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: 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. ‌ 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.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- 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. (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. ‌ An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: 3.7.2.1 reasons:‌ 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 SNBC‌ after termination for non- 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) application. 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. ‌ An Enrollee’s coverage in the MCO may be terminated by the STATE for one of the following reasons: 3.7.2.1 (A) Required termination includes: (1) The Enrollee becomes ineligible for Medical Assistance.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- 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. (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. ‌ 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;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).