CMS Pub. 100-16, ch. mc86c16a, § 160.2

Partial Network PFFS Plan

(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)

An MA organization with a PFFS non-network contract may consolidate some counties

in the service area of a current non-network PFFS PBP into a single new or renewal

partial network PFFS PBP under a separate contract held by the same legal entity.

Current members in the remaining counties in the current year’s non-network PFFS PBP

may remain in the current non-network PBP provided the MA organization follows the

rules for a renewal plan with a SAR described in section 140.6 of Chapter 4 of this

manual.

The MA organization must submit enrollment transactions to MARx for current members

in the counties affected by the SAR who will be transitioned to a new or renewing partial

network PBP under a separate contract held by the same legal entity. New members must

complete enrollment requests, and the MA organization will submit enrollment

transactions to MARx for those new members as usual. Current members transitioned to

the PFFS partial network plan must receive a standard ANOC.