US · guidance
CMS Pub. 100-16, ch. mc86c16b, § 30.4
Service Area Expansion
An MAO may only operate a SNP in its MA-PD approved service area. An MAO may seek to
expand its SNP service area either (1) into its existing MA-PD service area, or (2) into a service
area(s) where it does not currently operate. Please see table 5 below for application information
pertaining to these two different scenarios.
Table 5: SNP SAE Scenarios
Complete SNP
SAE Application?
Complete MA-PD
SAE Application?
1. MAO seeks to expand its SNP service
area into its existing MA-PD service
area.
Yes No
2. MAO seeks to expand its SNP service
area into a service area(s) where it
does not currently operate.
Yes Yes
The proposed SAE may not exceed the existing or pending service area for the MA contract. Please
note that every D-SNP must have a SMAC for each state in which the D-SNP operates, and the CMS-approved service area must match the service area delineated in the SMAC. In addition, beginning
for CY 2017, MAOs are not required to submit a new MOC when requesting an SAE for a SNP (see
the January 14, 2016, HPMS memo “Changes to Special Needs Plan and Medicare-Medicaid Plan
Model of Care Submissions and Updates in the Health Plan Management System”).
History
(Rev. 123, Issued: 08-19-16, Effective: 08-19-16, Implementation: 08-19-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8ecae9e50eec416540e773fc6cb22bcafde69b7d728f2912e5d85ffd7bd74065
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