Common use of Termination by CMS Clause in Contracts

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. (a) CMS may terminate a contract for any of the following reasons: (i) The MA M+C Organization has failed substantially to carry out the terms of its contract with CMS. (ii) The MA M+C Organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of 42 CFR Part part 422. (iii) CMS determines that the MA M+C Organization no longer meets the requirements of 42 CFR Part 422 this part for being a contracting organization. (iv) There is credible evidence that the MA The M+C Organization committed commits or participated participates in false, fraudulent or abusive activities affecting the Medicare program, including submission of false or fraudulent data. (v) The MA M+C 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 M+C Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart subpart M of this part relating to grievances and appeals. (vii) The MA M+C Organization fails to provide CMS with valid risk adjustment data as required under §422.310 and 423.329(b)(3)Section 422.257. (viii) The MA M+C Organization fails to implement an acceptable quality assessment and performance improvement program as required under 42 CFR Part 422 Subpart D.subpart D of part 422. (ix) The MA M+C Organization substantially fails to comply with the prompt payment requirements in §Section 422.520. (x) The MA M+C Organization substantially fails to comply with the service access requirements in §422.112Section 422.112 or Section 422.114. (xi) The MA M+C Organization fails to comply with the requirements of §Section 422.208 regarding physician incentive plans. (xii) The MA Organization M+CO substantially fails to comply with the marketing requirements in 422.80.

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 §Section 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 §Section 422.520. (x) The MA Organization substantially fails to comply with the service access requirements in §Section 422.112. (xi) The MA Organization fails to comply with the requirements of §Section 422.208 regarding physician incentive plans. (xii) The MA Organization substantially fails to comply with the marketing requirements in 422.80.

Termination by CMS. (a) CMS may terminate a contract for any of the following reasons: (i) The MA M+C Organization has failed substantially to carry out the terms of its contract with CMS. (ii) The MA M+C Organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of 42 CFR Part part 422. (iii) CMS determines that the MA M+C Organization no longer meets the requirements of 42 CFR Part 422 this part for being a contracting organization. (iv) There is credible evidence that the MA The M+C Organization committed commits or participated participates in false, fraudulent or abusive activities affecting the Medicare program, including submission of false or fraudulent data. (v) The MA M+C 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 M+C Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart subpart M of this part relating to grievances and appeals. (vii) The MA M+C Organization fails to provide CMS with valid risk adjustment data as required under §422.310 and 423.329(b)(3)§ 422.257. (viii) The MA M+C Organization fails to implement an acceptable quality assessment and performance improvement program as required under 42 CFR Part 422 Subpart D.subpart D of part 422. (ix) The MA M+C Organization substantially fails to comply with the prompt payment requirements in §§ 422.520. (x) The MA M+C Organization substantially fails to comply with the service access requirements in §422.112§ 422.112 or § 422.114. (xi) The MA M+C Organization fails to comply with the requirements of §§ 422.208 regarding physician incentive plans. (xii) The MA Organization M+CO substantially fails to comply with the marketing requirements in 422.80.

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 ss.422.3 10 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 §422.520ss.422.520. (x) The MA Organization substantially fails to comply with the service access requirements in §422.112ss.422.112. (xi) The MA Organization fails to comply with the requirements of §422.208 ss.422.20 8 regarding physician incentive plans. (xii) The MA Organization substantially fails to comply with the marketing requirements in 422.80.

Termination by CMS. (a) CMS may terminate a contract for any of the following reasons: (i) The MA M+C Organization has failed substantially to carry out the terms of its contract with CMS. (ii) The MA M+C Organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of 42 CFR Part part 422. (iii) CMS determines that the MA M+C Organization no longer meets the requirements of 42 CFR Part 422 this part for being a contracting organization. (iv) There is credible evidence that the MA The M+C Organization committed commits or participated participates in false, fraudulent or abusive activities affecting the Medicare program, including submission of false or fraudulent data. (v) The MA M+C 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 M+C Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart subpart M of this part relating to grievances and appeals. (vii) The MA M+C Organization fails to provide CMS with valid risk adjustment encounter data as required under §422.310 and 423.329(b)(3)422.257. (viii) The MA M+C Organization fails to implement an acceptable quality assessment and performance improvement program as required under 42 CFR Part 422 Subpart D.subpart D of part 422. (ix) The MA M+C Organization substantially fails to comply with the prompt payment requirements in §422.520. (x) The MA M+C Organization substantially fails to comply with the service access requirements in §422.112422.112 or §422.114. (xi) The MA M+C 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. (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. (a) CMS may terminate a contract for any of the following reasons: (i) The MA M+C Organization has failed substantially to carry out the terms of its contract with CMS. (ii) The MA M+C Organization is carrying out its contract with CMS in a manner that is inconsistent with the effective and efficient implementation of 42 CFR Part part 422. (iii) CMS determines that the MA M+C Organization no longer meets the requirements of 42 CFR Part 422 this part for being a contracting organization. (iv) There is credible evidence that the MA The M+C Organization committed commits or participated participates in false, fraudulent or abusive activities affecting the Medicare program, including submission of false or fraudulent data. (v) The MA M+C 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 M+C Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart subpart M of this part relating to grievances and appeals. (vii) The MA M+C Organization fails to provide CMS with valid risk adjustment encounter data as required under §422.310 and 423.329(b)(3)E422.257. (viii) The MA M+C Organization fails to implement an acceptable quality assessment and performance improvement program as required under 42 CFR Part 422 Subpart D.subpart D of part 422. (ix) The MA M+C Organization substantially fails to comply with the prompt payment requirements in §422.520E422.520. (x) The MA M+C Organization substantially fails to comply with the service access requirements in §422.112E422.112 or E422.114. (xi) The MA M+C Organization fails to comply with the requirements of §422.208 E422.208 regarding physician incentive plans. (xii) The MA Organization substantially fails to comply with the marketing requirements in 422.80.