Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.4
Some Counties of a Non-Network PFFS Plan Transitioning to a
160.4 - Some Counties of a 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 some counties
in the service area of a current non-network PFFS PBP into a single new or renewal full
network PFFS PBP under a separate contract held by the same legal entity. Current
members in the remaining counties in the current year non-network PFFS PBP may
remain in subsequent year’s non-network PBP provided the MA organization follows the
rules for a renewal plan with a SAR described in section 140.6 of Chapter 4 of this
manual.
The MA organization must submit enrollment transactions to MARx for current members
in the counties affected by the SAR who will be transitioned to a new or renewing full
network PBP under a separate contract held by the same legal entity. New members must
complete enrollment requests, and the MA organization will submit enrollment
transactions to MARx for those new members. Current members transitioned to the
PFFS full network plan must receive a standard ANOC.