42 C.F.R. § 423.2516

Current through September 30, 2024
Section 423.2516 - Selection of LI NET sponsor and contracting provisions
(a)Appointment by CMS. CMS appoints a Part D sponsor that meets the requirements at § 423.2512 to serve as the LI NET sponsor.
(b)Selection criteria. In appointing a LI NET sponsor, CMS evaluates the following:
(1) Experience covering low-income beneficiaries, including but not limited to enrolling and providing coverage to low-income subsidy individuals as defined in § 423.34 ;
(2) Pharmacy access as outlined in § 423.120 ;
(3) Past performance, including Star Ratings (as detailed in § 423.186 ), previous intermediate sanctions (as detailed in § 423.750 ), and consistent with past performance in § 423.503(b) ; and
(4) Ability to meet the requirements listed in § 423.505 that are not waived under § 423.2536 .
(c)Term of appointment. The term of the appointment will be ongoing provided mutual agreement between CMS and the selected party, subject to an annual contracting and bid process (per § 423.2524(b) ) to determine payment rates for the upcoming year.

42 C.F.R. §423.2516

88 FR 22342, 6/5/2023