Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.3
Non-Network PFFS Plan Transitioning to a Full Network PFFS
160.3 - Non-Network PFFS Plan Transitioning to a Full Network PFFS
Plan
(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)
An MA organization with a PFFS non-network contract may consolidate one or more
current entire non-network PFFS PBPs into a new or renewal full network PFFS PBP
under a separate contract held by the same legal entity.
Current members of a PFFS non-network plan or plans being consolidated into a new or
renewal PFFS full network plan will not be required to take any enrollment action, and
the organization will not submit enrollment transactions to MARx for those current
members, although it may need to submit updated 4Rx data to CMS for the current
members affected by the consolidation. New members must complete enrollment
requests, and the MA organization will submit enrollment transactions to MARx for
those new members. Current members of the consolidated PFFS full network plan must
receive a standard ANOC.