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In these cases, the plan still must provide the individual all materials described above no later than 10 calendar days after receipt of the enrollment request. Additionally, the plan is strongly encouraged to call these new enrollees as soon as possible (such as within one to three calendar days) to provide the effective date, information to access benefits, explain the plan’s rules, and that coverage will be active on the effective date required by regulation regardless of whether or not the enrollee has received all the information by the effective date.

50.10 – Enrollment Processing During Closed Periods – Part C only 42 CFR §§ 422.60(a)(2) and 422.60(b)

An MAO may close an MA plan to OEP and OEPI enrollments, or when it reaches a CMS- approved capacity limit. A capacity limit allows an MA plan to close or limit enrollment for all election periods. As described in § 50.5, when an MAO is open for enrollment, it must process elections in order of date of receipt of the completed enrollment request.

50.10.1 – Procedures After Reaching Capacity Limit – Part C only 42 CFR §§ 422.60(a)(2) and 422.60(b)

If the number of individuals who elect to enroll in an MA plan exceeds a CMS-approved capacity limit, then the MAO may limit enrollment, only if it provides priority by, (1) the date the request was received and (2) then for other individuals in a manner that does not discriminate based on any factor related to health as described in 42 CFR § 422.110.

If an MAO receives completed enrollment requests between the time it reaches its limit and the time CMS approves the limit, or is closed to OEP or OEPI enrollments, it may follow one of two options after it receives approval from CMS to limit enrollment:

Option 1 – Deny the enrollment, or

Option 2 – Place the enrollment on a waiting list to be processed as vacancies occur, in the priority of acceptance, based on the date the completed request was accepted.

The MAO must take the same action for all enrollment requests received. In the case of enrollments received after the plan closes for enrollment, the date the MA plan reopens for enrollment, becomes the “receipt date” of enrollment forms received when the plan was closed.

Example: If the plan was closed in April and reopens on May 1, then the receipt date of enrollment requests received in April is May 1. See below for procedures for following options 1 or 2.

If the MAO uses Option 1 – It must notify the individual in writing that it is denying the enrollment and should do so within 10 calendar days after it receives the enrollment request or after the MAO receives approval from CMS to limit enrollment.

If the MAO uses Option 2 – It must notify the individual in writing that they have been placed on a waiting list and should do so within 10 calendar days after the MAO receives the enrollment