Common use of Required termination includes Clause in Contracts

Required termination includes. (1) The Enrollee becomes ineligible for Medical Assistance; (2) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1;‌‌ (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; (4) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (5) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Beneficiary before the effective date. For MSHO enrollment, the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee does not pay the Medical Spenddown in full for three (3) months directly to the State as described in section 3.1.8(3). The Enrollee will not be allowed to re-enroll in MSHO after termination for non- payment unless all past due Medical Spenddowns are paid in full and the Enrollee no longer has a Medical Spenddown at the time of application;‌‌ (7) The Enrollee changes MCOs without cause within ninety (90) days following the Enrollee’s initial enrollment with the MCO. For counties where the MCO is the only choice, the Enrollee cannot disenroll, but may change Primary Care Providers pursuant to section 3.2.12. [42 CFR §438.56(c)]‌‌ (8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453]; (9) For MSC+, the Enrollee may elect to change MCOs once during the first year of initial enrollment in the MCO or during the first sixty (60) days after a change in enrollment from an MCO that is no longer participating [Minnesota Rules, Part 9500.1453, subpart 5]; (10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8]; (11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5]; (12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and‌‌ (13) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network under section 3.13.1;‌‌ (14) Incarceration‌ (a) For the MSHO program’s Medicaid benefits, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is Incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (b) For MSC+, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible will be covered on a fee-for-service basis.‌‌‌

Required termination includes. (1) The Enrollee becomes ineligible for Medical Assistance; (2) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1;‌‌3.1; (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; (4) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (5) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Beneficiary before the effective date. For MSHO enrollment, the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee does not pay the Medical Spenddown in full for three (3) months directly to the State as described in section 3.1.8(33.1.8(2). The Enrollee will not be allowed to re-enroll in MSHO after termination for non- payment unless all past due Medical Spenddowns are paid in full and the Enrollee no longer has a Medical Spenddown at the time of application;‌‌application; (7) The Enrollee changes MCOs without cause within ninety (90) days following the Enrollee’s initial enrollment with the MCO. For counties where the MCO is the only choice, the Enrollee cannot disenroll, but may change Primary Care Providers pursuant to section 3.2.12. [42 CFR §438.56(c)]‌‌438.56(c)] (8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453]; (9) For MSC+, the Enrollee may elect to change MCOs once during the first year of initial enrollment in the MCO or during the first sixty (60) days after a change in enrollment from an MCO that is no longer participating [Minnesota Rules, Part 9500.1453, subpart 5]; (10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8]; (11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5]; (12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and‌‌and (13) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network where a single-source Provider who is the only provider available to provide a specific service is removed from the network for cause under section 3.13.1;‌‌ (14) Incarceration‌ (a) For the MSHO program’s Medicaid benefits, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is Incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (b) For MSC+, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible will be covered on a fee-for-service basis.‌‌‌2.104(4);

Required termination includes. (1) The Enrollee becomes ineligible for Medical Assistance; (2) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1;‌‌3.1; (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; (4) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (5) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Beneficiary before the effective date. For MSHO enrollment, the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee does not pay the Medical Spenddown in full for three (3) months directly to the State as described in section 3.1.8(33.1.8(2). The Enrollee will not be allowed to re-enroll in MSHO after termination for non- payment unless all past due Medical Spenddowns are paid in full and the Enrollee no longer has a Medical Spenddown at the time of application;‌‌application; (7) The Enrollee changes MCOs without cause within ninety (90) days following the Enrollee’s initial enrollment with the MCO. For counties where the MCO is the only choice, the Enrollee cannot disenroll, but may change Primary Care Providers pursuant to section 3.2.12. [42 CFR §438.56(c)]‌‌438.56(c)] (8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453]; (9) For MSC+, the Enrollee may elect to change MCOs once during the first year of initial enrollment in the MCO or during the first sixty (60) days after a change in enrollment from an MCO that is no longer participating [Minnesota Rules, Part 9500.1453, subpart 5]; (10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8]; (11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5]; (12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and‌‌and (13) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network where a single-source Provider who is the only provider available to provide a specific service is removed from the network for cause under section 3.13.1;‌‌2.106(4); (14) Incarceration‌ (a) For the MSHO program’s Medicaid benefits, enrollment for a an Enrollee who is Incarcerated and on Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is Incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (b) For MSC+, enrollment for a an Enrollee who is Incarcerated and on Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible will be covered on a fee-for-service basis.‌‌‌basis.

Required termination includes. (1) The Enrollee becomes ineligible for Medical Assistance; (2) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1;‌‌ (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy;policy;‌‌‌‌‌ (4) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (5) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Beneficiary before the effective date. For MSHO enrollment, the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee does not pay the Medical Spenddown in full for three (3) months directly to the State as described in section 3.1.8(33.1.8(2). The Enrollee will not be allowed to re-enroll in MSHO after termination for non- payment unless all past due Medical Spenddowns are paid in full and the Enrollee no longer has a Medical Spenddown at the time of application;‌‌ (7) The Enrollee changes MCOs without cause within ninety (90) days following the Enrollee’s initial enrollment with the MCO. For counties where the MCO is the only choice, the Enrollee cannot disenroll, but may change Primary Care Providers pursuant to section 3.2.12. [42 CFR §438.56(c)]‌‌438.56(c)]‌ (8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453]; (9) For MSC+, the Enrollee may elect to change MCOs once during the first year of initial enrollment in the MCO or during the first sixty (60) days after a change in enrollment from an MCO that is no longer participating [Minnesota Rules, Part 9500.1453, subpart 5]; (10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8]; (11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5]; (12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and‌‌ (13) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network under section 3.13.1;‌‌ (14) Incarceration‌ (a) For the MSHO program’s Medicaid benefits, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is Incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (b) For MSC+, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible will be covered on a fee-for-service basis.‌‌‌basis.

Required termination includes. (1) The Enrollee becomes ineligible for Medical Assistance; (2) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1;‌‌3.1; (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; (4) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (5) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Beneficiary before the effective date. For MSHO enrollment, the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee does not pay the Medical Spenddown in full for three (3) months directly to the State as described in section 3.1.8(33.1.8(2). The Enrollee will not be allowed to re-enroll in MSHO after termination for non- payment unless all past due Medical Spenddowns are paid in full and the Enrollee no longer has a Medical Spenddown at the time of application;‌‌application; (7) The Enrollee changes MCOs without cause within ninety (90) days following the Enrollee’s initial enrollment with the MCO. For counties where the MCO is the only choice, the Enrollee cannot disenroll, but may change Primary Care Providers pursuant to section 3.2.12. [42 CFR §438.56(c)]‌‌438.56(c)] (8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453]; (9) For MSC+, the Enrollee may elect to change MCOs once during the first year of initial enrollment in the MCO or during the first sixty (60) days after a change in enrollment from an MCO that is no longer participating [Minnesota Rules, Part 9500.1453, subpart 5]; (10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8]; (11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5]; (12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and‌‌and (13) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network where a single-source Provider who is the only provider available to provide a specific service is removed from the network for cause under section 3.13.1;‌‌2.104(4); (14) Incarceration‌ (a) For the MSHO program’s Medicaid benefits, enrollment for a an Enrollee who is Incarcerated and on Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is Incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (b) For MSC+, enrollment for a an Enrollee who is Incarcerated and on Medical Assistance Incarcerated Enrollee will end at the end of the month in which the Enrollee is incarcerated. Provision of Covered Services ends when the Enrollee is Incarcerated. [Minnesota Statutes, §256B.055, subd. 14] (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible will be covered on a fee-for-service basis.‌‌‌basis.