Flashcards
Advanced SEP course
Cards in this deck (3)
- 1You're speaking to a member with LIS, & you see a CARA note in MARX. You mention it to the member & they say they're in an "at-risk" program. What does that mean?Members who are deemed "at risk" for opioid abuse by CMS are entered into a Comprehensive Addiction and Recovery Act program, which restricts them from using the LIS SEP.
- 2A member calls & says they received a letter from CMS indicating they're in a "poor performing plan". Is this an SEP?Yes - Low Performing Plan SEP. There are two ways to use it: If the code LPP isn't available, select "OTHER" & type the plan ID (e.g. H1095-001) & "Poor Performer"
- 3A member calls in, insisting that their plan violated their contract, & the member insists to be enrolled in another plan immediately. Is this an SEP?Trick question! It is an SEP, but the determination of a violation, as well as any resulting enrollments/disenrollments, are to be handled directly by CMS through a paper application.