Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.4

Some Counties of a Non-Network PFFS Plan Transitioning to a

Last amended: 2011Year: 2011Length: 185 wordsOfficial source
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.
Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.4: Some Counties of a Non-Network PFFS Plan Transitioning to a | Justis AI