Termination by STATE Clause Samples

Termination by STATE. An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: Required termination includes: The Enrollee becomes ineligible for Medical Assistance; The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1.1; The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; 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; 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 3.1.1(G)(1)(c). 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; The Enrollee changes MCOs without cause pursuant to 42 CFR §438.56(c) 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 3.1.2(M). The enrollee may change MCOs pursuant to 42 CFR § 438.56 and Minnesota Rules, Part 9500.1453 because of problems with access, service delivery, or other good cause; For MSC+, pursuant to Minnesota Rules, Part 9500.1453, subpart 5, the Enrollee elects 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; The Enrollee elects to change MCOs due to substantial travel time or Local Agency error, pursuant to Minnesota Rules, Part 9500.1453, subparts 7 and 8; The Enrollee elects to change MCOs during an annual open enrollment period, pursuant to Minnesota Rules, Part 9500.1453, subpart 5; or the Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G); and 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 3.6.14(A); Incarceration...

Termination by STATE. State may terminate this Agreement effective upon delivery of written notice of termination to Recipient, or at such later date as may be established by State in such written notice, if: i. Recipient fails to perform the Project within the time specified herein or any extension thereof or commencement, continuation or timely completion of the Project by Recipient is, for any reason, rendered improbable, impossible, or illegal; or ii. State fails to receive funding, appropriations, limitations or other expenditure authority sufficient to allow State, in the exercise of its reasonable administrative discretion, to continue to make payments for performance of this Agreement; or iii. Federal or state laws, rules, regulations or guidelines are modified or interpreted in such a way that the Project is no longer allowable or no longer eligible for funding under this Agreement; or iv. The Project would not produce results commensurate with the further expenditure of funds; or v. Recipient takes any action pertaining to this Agreement without the approval of State and which under the provisions of this Agreement would have required the approval of State.

Termination by STATE. ‌ An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: 3.7.2.1 Required termination includes: (1) The Enrollee becomes ineligible for Medical Assistance. (2) The Enrollee’s basis of eligibility changes and no longer meets the enrollment criteria for SNBC; (3) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy. (4) The Enrollee becomes ineligible for Medicare Part A or Part B. If the Enrollee loses eligibility for both Parts A and B but remains eligible for Medical Assistance, the Enrollee remains eligible for SNBC. (5) The Enrollee does not pay the Medical Spenddown in full for three months directly to the STATE. The Enrollee will not be allowed to re-enroll in SNBC 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.‌ (6) The SNBC SNP Enrollee elects to change MCOs as described in 42 CFR §422.62 (election of coverage for Medicare Advantage plan). (7) The Enrollee reaches the age of sixty-five (65).

Termination by STATE. The State may terminate this Agreement at any time by notice to the Retailer, if: the Retailer is or becomes bankrupt or insolvent, enters into voluntary administration or makes any arrangement with its creditors or takes advantage of any statute for the relief of insolvent debtors; the Retailer’s retailer authorisation for electricity under the National Energy Retail Law (Queensland) is transferred, surrendered or revoked; or the Retailer is in breach of a material provision of this Agreement, where, subject to clause 16.1(2), that breach: if capable of being remedied, is not remedied within the period (being a reasonable period, but in any event not less than 5 Business Days of notice of the breach or, if the dispute resolution process in clause 17.1 and 17.2 has been implemented, 5 Business Days of the conclusion of the mediation) specified in a notice by the State, or is not capable of being remedied. If the Retailer believes it will not be able to remedy the breach within the time specified in the notice under clause 16.1(1)(c)(i), the Retailer must provide the State, within 5 Business Days of the notice or conclusion of the mediation, a proposed action plan for remedying the breach within 20 Business Days or such other period agreed with the State. The parties will discuss the proposed action plan in good faith and, if the parties agree an action plan within 10 Business Days of the Retailer submitting the proposed action plan to the State, the State must not terminate this agreement under clause 16.1(1)(c)(i) for that breach unless: the Retailer fails to remedy the breach within the time agreed in the action plan; or the Retailer fails to take reasonable steps to ensure that the Retailer will remedy the breach within the time agreed in the action plan.

Termination by STATE. An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: (A) The Enrollee becomes ineligible for Medical Assistance or MinnesotaCare. (B) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy, except in the case where the Enrollee is receiving Inpatient Hospitalization services overnight on the last day of the month. (C) The Enrollee changes MCOs pursuant to Minnesota Rules, Part 9500.1453 because of problems with access, service delivery, or other good cause. (D) The Enrollee changes MCOs without cause pursuant to 42 CFR § 438.56(c) 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 3.1.2(I).

Termination by STATE. An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: (A) Required Termination includes: (1) The Enrollee becomes ineligible for Medical Assistance. (2) The Enrollee becomes ineligible for Medicare Part A or Part B. If the Enrollee loses eligibility for both Parts A and B but remains eligible for Medical Assistance, the Enrollee remains eligible for SNBC. (3) The Enrollee moves out of the MCO’s Service Area as defined in section 3.1 of this Contract and the MMIS county of residence is updated per eligibility policy, except in the case where the Enrollee is receiving Inpatient Hospitalization services overnight on the last day of the month. (4) The Enrollee no longer meets the eligibility criteria for SNBC; (5) The Enrollee does not pay the Medical Spenddown to the STATE for three consecutive months. (6) The Enrollee elects to change MCOs as described in 42 CFR § 422.62 (election of coverage for Medicare Advantage plan.) (7) SNBC Enrollees rejected by CMS will be re-enrolled into fee-for-service unless the Enrollee is sixty-five (65) years or older and has no Spenddown, in which case the Enrollee will be enrolled in MSC+, and the capitation payment will be adjusted. (B) Optional Termination includes the circumstances as listed in 42 CFR § 422.74(b)(1) as follows: (1) The Enrollee has engaged in disruptive behavior, and the request for disenrollment meets the requirements listed in 42 CFR § 422.74(d)(2). Disenrollment will be allowed only upon review and approval by CMS; or (2) The Enrollee provided fraudulent information on his or her enrollment form or permits abuse of his or her enrollment card.

Termination by STATE. An Enrollee’s coverage in the HEALTH PLAN may be terminated by the STATE for one of the following reasons: A. The Enrollee becomes ineligible for MA, GAMC or MinnesotaCare. B. The Enrollee moves out of the HEALTH PLAN’s Service Area after an absence of two calendar months, with the intent of a permanent move, except in the case where the Enrollee is in an inpatient facility. C. The Enrollee is permitted to change health plans pursuant to Minnesota Rules, Part 9500.1453 because of problems with access or service delivery, or other good cause. D. The Enrollee no longer meets the enrollment criteria in Section 3.1.1. E. This Contract expires or is terminated for any reason under the provisions of Article 5. ▇. ▇▇▇▇▇▇▇▇ to Minnesota Rules, Part 9500.1453, Subpart 5, the Enrollee elects to change health plans once during the first year of initial enrollment in the HEALTH PLAN or during the first 60 days after a change in enrollment from a health plan that no longer participates in PMAP, PGAMC or MinnesotaCare. G. Pursuant to Minnesota Rules, Part 9500.1453, Subparts 7 or 8, the Enrollee elects to change health plans due to substantial travel time or Local Agency error. H. The Enrollee elects to change health plans during the annual open enrollment period. I. The Enrollee elects to change health plans within 120 days following notice of a Material Modification of the HEALTH PLAN’s Provider Network under Section 3.2.4.A. J. A GAMC Recipient who becomes eligible for the MA program will be disenrolled from GAMC, and enrolled in MA. The HEALTH PLAN, to the best of its ability as soon as it becomes aware, shall notify the Local Agency regarding potential changes in an Enrollee’s eligibility status because of such factors as pregnancy or disability.

Termination by STATE. State or Commissioner of Administration may cancel this Contract at any time, with or without cause, upon forty-five (45) days’ written notice to Contractor. Upon termination, Contractor will be entitled to payment, determined on a pro rata basis, for services or goods satisfactorily performed or delivered, including services or goods in progress of being rendered at the time notice of cancellation of the Contract. For purposes of this Contract, Contractor shall complete Vaccine Services for Individuals who have made an appointment to receive a vaccine as of 11:59pm Central Time on the date of notice of cancellation of the Contract and shall not, unless directed otherwise by State, register/process any new Vaccine appointments after the date of any such cancellation notice.

Termination by STATE. An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: (A) The Enrollee becomes ineligible for Medical Assistance or MinnesotaCare. (B) The Enrollee’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1.1(D) (C) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy.