Common use of Temporary Management Clause in Contracts

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. 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. The State must may appoint temporary management as a remedy under the circumstances described in 42 CFR §438.706 and 42 CFR §438.704438.706, 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 an MCO 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’ the Department’s 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 the Department will notify, in writing, the MCO of the specific non-performance. Within ten (10) business working days of receipt of this written notification, the MCO will forward a plan to remedy this non-performance to BMSthe Department. BMS The Department 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 15 working 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’ the Department’s changes, and then will resubmit and then will immediately begin to remedy the non-performance and will have fifteen (15) business 15 working days to do so.

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 enrollees’ Medicaid and SNS benefits through other options included in the applicable State PlanPlans or waivers. Nothing precludes BMS’ the Department’s 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 the Department 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 BMSthe Department. BMS The Department 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’ the Department’s 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. 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’ the Department’s 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 the Department 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 BMSthe Department. BMS The Department 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’ the Department’s 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. 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’ the Department’s 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 the Department will notify, in writing, the MCO of the specific non-performance. Within ten (10) business working days of receipt of this written notification, the MCO will forward a plan to remedy this non-performance to BMSthe Department. BMS The Department 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 working 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’ the Department’s changes, and then will resubmit and then will immediately begin to remedy the non-performance and will have fifteen (15) business working days to do so.

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 enrollees’ Medicaid and SNS benefits through other options included in the applicable State PlanPlans or waivers. Nothing precludes BMS’ the Department’s 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 the Department 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 BMSthe Department. BMS The Department 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’ the Department’s 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. The State must may 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’ the Department’s 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 the Department will notify, in writing, the MCO of the specific non-performance. Within ten (10) business working days of receipt of this written notification, the MCO will forward a plan to remedy this non-performance to BMSthe Department. BMS The Department 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 15 working 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’ the Department’s changes, and then will resubmit and then will immediately begin to remedy the non-performance and will have fifteen (15) business 15 working days to do so.

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 (OIC) 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. 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’ the Department’s 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 the Department will notify, in writing, the MCO of the specific non-non- performance. Within ten (10) business working days of receipt of this written notification, the MCO will forward a plan to remedy this non-performance to BMSthe Department. BMS The Department 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 working 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’ the Department’s changes, and then will resubmit and then will immediately begin to remedy the non-performance and will have fifteen (15) business working days to do so.

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 (OIC) 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 enrollees’ Medicaid and SNS benefits through other options included in the applicable State PlanPlans or waivers. Nothing precludes BMS’ the Department’s 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 the Department 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 BMSthe Department. BMS The Department 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’ the Department’s 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.fifteen