning agreements provide a description of the following:

• The CMS data source the state will use to identify Medicaid managed care plan enrollees who are in their Medicare initial coverage election period (ICEP) based on age or disability; • Frequency at which the state will check the CMS data source; • Method the state will use to transmit CMS eligibility data to the D-SNP (e.g., 834 enrollment file or other proprietary file; • Data elements the state will share (necessary for the D-SNP to submit enrollment transactions to CMS) per § 422.66(d)(6) and § 422.60(e)(5); • Frequency with which the state will transmit prospective Medicare eligibility data • to the MAO to meet the noticing requirements. It is important to establish a process in which the state provides the Medicare eligibility data to the MAO in enough time for plans to send the required default enrollment notice to individuals no fewer than 60 days prior to the start of Medicare eligibility.

NOTE: Data provided by the state must include all information necessary to submit the enrollment transaction to CMS (Medicare Parts A and B entitlement date, Medicare number, date of birth, sex) for the default enrollment process to occur.

Medicaid eligibility redeterminations Generally, default enrollment depends on Medicaid eligibility redeterminations being completed far enough in advance of the prospective enrollee’s Medicare eligibility date for the D-SNP to meet the noticing requirement under 42 CFR § 422.66(c)(2)(iv). In certain circumstances, CMS can work with states when redeterminations cannot be completed at least 60-days in advance of the prospective enrollee’s Medicare eligibility date per 42 CFR § 422.66(c)(2)(iii).

For example, if a Medicaid MCO enrollee has a Medicare eligibility effective date of October 1, the state Medicaid redetermination would need to be completed by July for the D-SNP to confirm MA eligibility, submit transactions to CMS, and send the individual notice no later than August 1.

Default enrollment renewal process CMS only approves default enrollment for a period not to exceed five years, although CMS may suspend or rescind approval prior to the expiration of this period. To minimize the risk of disruption in default enrollment processing, MAOs should submit the required renewal documents to CMS well in advance of its 5-year approval end date. To continue conducting default enrollment without interruption, renewing D-SNP proposals must: