Contract with CMS for Special Needs Plan Sample Clauses

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract.
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Contract with CMS for Special Needs Plan. The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP). The MCO shall notify the STATE, consistent with section 3.6.14, of any material changes in its contract with CMS as a Special Needs Plan, including but not limited to, termination of the contract by either party. The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, failure to meet the CMS Low Income Subsidy (LIS) requirements, Part D issues that may materially affect the SNP, or a decision to conduct a Federal investigative audit that may lead to termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen
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Contract with CMS for Special Needs Plan. The MCO shall notify the STATE of any material changes in its contract with CMS as a Special Needs Plan, including but not limited to, termination of the contract by either party. The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, failure to meet the CMS Low Income Subsidy (LIS) requirements, Part D issues that may materially affect the SNP, or a decision to conduct a Federal investigative audit that may lead to termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligibles, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen
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Contract with CMS for Special Needs Plan. The MCO shall notify the STATE of any material changes in its contract with CMS as a Special Needs Plan, including but not limited to, termination of the contract by either party.
Sample 1Sample 2See All (4)
Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage, for its integrated SNP only, as a Dual Eligible Special Needs Plan (D-SNP), in compliance with 42 CFR 422.107(c)(3) , as the same entity holding both the D-SNP contract and this Contract. MCO understands that this designation as a Highly Integrated D-SNP (HIDE SNP) includes that its integrated SNP enrollment will be Exclusively Aligned, and agrees to align administrative systems including beneficiary communication materials, enrollment, communications, grievances and appeals processes, and quality improvement, to improve efficiency and beneficiary experience. [42 CFR §§422.2, 422.107]
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Contract with CMS for Special Needs Plan. The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP). The MCO shall notify the STATE, consistent with section 3.6.14, of any material changes in its contract with CMS as a Special Needs Plan, including but not limited to, termination of the contract by either party. The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, failure to meet the CMS Low Income Subsidy (LIS) requirements, Part D issues that may materially affect the SNP, or a decision to conduct a Federal investigative audit that may lead to termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable. Additional Benefits and Premiums. The SNP MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information. The process of notification is as follows: Prior to the submission of the initial annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including proposed changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.
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