Potential at-risk beneficiary

Potential at-risk beneficiary means a Part D eligible individual who is not an exempted beneficiary (as defined in this section) and -
(1) Who is identified using clinical guidelines (as defined in this section); or
(2) With respect to whom a Part D plan sponsor receives a notice upon the beneficiary's enrollment in such sponsor's plan that the beneficiary was identified as a potential at-risk beneficiary (as defined in paragraph (1) of this definition) under the prescription drug plan in which the beneficiary was most recently enrolled and such identification had not been terminated upon disenrollment.


42 CFR § 423.100

Scoping language

As used in this part, unless otherwise specified-

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