Page 87

86 | P a g e

requests for Medicare beneficiaries. For example, persons authorized under State law may include:

• Court-appointed legal guardians, • Persons having durable power of attorney for health care decisions, or • Individuals authorized to make health care decisions under State surrogate consent laws, provided they have the authority to act for the individual in this capacity.

When someone other than the eligible individual completes an enrollment or disenrollment request, they must:

1) Attest to having the authority under State law to do so; 2) Sign the completed form, or through other approved mechanisms, indicate their relationship to the individual; and 3) Provide contact information.

Plans must retain the record of this attestation as part of the record of the enrollment or disenrollment request.

Where plans are aware that an individual has a representative payee designated by SSA to handle the individual’s finances, plans should contact the representative payee to determine their legal relationship to the individual, and to ascertain whether they are the appropriate person, under State law, to execute the enrollment or disenrollment request. Representative payee status alone is not sufficient to enroll an individual.

If anyone has reason to believe that an individual making an election on behalf of an eligible individual may not be authorized under State law to do so, the organization should contact its CMS account manager with all applicable documentation regarding State law and the case in question. The account manager may request supporting documentation from the individual making the election.

When an authorized representative completes an enrollment request on behalf of an individual, the plan should inquire regarding the preference for the delivery of required notifications and other plan materials (i.e., sending mail to the eligible individual directly or to the representative, or both) and make reasonable accommodations to satisfy these wishes.

50.2 – Determining Individual Eligibility to Process an Enrollment 42 CFR §§ 422.60, 423.30, and 423.32

Upon receiving an enrollment request, plans must verify the individual’s eligibility to enroll in the MA or Part D plan.

To determine individual eligibility and consider the request complete, the plan must confirm:

• Medicare entitlement; • Election period eligibility; and