Termination by CMS Sample Clauses
Termination by CMS. (a) CMS may terminate a contract for any of the following reasons:
(i) The MA Organization has failed substantially to carry out the terms of its contract with CMS.
(ii) The MA Organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of 42 CFR Part 422.
(iii) CMS determines that the MA Organization no longer meets the requirements of 42 CFR Part 422 for being a contracting organization.
(iv) There is credible evidence that the MA Organization committed or participated in false, fraudulent or abusive activities affecting the Medicare program, including submission of false or fraudulent data.
(v) The MA Organization experiences financial difficulties so severe that its ability to make necessary health services available is impaired to the point of posing an imminent and serious risk to the health of its enrollees, or otherwise fails to make services available to the extent that such a risk to health exists.
(vi) The MA Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart M relating to grievances and appeals.
(vii) The MA Organization fails to provide CMS with valid risk adjustment data as required under §422.310 and 423.329(b)(3).
(viii) The MA Organization fails to implement an acceptable quality improvement program as required under 42 CFR Part 422 Subpart D.
(ix) The MA Organization substantially fails to comply with the prompt payment requirements in §422.520.
(x) The MA Organization substantially fails to comply with the service access requirements in §422.112.
(xi) The MA Organization fails to comply with the requirements of §422.208 regarding physician incentive plans.
(xii) The MA Organization substantially fails to comply with the marketing requirements in 422.80.
Termination by CMS. CMS may terminate a contract for any of the following reasons:
Termination by CMS. If CMS determines, at its sole discretion, that the State has not successfully implemented a required CAP or complied with an alternative CMS-provided corrective action in the time period specified in section 21.c or otherwise specified in this Agreement, CMS may immediately terminate this Agreement. CMS may also immediately or with advance notice terminate this Agreement if it determines, at its sole discretion, that there is no entity eligible under Section 8 to participate in the Model in a manner consistent with the elements, parameters, and scope of the Model as set forth in this Agreement.
Termination by CMS. (i) No longer meets the requirements specified in this subpart; or
(ii) Is not in substantial compliance with—
(A) The provisions of the agreement; or
(B) The requirements of this subpart, any other applicable regulations of this part, or any applicable provisions of title XVIII of the Act.
Termination by CMS i. CMS may immediately or with advance notice terminate the Model, a Participation Agreement, the Implementation Period and/or Transition Period of the Model, or this Agreement if CMS, in its sole discretion, determines that:
1. the State has failed to submit, obtain approval for, successfully implement, or fully comply with the terms of a CAP required by Section 20.g. and the CAP was required due to a triggering event listed in Section 20.b.7. through 20.b.24; or
2. the State has not timely complied with an enforcement action required by CMS pursuant to Section 20.f.ii. through 20.f.v., provided such enforcement action was due to a triggering event listed in event listed in Section 20.b.7. through 20.b.26; or
ii. CMS will immediately terminate this Agreement and/or the Pre-Implementation Period of the Model if the State has failed to receive approval by CMS for a Proposed State-Designed Medicare FFS Hospital Global Budget Methodology by April 1, 2025, as described in Section 11.a.iii.
Termination by CMS. 1. CMS may terminate this Agreement if the Track 1+ ACO, its ACO participants, ACO providers/suppliers, or other individuals or entities performing functions or services related to ACO activities fail to comply with any of the requirements of this Agreement.
2. CMS may terminate or modify this Agreement pursuant to Section 1115A(b)(3) of the Act.
3. If CMS terminates this Agreement under Section X.C.1, CMS will terminate the ACO’s participation in the Shared Savings Program under 42 CFR 425.218.
Termination by CMS. (1) CMS may terminate an agreement with a FQHC if it finds that the FQHC—
(i) No longer meets the requirements specified in this subpart; or
(ii) Is not in substantial compliance with—
(A) The provisions of the agreement; or
(B) The requirements of this subpart, any other applicable regulations of this part, or any applicable provisions of title XVIII of the Act.
Termination by CMS. CMS may terminate the agreement with a State or local government agency as follows:
(1) If a State or local government agency’s payments are delinquent 30 days or more, CMS may terminate the agreement with 30 days advance notice.
(2) If the State or local government agency fails to comply with the terms of the agreement or procedures promul- gated by CMS, CMS may terminate the agreement with 30 days advance notice.
(3) If CMS finds that the State or local government agency is not acting in the best interest of the enrollees, or CMS, or for any reason other than those in paragraphs (b)(1) and (b)(2) of this section, CMS may terminate the agreement at any time.
Termination by CMS. CMS may terminate a contract for any of the fol- lowing reasons:
(1) The MA organization has failed substantially to carry out the terms of its current or previous contract terms with CMS.
(2) The MA organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of this part.
(3) CMS determines that the MA or- ganization no longer meets the require- ments of this part for being a con- tracting organization.
(4) There is credible evidence that the MA organization committed or par- ticipated in false, fraudulent, or abu- sive activities affecting the Medicare program, including submission of false or fraudulent data.
Termination by CMS. (a) CMS may immediately or with advance notice terminate this Agreement or the Agreement Performance Period if:
(i) CMS determines that the Agency no longer has the funds to support the MDPCP or the Model;
(ii) CMS modifies or terminates the Model pursuant to Section 1115A(b)(3)(B) of the Act;
(iii) CMS or the State terminates the Model or the State Agreement;
(iv) CMS or the State terminates the MDPCP pursuant to the State Agreement; or
(v) CMS determines that the MDPCP Practice:
(A) Has failed to comply with any terms of this Agreement or any other Medicare program requirement, rule, or regulation;
(B) Has failed to sign an amended and restated version of this Agreement offered by CMS pursuant to Article 1.4;
(C) Has failed to comply with a monitoring and/or auditing plan imposed by CMS;
(D) Has failed to submit, obtain approval for, implement, or fully comply with the terms of a CAP required pursuant to Article 14.1;
(E) Has failed to demonstrate improved performance following any remedial action taken by CMS pursuant to this Agreement;
(F) Has taken any action that threatens the health or safety of an MDPCP Beneficiary or other patient;
(G) Has submitted false data or made false representations, warranties, or certifications in connection with any aspect of the MDPCP;
(H) Is subject to sanctions or other actions of an accrediting organization or a federal, state, or local government agency;
(I) Is subject to investigation or action by HHS (including HHS-OIG and CMS) or DOJ due to an allegation of fraud or significant misconduct, including being subject to the filing of a complaint, filing of a criminal charge, being subject to an indictment, being named as a defendant in a False Claims Act qui tam matter in which the government has intervened, or similar action; or
(J) Assigns or purports to assign any of the rights or obligations under this Agreement, voluntarily or involuntarily, whether by merger, consolidation, dissolution, operation of law, or any manner, without the written consent of CMS.
(b) CMS shall provide a written notice to the MDPCP Practice which sets forth the effective date of such termination.