[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR423.34]

[Page 379-380]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 423_VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT--Table of Contents
 
                  Subpart B_Eligibility and Enrollment.
 
Sec.  423.34  Enrollment of full-benefit dual eligible individuals.

    (a) General rule. CMS must ensure the enrollment into Part D plans 
full-benefit dual eligible individuals who fail to enroll in a Part D 
plan.
    (b) Definition of full-benefit dual eligible individual. For 
purposes of this section, a full-benefit dual eligible individual means 
an individual who is:
    (1) Determined eligible by the State for--
    (i) Medical assistance for full-benefits under title XIX of the Act 
for the month under any eligibility category covered under the State 
plan or comprehensive benefits under a demonstration under section 1115 
of the Act. ; or
    (ii) Medical assistance under section 1902(a)(10)(C) of the Act 
(medically needy) or section 1902(f) of the Act (States that use more 
restrictive eligibility criteria than are used by the SSI program) for 
any month if the individual was eligible for medical assistance in any 
part of the month.
    (2) Eligible for Part D in accordance with Sec.  423.30(a).
    (c) Enrolling a full-benefit duel eligible individual. 
Notwithstanding Sec.  423.32(e), during the annual coordinated election 
period, CMS may enroll a full-benefit dual eligible individual in 
another PDP

[[Page 380]]

if CMS determines that the further enrollment is warranted.
    (d) Automatic enrollment rules--(1) General rule. CMS must 
automatically enroll full-benefit dual eligible individuals who fail to 
enroll in a Part D plan into a PDP offering basic prescription drug 
coverage in the area where the individual resides that has a monthly 
beneficiary premium that does not exceed the low-income premium subsidy 
amount (as defined in Sec.  423.780(b)). In the event that there is more 
than one PDP in an area with a monthly beneficiary premium at or below 
the low-income premium subsidy amount, individuals must be enrolled in 
such PDPs on a random basis.
    (2) Individuals enrolled in an MSA plan or one of the following that 
does not offer a Part D benefit. Full-benefit dual eligible individuals 
enrolled in an MA Private Fee For Service (PFFS) plan or cost-based HMO 
or CMP that does not offer qualified prescription drug coverage or an 
MSA plan and who fail to enroll in a Part D plan must be automatically 
enrolled into a PDP plan as described in paragraph (d)(1) of this 
section.
    (e) Declining enrollment and disenrollment. Nothing in this section 
prevents a full-benefit dual eligible individual from--
    (1) Affirmatively declining enrollment in Part D; or
    (2) Disenrolling from the Part D plan in which the individual is 
enrolled and electing to enroll in another Part D plan during the 
special enrollment period provided under Sec.  423.38.
    (f) Effective date of enrollment. Enrollment of full-benefit dual 
eligible individuals under this section must be effective as follows:
    (1) January 1, 2006 for individuals who are full-benefit dual 
eligible individuals as of December 31, 2005;
    (2) The first day of the month the individual is eligible for Part D 
under Sec.  423.30(a)(1) for individuals who are Medicaid eligible and 
subsequently become newly eligible for Part D under Sec.  423.30(a)(1) 
on or after January 1, 2006; and
    (3) For individuals who are eligible for Part D under Sec.  
423.30(a)(1) and subsequently become newly eligible for Medicaid on or 
after January 1, 2006, enrollment is effective as soon as practicable 
after being identified as a newly full-benefit dual eligible individual, 
in a process to be determined by CMS.