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Individuals who are confined to IMDs as a result of court orders not related to penal violations, are not incarcerated as CMS defines that term, and are therefore not excluded on that basis from the plan service area.

Institutional-equivalent special needs plan (IE-SNP) – A type of I-SNP that restricts enrollment to MA eligible individuals who meet the definition of institutionalized-equivalent in 42 CFR § 422.2.

Institutional special needs plan (I-SNP) – A SNP that restricts enrollment to MA eligible individuals who meet the definition of institutionalized and institutionalized-equivalent in 42 CFR § 422.2. I-SNPs include the following subtypes:

• IE-SNP, • HI-SNP, and • FI-SNP.

Institutionalized – Please refer to 42 CFR § 422.2 “Institutionalized.”

Institutionalized-equivalent – Please refer to 42 CFR § 422.2 “Institutionalized-equivalent.”

Involuntary Disenrollment – Disenrollments initiated by CMS or the plan. Such disenrollments may be the result of the individual no longer being eligible to remain enrolled in a plan (e.g., resides out of the plan service area) or other circumstances (e.g., failure to pay premiums, plan termination).

Lawfully Present Individual – Refer to 8 CFR § 1.3 (Lawfully present aliens for purposes of applying for Social Security benefits) for a definition of an alien who is considered lawfully present in the United States. An individual who is not lawfully present in the Unites States is not eligible for any federal public benefit, including payment of Medicare benefits, under 8 U.S.C. § 1611.

MA-only Plan – A Medicare Advantage plan that does not include Medicare Part D qualified prescription drug coverage.

Medicaid MCO – A health plan that provides Medicaid services within a State as defined in § 438.2, and may be aligned with a FIDE, HIDE or AIP D-SNP.

Medicare Advantage Prescription Drug Plan (MA-PD) – A Medicare Advantage plan that includes Medicare Part D qualified prescription drug coverage.

Medicare Advantage Organization (MA organization) (MAO) – A public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider- sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements.