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the enrollment request transaction to CMS. For example, the individual is not entitled to Medicare Part A or enrolled in Part B, the individual is not making the enrollment request during an election period, etc.

Dual Eligible Special Needs Plan (D-SNP) – A type of SNP that exclusively serves Medicare beneficiaries who are also entitled to Medicaid.

D-SNPs enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility. Individuals in the following Medicaid eligibility categories may be eligible to enroll in D-SNPs, to the extent permitted in the state Medicaid agency contract (see § 20.2.2 of Chapter 16-B): • Full Medicaid (only); • Qualified Medicare Beneficiary without other Medicaid (QMB Only); • QMB Plus; • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only); • SLMB Plus; • Qualifying Individual (QI); and • Qualified Disabled and Working Individual (QDWI).

States may vary in determining their eligibility categories; therefore, there may be state specific differences in the eligibility levels in comparison to those listed here.

Requirements for D-SNPs are described and defined further in 42 CFR § 422.2 and Chapter 16- B.

Effective Date (enrollment and disenrollment) – The date that an individual’s coverage in a plan begins or ends.

Election (enrollment and disenrollment) – The act of an individual making an enrollment or disenrollment request. The term “election” is used to describe either an enrollment or voluntary disenrollment. If the term “enrollment” is used alone, it describes only an enrollment, not a disenrollment. If the term “disenrollment” is used alone, it describes only a disenrollment, and not an enrollment.

Election Period – The time frame that an eligible individual may request to enroll in or disenroll from a plan. Election periods vary and are outlined in § 30.

Enrollment Request Mechanism – A method used by individuals to request enrollment in a plan.

Exempted Beneficiary – Means with respect to a drug management program, an enrollee who: • Has elected to receive hospice care or is receiving palliative or end-of-life care; • Is a resident of a long-term care facility, of a facility described in Section 1905(d) of the Act, or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy;