Part C & Part D Enrollment and Eligibility Guidance
On August 15, CMS released the updated guidance for Part C and Part D enrollment and eligibility. Included with the policy and technical changes was a new MA model enrollment request form.
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On August 15, 2023, CMS released the updated guidance for Part C and Part D enrollment and eligibility. Included with the policy and technical changes was a new MA model enrollment request form. Notable updates include:
- Race/ethnicity enrollment questions added to model forms and in form fields guidance.
- Pronouns related to “the individual/enrollee/beneficiary” made gender neutral.
- URL updates: SSA and CMS web links have been updated to working links.
- SEP for Individuals who gain, lose, or have a change in their dual or LIS-eligible status was revised for clarity and to match the regulation at 42 CFR 423.38(c)(9).
- Model notice for CMS rejection of enrollment (Chapter 2, Exhibit 8) was revised for typo errors.
- 4201-F1 updates:
- NET language updated/deleted to reflect status as a permanent program.
- Language updated for partial/full benefit subsidy eligible individuals to reflect changes in federal poverty level.
- Added SEP for individuals who enroll in Medicare Premium-Part A or Part B using an exceptional condition SEP, as described in 42 CFR Parts 406.27 and407.23.
- Clarification of SEP for other exceptional circumstances review process and possible effective dates.
The following are some useful links:
- Updated Medicare Managed Care Manual Chapter 2 Medicare Advantage Enrollment and Disenrollment
- Updated Medicare Managed Care Manual Chapter 17 Subchapter D Medicare Cost Plan Enrollment and Disenrollment Instructions
The Model Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (MA) or a Medicare Prescription Drug Plan (Part D) are required to be included on your enrollment form. However, applicant response to these questions is optional.
MA plans are expected to use the new form for enrollment requests received on or after January 1, 2023. The new form (new form requirements) should be used for all enrollments after January 1, 2023.
The Garnet Care team can help you implement these changes prior to the Annual Election period as well as throughout CY 2024. Garnet Care also understands budget constraints and ongoing challenges, but we do more with less! Our customized approach delivers superior results with expert guidance and support. We would love to hear from you! Please feel free to email me or give me a call 1-518-605-0216.
Courtney Seypura is practice lead for Garnet Care. She has more than 20 years of experience in Medicare and Medicaid operations and project management. Garnet Care helps health plans, administrators, hospitals, and providers improve patient experience and program performance through system and process optimization. Courtney can be reached by email at cseypura@garnetriver.com or by phone 518-605-0216.
