Page 8

7 | P a g e

• Is being treated for active cancer-related pain or • Has sickle cell disease.

Facility-based Institutional special needs plan (FI-SNP) – A type of I-SNP that— • Restricts enrollment to MA eligible individuals who meet the definition of institutionalized; • Must own or contract with at least one institution, specified in the definition of institutionalized in this section, for each county in the plan's service area; and • Must own or have a contractual arrangement with each institutionalized facility serving enrollees in the plan.

Full-Benefit Dual Eligible Individual – An individual who, for any month: • Has coverage under a Part D or MA-PD plan, and • Is determined eligible by the State for medical assistance for full benefits under title XIX of the Social Security Act (the Act) for the month under any eligibility category covered under the State plan or comprehensive benefits under a demonstration under Section 1115 of the Act (this does not include individuals under Pharmacy Plus program demonstrations or under a Section 1115 demonstration that provides pharmacy-only benefits to these individuals) or is determined by the state to be eligible for medical assistance under Section 1902(a)(10)(C) of the Act (medically needy) or Section 1902(f) of the Act (States that use more restrictive eligibility criteria than are used by the SSI program) for any month if the individual was eligible for medical assistance in any part of the month.

Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) – A type of integrated D-SNP defined in 42 CFR § 422.2 and Chapter 16-B.

Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP) – A type of integrated D- SNP defined in 42 CFR § 422.2 and Chapter 16-B.

Hybrid Institutional special needs plan (HI-SNP) – A type of I-SNP that— • Restricts enrollment to both MA eligible individuals who meet the definition of institutionalized and MA eligible individuals who meet the definition of institutionalized- equivalent in this section; and • Meet the standards specified in the definitions of FI-SNP and IE-SNP.

Incarceration/Incarcerated – The status of an individual who is in the custody of a penal authority and confined to a correctional facility (e.g., a jail or prison, or a mental health institution) as a result of a criminal offense. This includes individuals who are confined to an Institution for Mental Disease (IMD) (e.g., state hospital, psychiatric hospital, or the psychiatric unit of a hospital), as a result of violations of the penal code. Such individuals reside outside of the service area for the purposes of plan eligibility, even if the correctional facility is located within the plan service area.