Common use of Termination of Eligibility Clause in Contracts

Termination of Eligibility. If a member becomes ineligible for HIP, either during eligibility redetermination or at another time, the Contractor shall inactivate the member POWER Account. To allow for members that return to the program, the account will be held inactive through the end of the calendar year. One hundred and twenty (120) days following the end of the calendar year, the contractor will refund the State and member share of the remaining POWER Account balance, if any. This Section 5.9 is also applicable when an American Indian/ Alaska Native member elects to opt-out of managed care pursuant to 42 USC § 1396u–2(a)(2)(C) and transfer to fee-for-service benefits through the State. Any prepaid balance in excess of member’s pro rata share of the remaining POWER Account balance, as determined in accordance with Section 5.9.1, shall be refunded to the member within thirty (30) days of end of the termination. The State share shall be reported one hundred and twenty (120) calendar days following the end of the calendar year. The Contractor shall submit an initial reconciliation for the member termination thirty (30) days after the end of their benefit period. In performing the POWER Account reconciliation function when a member loses eligibility, the Contractor shall comply with the procedures set forth in this section and HIP MCE Policies and Procedures Manual. POWER Account technical requirements are updated from time to time. The Contractor shall be required to comply with these requirements as of their effective date. The Contractor shall have the capability to transmit the required reconciliation data electronically as of the effective date of the Contract. This capability will be tested during the readiness review.

Termination of Eligibility. If a member becomes ineligible for HIP, either during eligibility redetermination or at another time, the Contractor shall inactivate the member POWER Account. To allow for members that return to the program, the account will be held inactive through the end of the calendar year. One hundred and twenty (120) days following the end of the calendar year, the contractor will refund the State and member share of the remaining POWER Account balance, if any. This Section 5.9 is also applicable when an American Indian/ Alaska Native member elects to opt-out of managed care pursuant to 42 USC § 1396u–2(a)(2)(C1396u– 2(a)(2)(C) and transfer to fee-for-service benefits through the State. Any prepaid balance in excess of member’s pro rata share of the remaining POWER Account balance, as determined in accordance with Section 5.9.1, shall be refunded to the member within thirty (30) days of end of the termination. The State share shall be reported one hundred and twenty (120) calendar days following the end of the calendar year. The Contractor shall submit an initial reconciliation for the member termination thirty (30) days after the end of their benefit period. In performing the POWER Account reconciliation function when a member loses eligibility, the Contractor shall comply with the procedures set forth in this section and HIP MCE Policies and Procedures Manual. POWER Account technical requirements are updated from time to time. The Contractor shall be required to comply with these requirements as of their effective date. The Contractor shall have the capability to transmit the required reconciliation data electronically as of the effective date of the Contract. This capability will be tested during the readiness review.