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.
3.21.1.1 The MCO shall notify the STATE of any material changes in its contract with CMS as a Special Needs Plan, or the administration of Medicare Programs including but not limited to termination of the contract by either party. Changes include but are not limited to terminations of SNPs, changes in type of SNP approved or applied for, denial of a SNP application or 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 the termination of the SNP, within thirty (30) days of when the MCO receives notice of such actions. for any SNP that may enroll Dual Eligibles.
3.21.1.2 The MCO shall inform the STATE regarding any changes in its Minnesota Medicare service area, in order to facilitate operating MSHO in as fully integrated a manner as possible. Any change in MSHO SNP Medicare service area made outside of the RFP process must be agreed to in advance by the STATE and MCO before the first day of the calendar year preceding the change. If the MCO offers MSHO in a county then the MCO must also offer MSC+ in the same county.
3.21.1.3 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.
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
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.
(A) The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs; in order to facilitate operating SNBC in as fully integrated a manner as possible.
(B) The MCO will notify the STATE of changes, including but not limited to terminations of SNPs, changes in type of SNP approved or applied for, denial of a SNP application or failure to meet the CMS Low Income Subsidy (LIS) requirements, Part D issues that may materially effect the SNP, or a decision to conduct a Federal investigative audit that may lead to the 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(s) service area 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 and within fifteen (15) days of receipt of notice from CMS, whichever is applicable.
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]
3.21.1.1 The MCO shall notify the STATE of any material changes in its contract with CMS as a Special Needs Plan, or the administration of Medicare Programs including but not limited to termination of the contract by either party. Changes include but are not limited to terminations of SNPs, changes in type of SNP approved or applied for, denial of a SNP application or 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 the termination of the SNP, within thirty (30) days of such actions for any SNP that may enroll Dual Eligibles.
3.21.1.2 The MCO shall inform the STATE regarding any changes in its Minnesota Medicare , service area in order to facilitate operating Integrated SNBC in as fully integrated a manner as possible. Any change in SNBC SNP Medicare service area made outside of the RFP process must be agreed to in advance by the State and MCO before the first day of the calendar year preceding the change. If the MCO offers Integrated SNBC in a county the MCO must also offer non-integrated SNBC.
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
Contract with CMS for Special Needs Plan. The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP).
(A) The MCO shall notify the STATE, consistent with section 3.2.8, 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.
(B) 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.
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.
3.19.1.1 The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating SNBC in as fully integrated a manner as possible. Significant changes include, for this section, a change in the SNP service area. MCOs must send a copy of the proposed service area to the STATE within ten (10) days of the time a Notice of Intent to Apply is submitted to CMS.
3.19.1.2 The MCO will notify the STATE of changes, including but not limited to terminations of SNPs, changes in type of SNP approved or applied for, denial of a SNP application or 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 the 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(s) service area 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 and within fifteen (15) days of receipt of notice from CMS, whichever is applicable.