42 C.F.R. § 422.52 Eligibility to elect an MA plan for special needs individuals.
Title 42 - Public Health
(a) General rule. In order to elect a specialized MA plan for a special needs individual (Special Needs MA plan, or SNP), the individual must meet the eligibility requirements specified in this section. (b) Basic eligibility requirements. Except as provided in paragraph (c) of this section, to be eligible to elect an SNP, an individual must: (1) Meet the definition of a special needs individual, as defined at §422.2; (2) Meet the eligibility requirements for that specific SNP; and (3) Be eligible to elect an MA plan under §422.50. (c) Exception to §422.50. CMS may waive §422.50(a)(2) concerning the exclusion of persons with ESRD. (d) Deeming continued eligibility. If an SNP determines that the enrollee no longer meets the eligibility criteria, but can reasonably be expected to again meet that criteria within a 6-month period, the enrollee is deemed to continue to be eligible for the MA plan for a period of not less than 30 days but not to exceed 6 months. (e) Restricting Enrollment. An SNP must restrict future enrollment to only special needs individuals as established under §422.2. (f) Exceptions. (1) As specified in §422.4, CMS may designate certain MA plans that disproportionately serve special needs individuals, as defined in §422.2 as SNPs. (2) Individuals already enrolled in an MA plan that CMS subsequently designates as an SNP may continue to be enrolled in the plan and may not be involuntarily disenrolled because they do not meet the definition of special needs individuals in §422.2. [70 FR 4716, Jan. 28, 2005]
Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart B—Eligibility, Election, and Enrollment
§ 422.52 Eligibility to elect an MA plan for special needs individuals.
