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: (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).