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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): compare the MA network of the relinquishing D-SNP to that of the receiving D-SNP to assess overlap in provider and facility specialty types with the highest utilization by dually eligible individuals. No additional network restrictions

Substantially similar Medicare and Medicaid covered benefits. Receiving D- SNPs will always meet the Medicare benefit comparability requirements provided they have an approved Plan Benefit Package (PBP) submission for the applicable Contract Year for which the passive enrollment takes place. CMS will not consider the receiving or relinquishing D- SNPs’ supplemental benefits as part of the analysis of benefit comparability. CMS will consult with the applicable state Medicaid agency to ensure that affected enrollees’ Medicaid benefits under the various available options are substantially similar to the benefits under their current Medicaid coverage. Premium is not significantly higher

Have limits on premiums and cost-sharing that are appropriate for full-benefit dually eligible individuals (CMS interprets this standard as having no premium or cost- sharing ($0 for enrollees) (see Chapter 16- B) Equivalent or higher value Part D benefit and formulary structure

Have overall MA star rating of at least three stars (Exception: plan is low enrollment contract or new plan without star ratings) Similar Part B buy-down feature, if applicable

Not under sanction for new enrollments Not under sanction for new enrollments

Have operational capacity (and agree) to accept the enrollments. CMS will scale the review of operational capacity based on the overall volume of passive enrollment and presence of other risk factors. CMS will assess several factors to determine operational capacity. These factors may include, but are not limited to: current