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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): enrollment in relation to the projected volume of passive enrollment; available Part C and Part D performance metrics; recent Medicare program audits; other compliance and enforcement activity; and other factors identified or requested by the state.

Special Election Period: An SEP is available to all individuals who are passively enrolled in addition to the ability to opt- out of a passive enrollment. See § 30.6.30 for more details about this SEP. Individuals in non- renewing or terminating plans and dually eligible individuals also have the ability to use other existing SEPs outlined in § 30.

40.1.7 – Simplified (Opt-In) Enrollment Mechanism – Part C only 42 CFR § 422.66(d)(5)

This mechanism permits an MAO to use existing data it has from its non-Medicare lines of business (commercial, Marketplace, Medicaid, etc.) to obtain some of the information it would otherwise need to receive from the individual in the enrollment request. The MAO then obtains any other necessary data from the individual that it cannot get from its existing data source.

Use of this mechanism is not required. It is up to the MAO whether it has the capability and wants to share data between its Medicare and non-Medicare lines of business. CMS reminds MAOs of their obligations to the privacy and security of protected health information under the HIPAA Privacy and Security Rules, 45 CFR §§ 160 and 164, and that the MAO must evaluate whether and how use of data from other lines of business may be permissibly shared under those rules. This document is not HIPAA guidance.

MAOs may offer simplified enrollment only to individuals who: • Are in their ICEP; • Are enrolled in any type of non-Medicare plan under the same organization (or an entity under the same parent organization as the MAO); and • Do not have a break in coverage between the non-Medicare plan and the MA plan.

The MAO identifies individuals who are enrolled in its non-Medicare coverage and in their ICEP. It may conduct outreach to these current enrollees and offer them the opportunity to enroll in their MA plan. Outreach efforts are considered marketing, and should clearly articulate the various plan offerings, plan structure, premium, costs, network, etc. Refer to the Medicare Communications and Marketing Guidelines (MCMG) for more information.