Page 66

65 | P a g e

CMS will provide specific instructions directly to the affected organizations (both the plan losing the enrollee and the plan receiving the enrollee) regarding processing the enrollments and specific information relevant to the situation for inclusion in notices.

Notices: The receiving D-SNP will send notices to enrollees for all passive enrollments. The chart below outlines the requirements and timing: Passive enrollment due to immediate plan termination or potential harm to enrollees Passive enrollment to continue access to integrated care (Part C policy) 1 notice required 2 notices required Notice language must: • Describe the costs and benefits of the plan; • Outline the process for accessing care in the plan; and • Explain how to decline the enrollment or choose another plan, including information on available SEPs, how to take that action and by when.

CMS must approve notice language Notice must be sent: • Prior to the date coverage in the new plan begins; or • As soon as possible after coverage in the new plan begins if prior notice is not practicable Notices must be sent: • First notice at least 60 calendar days prior to the date coverage in the new plan begins; and • Second notice at least 30 calendar days prior to the date coverage in the new plan begins

Evaluation of Plans Receiving Passive Enrollments: For passive enrollment, CMS evaluates whether the receiving plan meets certain standards, including benefit structures and cost sharing similar to the plan losing enrollees due to passive enrollment, and ensures that individuals do not lose Part D coverage unintentionally (e.g., individuals in employer or union sponsored coverage not indicated in CMS’ systems).

The charts below outline the parameters and requirements for this evaluation: Passive enrollment due to immediate plan termination or potential harm to enrollees Key criteria CMS may use:

Passive enrollment to continue access to integrated care (Part C policy) Requirements (all must be met): Similar or lower out-of-pocket maximum

Currently operate as a fully integrated dual eligible SNP (FIDE SNP) or, a highly integrated dual eligible SNP (HIDE SNP) (see Chapter 16-B) Similar or lower hospital cost-sharing amount

Substantially similar provider and facility networks. Using National Provider Identifier (NPI) numbers, CMS will