Common use of Contract with CMS for Special Needs Plan Clause in Contracts

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.