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CMS Updates Enrollment and Disenrollment Guidance for Medicare Advantage and Part D Plans


Email Alert

July 28, 2008
By Stefanie A. Doebler*

On July 17, 2008, CMS issued updated versions of its guidance to Medicare Advantage (MA) and prescription drug plan (PDP) sponsors regarding enrolling and disenrolling beneficiaries from MA and PDP plans. These guidances are contained in the Medicare Managed Care Manual and Prescription Drug Benefit Manual respectively. They constitute final CMS policy and are effective for contract year 2009, including all enrollments with an effective date on or after January 1, 2009, except that all updates and clarifications regarding special election periods are effective immediately.

The updates contain a number of important changes. Several of the most significant changes include new information about how plans should determine whether beneficiaries are eligible for a special election period (SEP), including: how individuals who have a severe/disabling chronic condition can qualify for a SEP to enable them to enroll in a chronic care special needs plan; additional security measures for plans that wish to accept disenrollment requests via the Internet; notice requirements for involuntary disenrollments and loss of special-needs status; and additional enrollment request mechanisms for employer- and union-sponsored plans. The updated chapters also contain additional and revised model enrollment notices and forms.

Redlines of the chapters showing the changes for 2009 are available on CMS' website.

Access the MA guidance.

Access the PDP guidance.

*We would like to thank Stefanie A. Doebler (Covington & Burling LLP, Washington, DC) for providing this email alert.

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