CMS Pub. 100-16, ch. mc86c16b, § 40.1

As specified in section 1859(f) of the Act, SNPs may only enroll individuals who meet the plan’s

specific eligibility criteria and enrollment requirements. For example, a D-SNP that is approved to

serve only full-benefit Medicaid beneficiaries may not enroll an individual who is not qualified for

full-benefit Medicaid even though the individual may qualify for a different category of Medicaid.

Similarly, an individual who has no Medicaid entitlement may not enroll in a D-SNP of any type. A

C-SNP approved to serve a population with diabetes may not enroll individuals who do not have the

diabetic condition. However, enrollees who are dually eligible and who qualify for a C-SNP can

choose to enroll in either a D-SNP or a C-SNP. An individual who loses eligibility and is disenrolled

from a SNP may re-enroll in the same SNP if that individual once again meets the specific eligibility

criteria of the SNP. In general, limits on enrollment, whether specific to persons with Medicare or

for any individual eligible to enroll in the SNP, are not permissible. MA organizations, including

those offering SNPs, must accept, without restriction, all eligible individuals whose enrollment

elections are received during a valid election period, expect where a state limits or freezes

enrollment through a D-SNP’ s SMAC. See 42 CFR 422.52, 42 CFR 422.60 and section 1851(g)(1)

of the Act.

42 CFR 422.52 establishes eligibility rules for SNPs. SNPs must include elements on the

enrollment request that correspond to the special needs criteria of the particular SNP. Refer to

policy regarding enrollment request mechanisms, including special guidance for C-SNPs, in the

Medicare Advantage Enrollment and Disenrollment Guidance.

SNPs that choose whether to opt in to the Online Enrollment Center (OEC) are held to the same

accountability as other MA organizations. MA organizations must accept enrollments through the

OEC except when limited by CMS or when a D-SNP is limited by provisions in its SMAC. Additional

guidance on enrollment processes is available in the Medicare Advantage Enrollment and

Disenrollment Guidance. Refer to section 40.2.1 of this chapter and the Medicare Advantage

Enrollment and Disenrollment Guidance for more information about C-SNP eligibility verification

processes. The Medicare Advantage Enrollment and Disenrollment Guidance also includes

information about special election periods (SEPs) for dually eligible enrollees or enrollees who lose

their dual eligibility.