Required termination includes Sample Clauses
The 'Required termination includes' clause defines specific circumstances or events that mandate the termination of an agreement or contract. In practice, this clause lists particular triggers—such as breach of contract, insolvency, or regulatory changes—that automatically require the parties to end their contractual relationship. By clearly outlining these mandatory termination events, the clause ensures that both parties understand when termination is not optional, thereby reducing ambiguity and helping to manage risk in the contractual arrangement.
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;
(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 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 3.1.8(3). 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 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 3.2.12. [42 CFR §438.56(c)]
(8) The enrollee may change MCOs because of concerns with access, service delivery, or other good cause [42 CFR §438.56 and Minnesota Rules, Part 9500.1453];
(9) For MSC+, the Enrollee may elect 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 [Minnesota Rules, Part 9500.1453, subpart 5];
(10) The Enrollee elects to change MCOs due to substantial travel time or Local Agency error [Minnesota Rules, Part 9500.1453, subparts 7 and 8];
(11) The Enrollee elects to change MCOs during an annual open enrollment period [Minnesota Rules, Part 9500.1453, subpart 5];
(12) The Enrollee misses the opportunity to change during the annual health-plan selection period due to disenrollment; or for MSHO, monthly, pursuant to section 3.2.7; and
(13) 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 3.13.1;
(14) Incarceration
(a) For the MSHO program’s Medicaid benefits, enrollment for a Medical Assistance Incarcerated Enrollee will end at the end of the month ...
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;
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).