Significant Network Change Special Election Period (SEP)

110.1.2.5 – Significant Network Change Special Election Period (SEP) (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) Pursuant to 42 CFR § 422.62(b)(4), enrollees who meet the exceptional conditions of being substantially affected by a significant no-cause provider network termination may be afforded a special election period (SEP). If CMS determines that an MAO’s network change is significant with substantial enrollee impact, then a “significant network change SEP” may be warranted. CMS will use a variety of criteria for making this determination, such as: (1) the number of enrollees affected; (2) the size of the service area affected; (3) the timing of the termination; (4) whether adequate and timely notice is provided to enrollees, (5) and any other information that may be relevant to the particular circumstance(s). The MAO will be required to notify eligible enrollees of the significant network change SEP if the SEP is granted by CMS. SEPs will not be granted when MAOs make changes to their network that are effective on January 1 of the following contract year, as long as affected enrollees are notified of the changes prior to the AEP. For more information regarding the significant network change SEP, please see the Medicare Advantage Enrollment and Disenrollment Guidance at: https://www.cms.gov/Medicare/Eligibility-and- Enrollment/MedicareMangCareEligEnrol/index.html.