Page 97

96 | P a g e

request or after the MAO receives approval from CMS to limit enrollment. The notice must: (1) inform the individual that the enrollment request will not be processed until the plan reopens for enrollment, (2) include the date the plan will reopen, and (3) inform the individual that they may cancel the request for enrollment before the plan reopens or a vacancy occurs. All individuals who wish to wait for an opening must be placed on the waiting list.

If a vacancy becomes available, and the plan was closed for more than 30 calendar days since the receipt of the enrollment form, the MAO must first contact (by telephone or in writing) the individual to reaffirm the individual’s intent to enroll before processing the enrollment.

There may be situations in which the MAO has closed enrollment in a service area yet receives an approval for a capacity limit for a portion of that same service area. Given that MA plans are either open or closed to OEP and OEPI enrollments for an ENTIRE plan service area, any vacancies which may open up may only be filled by individuals making AEP, ICEP or SEP enrollment elections by applying the rules for accepting enrollments when MA plans are closed. Further, it must take those individuals based upon enrollments received in chronological order.

The date the MA plan reopened becomes the “receipt date” of enrollment forms received when the plan was closed.

Example: If the plan was closed in February and reopens on March 1, then the receipt date of enrollment requests received in February is March 1.

50.11 – Enrollment Procedures for Medicare MSA Plans – Part C only 42 CFR § 422.56

Individuals may enroll into a Medicare MSA plan only through the MAO offering that plan. MSA plans must have a paper enrollment form available for eligible individuals to request enrollment but may also offer an online enrollment mechanism as defined in § 40.1.2 through the organization’s website. However, MSA plans are not available through the OEC on the Medicare.gov website.

Applications for Medicare MSAs must include the questions below. An individual must provide all required MSA specific information in order for the enrollment request for the MSA plan to be considered complete, including the answers to the following questions:

Question Yes No 1. To enroll in <MSA plan name>, you may not have other health coverage. a. Are you enrolled in a State Medicaid program? b. Are you receiving Medicare Hospice Benefits? c. Will you have other health coverage in addition to <MSA plan name>?