Temporary Management. The State must appoint temporary management as a remedy under the circumstances described in 42 CFR §438.706 and 42 CFR §438.704, if the State determines that the MCO has repeatedly failed to meet the substantive requirements in Sections 1903(m) or 1932 of the Social Security Act and that the continued operation of the MCO would be hazardous to enrollees. The Commissioner of the Offices of the Insurance Commissioner will be responsible for the imposition of such remedy as set forth in Section 33-25A-19 of the West Virginia HMO Act of 1977. If temporary management is imposed, the State will notify enrollees of their right to terminate enrollment in the MCO. The State may terminate the Contract and enroll that entity’s enrollees in other MCOs or provide their Medicaid benefits through other options included in the State Plan. Nothing precludes BMS’ right to appoint temporary management during the time in which the MCO is remedying the condition(s) or while an appeal requested by the MCO is pending. However, before any temporary management is appointed, BMS will notify, in writing, the MCO of the specific non-performance. Within ten (10) business days of receipt of this written notification, the MCO will forward a plan to remedy this non-performance to BMS. BMS will, as soon as possible, notify the MCO whether it agrees to the plan, and if so, the MCO will immediately begin to remedy the non-performance in accordance with the plan, and will have fifteen (15) business days to do so. If the plan is not accepted, such reasons will be given, and the MCO will revise the plan to reflect BMS’ changes, and then will resubmit and then will immediately begin to remedy the non-performance and will have fifteen (15) business days to do so.
Temporary Management. In addition to the remedies listed in section 5.6, the STATE shall impose temporary management of the MCO pursuant to 42 CFR § 438.706 (b) if the STATE finds that the MCO has repeatedly failed to meet the substantive requirements of §§ 1903(m) or 1932 of the Social Security Act. When imposing this sanction the STATE shall:
(A) Allow Enrollees the right to terminate enrollment without cause and notify the affected Enrollees of their right to disenroll;
(B) Not delay the imposition of temporary management to provide a hearing; and
(C) Maintain temporary management of the MCO until the STATE determines that the MCO can ensure that the sanctioned behavior will not recur.
Temporary Management. The Division can require the appointment of temporary management upon the finding by the Division that there is continued egregious behavior or substantial risk to the health of Enrollees or to assure the health of Enrollees during a time or for an orderly termination or reorganization of the Contractor's Plan or until improvements are made to remedy Contract violations. Temporary management cannot be terminated until the Contractor has the capability to ensure violations will not recur. If the Contractor repeatedly fails to comply with Contract provisions, the Division may impose the sanction of temporary management and give Enrollees the right to terminate enrollment with the Contractor's Plan.
Temporary Management. AHS may impose temporary management if it finds that: • There is continued egregious behavior by DVHA, including, but not limited to behavior that is described in 42 CFR 438.700, or that is contrary to any requirements of sections 1903(m) and 1932 of the Act; or • There is substantial risk to enrollees’ health; or • The sanction is necessary to ensure the health of DVHA’s enrollees while improvements are made to remedy violations under 438.700 or until there is an orderly contract termination or reorganization of DVHA. Nothing in this subpart should be construed as requiring AHS to impose temporary management in these situations. However, AHS will impose temporary management if it finds that DVHA has repeatedly failed to meet substantive requirements in section 1903(m) or section 1932 of the Social Security Act. AHS will also grant enrollees the right to terminate enrollment without cause and will notify affected enrollees of their right to terminate. AHS will not delay imposition of temporary management to provide a hearing before imposing this sanction. AHS will not terminate temporary management until it determines that DVHA can ensure that the sanctioned behavior will not reoccur.
Temporary Management. While one or more agencies within the State of Illinois have the authority and retain the power to impose temporary management upon Contractor for repeated violations of the Contract, the Department will exercise its option to terminate the Contract prior to imposing temporary management. This does not preclude other state agencies from exercising such power at their discretion.
Temporary Management. In addition to the remedies listed in section 5.5, the STATE shall impose temporary management of the MCO if the STATE finds that the MCO has repeatedly failed to meet the substantive requirements of §§ 1903(m) or 1932 of the SSA. If the STATE enforces a remedy for breach under this section, the STATE shall provide the MCO written notice of the remedy to be imposed. When imposing this sanction the STATE shall:
5.6.1 Allow Enrollees the right to terminate enrollment without cause and notify the affected Enrollees of their right to disenroll;
5.6.2 Not delay the imposition of temporary management to provide a hearing; and
5.6.3 Maintain temporary management of the MCO until the STATE determines that the MCO can ensure that the sanctioned behavior will not recur. [42 CFR §438.706(b)]
Temporary Management. While one (1) or more agencies of the State have the authority and retain the power under 42 C.F.R. 438.702 to impose temporary management upon Contractor for repeated violations of the Contract, the Department may exercise its option to terminate the Contract prior to imposition of temporary management. This does not preclude other State agencies from exercising such power at their discretion.
Temporary Management. TENNCARE may impose temporary management if it finds that the CONTRACTOR has repeatedly failed to meet substantive requirements in Section 1903(m) or Section 1932 of the Social Security Act.
Temporary Management. The State must impose mandatory temporary management when the Contractor repeatedly fails to meet substantive requirements in sections 1903(m) or 1932 of the Social Security Act or 42 C.F.R. § 438. The State may not delay the imposition of temporary management to provide a hearing and may not terminate temporary management until it determines that the Contractor can ensure the sanctioned behavior will not reoccur. See: 42 C.F.R. § 438.706(b) - (d); section 1932(e)(2)(B)(ii) of the Social Security Act; 42 C.F.R. § 457.1270. {From CMSC J.5.19}.
Temporary Management. 62 8.5 Termination for Breach of HIPAA Compliance Obligations............................. 62 8.6
