CMS Pub. 100-16, ch. mc86c16b, § 50.2

Contract

(Rev. 131; Issued: 11-22-24; Effective: 11-22-24; Implementation: 11-22-24)

All MA organizations that offer D-SNPs must have contracts with state Medicaid agencies in the

states in which they operate per section 1859(f)(3)(D) of the Act and 42 CFR 422.107. In the event

that an MA organization is not able to secure such a contract (or subcontract) with the state

Medicaid agency(ies) for one or more of its D-SNPs, the MA organization must non-renew or

terminate those D-SNPs in accordance with 42 CFR 422.506 through 422.510. Enrollees in those

plans will be disenrolled from their D-SNP and may elect to receive Part A and Part B benefits

under original Medicare or another MA plan into which they wish to enroll.

Several SEPs are available to individuals affected by such an action, including:

• Enrollees have a SEP at 42 CFR 422.62(b)(1) available when an MA plan (including a D-SNP) is terminating.

• Enrollees who are dually eligible individuals or LIS-eligible individuals have a SEP at 42

CFR 423.38(c)(4) that may be used in any month to enroll into original Medicare and a

standalone Part D prescription drug plan.

• Full-benefit dually eligible individuals also have a SEP at 42 CFR 423.38(c)(35) that may

be used in any month to enroll into a FIDE SNP , HIDE SNP , or AIP to facilitate aligned

enrollment in the affiliated Medicaid MCO.

1 See also the final rules at 86 FR 5864, 5963 - 5969 (Jan. 19, 2021) (available online here:

https://www.govinfo.gov/content/pkg/FR-2021-01-19/pdf/2021-00538.pdf) and 87 FR 27704, 27743 – 27768 (May 9, 0222) (available online here:

https://www.govinfo.gov/content/pkg/FR-2022-05-09/pdf/2022-09375.pdf) for discussion of § 422.530.

.

In the event of a D-SNP termination or non-renewal, the D-SNP enrollees who do not make an

enrollment request will be enrolled into original Medicare and automatically enrolled in a

benchmark stand-alone PDP after the termination of the D-SNP. For more information about SEPs

and enrollment periods available to dually eligible individuals, refer to Chapter 2 of the MMCM,

which is also posted as the MA Enrollment and Disenrollment Guidance here:

https://www.cms.gov/medicare/eligibility-andenrollment/medicaremangcareeligenrol.