Common use of Termination by STATE Clause in Contracts

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 (a) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: The MSHO 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. 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 MCO may be terminated by the STATE for one of the following reasons: Required termination includes: reasons:‌ (A) 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; , GAMC or MinnesotaCare. (B) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; For MSHO, except in the case where 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 receiving Inpatient Hospitalization services overnight on the effective date. For MSHO enrollment, last day of 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 month. (3C) months directly to the State as described in section 3.1.1(G)(1)(c). The Enrollee will not be allowed changes MCOs pursuant 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 Minnesota Rules, Part 9500.1453 because of application; 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(M3.1.2(J). . (E) 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 Enrollee no longer meets the eligibility criteria in section 3.1.1. (F) 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 participates in PMAP, PGAMC or MinnesotaCare. (G) Pursuant to Minnesota Rules, Part 9500.1453, subparts 7 or 8, 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; . (H) The Enrollee elects to change MCOs during an the 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 open enrollment due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G); and disenrollment.‌ (I) The Enrollee elects to change MCOs within one hundred twenty (120) days following notice of a Material Modification of the MCO’s Provider network Network as outlined under section 3.6.14(A3.2.6(A)(2); Incarceration (a) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (bJ) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, enrollment A GAMC Enrollee who becomes eligible for a the 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. (c) Incarcerated individuals admitted to a medical institution must apply for and be determined eligible for Medical Assistance inpatient services, and if eligible program will be covered on a fee-for-service basis. For MSHO disenrolled from GAMC and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described enrolled in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: The MSHO 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 CMSMedical Assistance. The Enrollee provided fraudulent information on his MCO, 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 her enrollment form or permits abuse of his or her enrollment carddisability.

Termination by STATE. An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: reasons:‌ (A) Required termination includes: : (1) The Enrollee becomes ineligible for Medical Assistance; ; (2) The Enrollee’s basis of eligibility changes and Enrollee no longer meets enrollment the eligibility criteria in section 3.1.1; .; (3) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (4) The Enrollee’s MA Plan application is rejected by CMS. For MSHO enrollment rejected by CMS, the Recipient will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (5) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; For MSHO, except in the case where 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 receiving Inpatient Hospitalization services overnight on the effective date. For MSHO enrollment, last day of the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; month; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee enrollee does not pay the Medical Spenddown in full for three (3) consecutive months directly to the State as described in section 3.1.1(G)(1)(c3.1.1(G)(4). 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 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(M3.1.2(K). 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; ; (8) 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; ; (9) 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; ; (10) 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 open enrollment due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G3.1.2(I); and ; (11) 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(A3.2.8(A); Incarceration; (aB) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: follows:‌ (1) The MSHO 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. . (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 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’s basis of eligibility changes and Enrollee no longer meets enrollment the eligibility criteria in section 3.1.1; .; (3) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (4) The Enrollee’s MA Plan application is rejected by CMS or cancelled by the Recipient before the effective date. For MSHO enrollment, the Recipient will be re- enrolled in MSC+ retroactively, and the capitation will be re-processed; (5) 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; ; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee 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 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 enrollee no longer has a Medical Spenddown at the time of application; ; (7) 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(M3.1.2(L). 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; ; (8) 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; ; (9) 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; ; (10) 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 open enrollment due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G); and and (11) 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; (aB) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: : (1) The MSHO 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. . (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 MCO may be terminated by the STATE for one of the following reasons: 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 (a) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: follows:‌ The MSHO 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. 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 MCO may be terminated by the STATE for one of the following reasons: reasons:‌ (A) Required termination includes: : (1) The Enrollee becomes ineligible for Medical Assistance; ; (2) The Enrollee’s basis of eligibility changes and Enrollee no longer meets enrollment the eligibility criteria in section 3.1.1; .; (3) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (4) The Enrollee’s MA Plan application is rejected by CMS. For MSHO enrollment rejected by CMS, the Recipient will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (5) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; For MSHO, except in the case where 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 receiving Inpatient Hospitalization services overnight on the effective date. For MSHO enrollment, last day of the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; month; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee enrollee does not pay the Medical Spenddown in full for three (3) consecutive months directly to the State as described in section 3.1.1(G)(1)(c3.1.1(G)(4). 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 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(M3.1.2(K). 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; ; (8) 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; ; (9) 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; ; (10) 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 open enrollment due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G3.1.2(I); 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 (a) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: The MSHO 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. 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 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’s basis of eligibility changes and Enrollee no longer meets enrollment the eligibility criteria in section 3.1.1; .; (3) For MSHO, the Enrollee becomes ineligible for Medicare Part A or Part B; (4) The Enrollee’s MA Plan application is rejected by CMS. For MSHO enrollment rejected by CMS, the Recipient will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; (5) The Enrollee moves out of the MCO’s Service Area and the MMIS county of residence is updated per eligibility policy; For MSHO, except in the case where 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 receiving Inpatient Hospitalization services overnight on the effective date. For MSHO enrollment, last day of the Beneficiary will be re-enrolled in MSC+ retroactively, and the capitation will be re-processed; month; (6) For MSHO, for non-payment of Medical Spenddown if the Enrollee 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 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 enrollee no longer has a Medical Spenddown at the time of application; . (7) 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(M3.1.2(J). 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; ; (8) 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; ; (9) 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; ; (10) 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 open enrollment due to disenrollment; or for MSHO, monthly, pursuant to section 3.1.2(G3.1.2(D); and ; (11) 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(A3.2.8(A); Incarceration; (aB) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: : (1) The MSHO 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. . (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 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’s basis of eligibility changes and no longer meets enrollment criteria in section 3.1.1; ; (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 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 3.1.1(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; ; (7) 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). . (8) 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; ; (9) 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; ; (10) 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; ; (11) 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 and (12) 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 (a) For the MSHO program’s Medicaid benefits, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (b) For MSC+, pursuant to Minnesota Statutes, § 256B.055, subd. 14, 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. (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. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(C). Optional termination includes the circumstances listed in 42 CFR § 422.74(b)(1) as follows: The MSHO 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. The Enrollee provided fraudulent information on his or her enrollment form or permits abuse of his or her enrollment card.;