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CMS Memo: "New Exceptional Circumstance Special Enrollment Period Based on Incorrect or Misleading Information"

Category: Special Enrollment Periods SEP
Published on 2007-09-11 09:40:51

In the wake of the June 15, 2007 CMS Press Release where a number of national Medicare Advantage Private Fee for Service (PFFS) voluntarily suspended Medicare Advantage plan marketing pending  Centers for Medicare and Medicaid Services (CMS) review; CMS established a new Special Enrollment Period (SEP) allowing Medicare beneficiaries a re-enrollment or dis-enrollment opportunity outside of the Annual Election Period (AEP) or Open Enrollment Period (OEP).

The CMS  memo dated July, 18, 2007,  provides the SEP for Medicare beneficiaries who enrolled in a Medicare Advantage plan "based on misleading or incorrect information".  Once the SEP is approved, the Medicare beneficiary can return to original Medicare, enroll in a stand-alone Prescription Drug Plan (PDP) or enroll in another Medicare Advantage plan.

Medicare beneficiaries should contact Medicare (telephone numbers provided below) with any questions.

The following is the complete text of the CMS memo regarding a Special Enrollment Period.

DATE: July 18, 2007
TO: All Medicare Advantage and Part D Organizations
FROM: Anthony J. Culotta, Director Medicare Enrollment and Appeals Group
SUBJECT: New Exceptional Circumstance Misleading Information

CMS has established a Special Election Period (SEP) to address situations where an individual has enrolled in a Medicare Advantage (MA) plan based on misleading or incorrect information provided by plan employees, agents or brokers. All interested individuals should be advised to call 1-800-MEDICARE to see if they qualify for this SEP. Customer service representatives at 1-800-MEDICARE and CMS regional office (RO) caseworkers will evaluate beneficiaries’ requests on a case-by-case basis to confirm that they qualify for this SEP.

Upon approval of the SEP, CMS will provide all qualified beneficiaries assistance in selecting new Medicare plan options, which may include another MA plan, a Part D plan, or Original Medicare. Please note that prospective enrollments input by 1-800-MEDICARE will be entered via the online enrollment center (OEC). In such cases, “1-800-Medicare Marketing Misrepresentation SEP" will be entered into the "For CMS Use Only" field. Thus, there will be no need for plans to verify eligibility for this SEP.

All requests for retroactive enrollment changes under this SEP will be handled and processed by the appropriate CMS RO caseworkers, who will discuss the possible ramifications of retroactive changes with affected beneficiaries. When requests for retroactive enrollments are warranted, the RO caseworkers will input the enrollments directly (without any involvement with the Integriguard process). For those transactions input by CMS staff, only CMS staff information (e.g., last name and region) will be entered into the "For CMS Use Only" field. Note that CMS has created a new subcategory in the complaint tracking module (CTM) in order to help identify, trend, and monitor these cases.

If you have any general questions about this SEP, please contact Lynn Orlosky at (410) 786-9064; questions about specific cases may be directed to your CMS account or plan manager.

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

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