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 as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 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 when the MCO receives notice 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 MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 3.21.1.1 3.19.1.1 The MCO shall notify the STATE STATE, consistent with section 3.13, 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 when the MCO receives notice of such actions. for any SNP that may enroll Dual Eligibles.party.‌‌ 3.21.1.2 3.19.1.2 The MCO shall inform the STATE regarding any significant changes in its Minnesota Medicare service areaProgram or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. Any Significant changes include, for this section, a change in MSHO the SNP Medicare service area. MCOs must send a copy of the proposed service area made outside to the STATE within ten (10) days of the RFP process must be agreed time a Notice of Intent to in advance by the STATE and MCO before the first day of the calendar year preceding the change. If the MCO offers MSHO in a county then the MCO must also offer MSC+ in the same countyApply is submitted to CMS. 3.21.1.3 3.19.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 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 The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating SNBC in as fully integrated a manner as possible. The MCO will notify the STATE of changes, including 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 Federal investigative audit that may lead to the termination of the SNP, within thirty (30) days of when the MCO receives notice of such actions. 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 MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area service area changes in its SNP Service Area(sSNP(s) service area within Minnesota, Minnesota and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or and within fifteen (15) days of receipt of notice from CMS, whichever is applicableapplicable.‌ Additional Benefits and Premiums. The MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information unless required to do so by law. The process of notification is as follows: (1) Prior to the submission of annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and (2) Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 3.21.1.1 . The MCO shall notify the STATE STATE, consistent with section 3.6.14, 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 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 when the MCO receives notice of such actions. for any SNP that may enroll Dual Eligibles. 3.21.1.2 The MCO shall inform the STATE regarding any significant changes in its Minnesota Medicare service areaProgram or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable. Additional Benefits and Premiums. The SNP MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information. The process of notification is as follows: Prior to the submission of the initial annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including proposed changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 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 partyparty.‌ The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating SNBC in as fully integrated a manner as possible. Changes include The MCO will notify the STATE of changes, including 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 Federal investigative audit that may lead to the termination of the SNP, within thirty (30) days of when the MCO receives notice of such actions. 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 MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area service area changes in its SNP Service Area(sSNP(s) service area within Minnesota, Minnesota and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or and within fifteen (15) days of receipt of notice from CMS, whichever is applicable. Additional Benefits and Premiums. The MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information unless required to do so by law. The process of notification is as follows: (1) Prior to the submission of annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and (2) Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 3.21.1.1 SNP).‌ The MCO shall notify the STATE STATE, consistent with section 3.6.14, 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 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 when the MCO receives notice of such actions. for any SNP that may enroll Dual Eligibles. 3.21.1.2 The MCO shall inform the STATE regarding any significant changes in its Minnesota Medicare service areaProgram or the administration of Medicare Programs, in order to facilitate operating MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable. Additional Benefits and Premiums. The SNP MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information. The process of notification is as follows: Prior to the submission of the initial annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including proposed changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 3.21.1.1 3.22.1.1 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 when the MCO receives notice of such actions. for any SNP that may enroll Dual Eligibles. 3.21.1.2 3.22.1.2 The MCO shall inform the STATE regarding any changes in its Minnesota Medicare service area, in order to facilitate operating MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 3.22.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area changes in its SNP Service Area(s) within Minnesota, and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or within fifteen (15) days of receipt of notice from CMS, whichever is applicable.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP), in compliance with 42 CFR 422.107(c)(3), as the same entity holding both the SNP contract and this Contract. 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 partyparty.‌ The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating SNBC in as fully integrated a manner as possible. Changes include The MCO will notify the STATE of changes, including 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 Federal investigative audit that may lead to the termination of the SNP, within thirty (30) days of when the MCO receives notice of such actions. 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 MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area service area changes in its SNP Service Area(sSNP(s) service area within Minnesota, Minnesota and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or and within fifteen (15) days of receipt of notice from CMS, whichever is applicable. Additional Benefits and Premiums. The MCO will notify the STATE of proposed changes with the understanding that the STATE will not share this information unless required to do so by law. The process of notification is as follows: Prior to the submission of annual Medicare Advantage bids to CMS, the MCO/SNP will consult with the STATE about any changes in proposed Plan Benefit Packages (PBPs), including changes in current benefits or additional premiums the SNP is expecting to request to have approved through the bid; and Notify the STATE of the status of final changes to benefits or premium levels, on or before September 1st of each Contract Year.

Contract with CMS for Special Needs Plan. ‌ The MCO agrees to participate in Medicare Advantage 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 3.19.1.1 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. 3.19.1.2 The MCO shall inform the STATE regarding significant changes in its Medicare Program or the administration of Medicare Programs, in order to facilitate operating SNBC in as fully integrated a manner as possible. Changes include Significant changes include, for this section, a change in the SNP service area. MCOs must send a copy of the proposed service area to the STATE within ten (10) days of the time a Notice of Intent to Apply is submitted to CMS. 3.19.1.3 The MCO will notify the STATE of changes, including 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 Federal investigative audit that may lead to the termination of the SNP, within thirty (30) days of when the MCO receives notice of such actions. 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 MSHO in as fully integrated a manner as possible. Any change in MSHO 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 MSHO in a county then the MCO must also offer MSC+ in the same county. 3.21.1.3 The MCO will notify the STATE of changes, including but not limited to terminations of SNP plans, changes in type of SNPs approved or applied for, denial of a SNP application, 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 termination of the SNP, within thirty (30) days of such actions. For any SNP that may enroll Dual Eligible persons, the MCO also agrees to inform the STATE of any requests to CMS for Service Area service area changes in its SNP Service Area(sSNP(s) service area within Minnesota, Minnesota and of final approval, denial or withdrawal of such requests to CMS within fifteen (15) days of submission of such requests to CMS or and within fifteen (15) days of receipt of notice from CMS, whichever is applicable.