CMS Pub. 100-16, ch. mc86c17d, § 40.4

The cost plan must maintain a system for receiving, controlling and processing

applications for membership in which it:

• Date-stamps each application with the date the form was received;

• Ensures that each beneficiary who enrolls (whether previously a member of the

organization or not) receives a signed and dated copy of the application form;

• Processes applications from beneficiaries in chronological order by received date;

• Notifies the beneficiary in writing of the cost plan’s acceptance or denial of

his/her application no later than 30 calendar days following the date the

application was received;

• If the application is accepted, the plan must inform the beneficiary of the

proposed effective date of coverage (see Exhibit 2);

• If the application is denied, the plan must provide the applicant with a written

explanation of the reason for denial (see Exhibit 5 and additional detail in §40.5

of this chapter); and

• Contacts the beneficiary if additional information is needed to process the

enrollment (see Exhibit 3 and additional information in §40.2.2).

For Cost Plans that have obtained a capacity waiver:

• Places the application on a waiting list as described in §30.1.5 of this chapter, and

provides the beneficiary with an explanation of procedures to follow as vacancies

occur, and

• Fills vacancies occurring during an enrollment period in chronological order,

beginning with the earliest dated application on the list.

Once the plan receives a reply listing report from CMS indicating whether the

individual’s enrollment has been accepted or rejected, the plan should send written

notification to the beneficiary that CMS accepted or rejected his/her enrollment

application. (See Exhibit 4 and Exhibit 6.)