{"component": "clause", "props": {"groups": [{"size": 32, "snippet_links": [{"key": "contract-for", "type": "definition", "offset": [24, 36]}, {"key": "terms-of", "type": "definition", "offset": [133, 141]}, {"key": "cfr-part", "type": "clause", "offset": [315, 323]}, {"key": "meets-the-requirements", "type": "definition", "offset": [385, 407]}, {"key": "contracting-organization", "type": "definition", "offset": [439, 463]}, {"key": "credible-evidence", "type": "definition", "offset": [479, 496]}, {"key": "medicare-program", "type": "clause", "offset": [605, 621]}, {"key": "submission-of", "type": "clause", "offset": [633, 646]}, {"key": "financial-difficulties", "type": "definition", "offset": [709, 731]}, {"key": "ability-to-make", "type": "clause", "offset": [751, 766]}, {"key": "services-available", "type": "clause", "offset": [784, 802]}, {"key": "to-the-extent", "type": "clause", "offset": [945, 958]}, {"key": "comply-with-the", "type": "clause", "offset": [1042, 1057]}, {"key": "relating-to", "type": "definition", "offset": [1100, 1111]}, {"key": "grievances-and-appeals", "type": "clause", "offset": [1112, 1134]}, {"key": "to-provide", "type": "definition", "offset": [1168, 1178]}, {"key": "risk-adjustment-data", "type": "clause", "offset": [1194, 1214]}, {"key": "as-required", "type": "clause", "offset": [1215, 1226]}, {"key": "quality-improvement-program", "type": "definition", "offset": [1321, 1348]}, {"key": "prompt-payment-requirements", "type": "clause", "offset": [1458, 1485]}, {"key": "access-requirements", "type": "definition", "offset": [1570, 1589]}, {"key": "physician-incentive-plans", "type": "clause", "offset": [1688, 1713]}, {"key": "marketing-requirements", "type": "definition", "offset": [1780, 1802]}], "snippet": "(a) CMS may terminate a contract for any of the following reasons:\n(i) The MA Organization has failed substantially to carry out the terms of its contract with CMS.\n(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.\n(iii) CMS determines that the MA Organization no longer meets the requirements of 42 CFR Part 422 for being a contracting organization.\n(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.\n(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.\n(vi) The MA Organization substantially fails to comply with the requirements in 42 CFR Part 422 Subpart M relating to grievances and appeals.\n(vii) The MA Organization fails to provide CMS with valid risk adjustment data as required under \u00a7422.310 and 423.329(b)(3).\n(viii) The MA Organization fails to implement an acceptable quality improvement program as required under 42 CFR Part 422 Subpart D.\n(ix) The MA Organization substantially fails to comply with the prompt payment requirements in \u00a7422.520.\n(x) The MA Organization substantially fails to comply with the service access requirements in \u00a7422.112.\n(xi) The MA Organization fails to comply with the requirements of \u00a7422.208 regarding physician incentive plans.\n(xii) The MA Organization substantially fails to comply with the marketing requirements in 422.80.", "samples": [{"hash": "j0mRZPKVELo", "uri": "/contracts/j0mRZPKVELo#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (HealthSpring, Inc.)", "score": 19.1122518823, "published": true}, {"hash": "cJWDPLYt3Pl", "uri": "/contracts/cJWDPLYt3Pl#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (HealthSpring, Inc.)", "score": 19.1122518823, "published": true}, {"hash": "kDdZSCjSiOy", "uri": "/contracts/kDdZSCjSiOy#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}], "hash": "6c171b2c190ef46f0c451d7006b5ad81", "id": 1}, {"size": 11, "snippet_links": [{"key": "contract-for", "type": "definition", "offset": [20, 32]}], "snippet": "CMS may terminate a contract for any of the following reasons:", "samples": [{"hash": "g7Eu2wweBHZ", "uri": "/contracts/g7Eu2wweBHZ#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}, {"hash": "ebqj3lcEPkN", "uri": "/contracts/ebqj3lcEPkN#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}, {"hash": "dOxq1kv6QI", "uri": "/contracts/dOxq1kv6QI#termination-by-cms", "label": "Contract With Eligible Medicare Advantage Organization (Wellcare Health Plans, Inc.)", "score": 19.0, "published": true}], "hash": "81e844af12138279b6593f3dc5acc560", "id": 2}, {"size": 3, "snippet_links": [{"key": "sole-discretion", "type": "clause", "offset": [26, 41]}, {"key": "the-state", "type": "clause", "offset": [48, 57]}, {"key": "corrective-action", "type": "definition", "offset": [151, 168]}, {"key": "time-period", "type": "definition", "offset": [176, 187]}, {"key": "in-this-agreement", "type": "clause", "offset": [237, 254]}, {"key": "terminate-this-agreement", "type": "clause", "offset": [276, 300]}, {"key": "with-advance-notice", "type": "clause", "offset": [330, 349]}, {"key": "no-entity", "type": "clause", "offset": [431, 440]}, {"key": "section-8", "type": "clause", "offset": [456, 465]}, {"key": "participate-in", "type": "definition", "offset": [469, 483]}, {"key": "the-model", "type": "clause", "offset": [484, 493]}, {"key": "consistent-with-the", "type": "clause", "offset": [506, 525]}, {"key": "scope-of-the", "type": "clause", "offset": [552, 564]}], "snippet": "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.", "samples": [{"hash": "20U2872YxnG", "uri": "/contracts/20U2872YxnG#termination-by-cms", "label": "Vermont All Payer Accountable Care Organization Model Agreement", "score": 33.8902639349, "published": true}, {"hash": "fzQhwRUqXwX", "uri": "/contracts/fzQhwRUqXwX#termination-by-cms", "label": "Vermont All Payer Accountable Care Organization Model Agreement", "score": 33.8738397294, "published": true}, {"hash": "6W2wDbtyZX0", "uri": "/contracts/6W2wDbtyZX0#termination-by-cms", "label": "Vermont All Payer Accountable Care Organization Model Agreement", "score": 33.8327792157, "published": true}], "hash": "cd3d48faec2e2b2843fac7e521909055", "id": 3}, {"size": 3, "snippet_links": [{"key": "meets-the-requirements", "type": "definition", "offset": [14, 36]}, {"key": "compliance-with", "type": "definition", "offset": [94, 109]}, {"key": "provisions-of-the-agreement", "type": "clause", "offset": [119, 146]}, {"key": "applicable-regulations", "type": "clause", "offset": [199, 221]}, {"key": "applicable-provisions", "type": "definition", "offset": [243, 264]}, {"key": "title-xviii", "type": "definition", "offset": [268, 279]}, {"key": "the-act", "type": "clause", "offset": [283, 290]}], "snippet": "(i) No longer meets the requirements specified in this subpart; or\n(ii) Is not in substantial compliance with\u2014\n(A) The provisions of the agreement; or\n(B) The requirements of this subpart, any other applicable regulations of this part, or any applicable provisions of title XVIII of the Act.", "samples": [{"hash": "ksFBMb9H05q", "uri": "/contracts/ksFBMb9H05q#termination-by-cms", "label": "Provider Agreement", "score": 23.4930359001, "published": true}, {"hash": "aLIAdk4CXuu", "uri": "/contracts/aLIAdk4CXuu#termination-by-cms", "label": "Federally Qualified Health Center Agreement", "score": 20.8369285141, "published": true}, {"hash": "iOt6QqLfIR3", "uri": "/contracts/iOt6QqLfIR3#termination-by-cms", "label": "Federally Qualified Health Center Agreement", "score": 20.6480501511, "published": true}], "hash": "f9f9f39de3e9164d5ef2363f3a653ebb", "id": 4}, {"size": 2, "snippet_links": [{"key": "terminate-this-agreement", "type": "clause", "offset": [11, 35]}, {"key": "track-1", "type": "definition", "offset": [43, 50]}, {"key": "other-individuals", "type": "definition", "offset": [107, 124]}, {"key": "related-to", "type": "clause", "offset": [170, 180]}, {"key": "aco-activities", "type": "definition", "offset": [181, 195]}, {"key": "comply-with", "type": "clause", "offset": [204, 215]}, {"key": "requirements-of-this-agreement", "type": "clause", "offset": [227, 257]}, {"key": "pursuant-to-section", "type": "definition", "offset": [305, 324]}, {"key": "the-act", "type": "clause", "offset": [340, 347]}, {"key": "shared-savings-program", "type": "definition", "offset": [456, 478]}], "snippet": "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.\n2. CMS may terminate or modify this Agreement pursuant to Section 1115A(b)(3) of the Act.\n3. If CMS terminates this Agreement under Section X.C.1, CMS will terminate the ACO\u2019s participation in the Shared Savings Program under 42 CFR 425.218.", "samples": [{"hash": "fmM1VFdEW0z", "uri": "/contracts/fmM1VFdEW0z#termination-by-cms", "label": "Participation Agreement", "score": 24.1704312115, "published": true}, {"hash": "41Iu9iBrO5G", "uri": "/contracts/41Iu9iBrO5G#termination-by-cms", "label": "Participation Agreement", "score": 23.7049965777, "published": true}], "hash": "c1e69e8f5b73cbde79974acc64c9178e", "id": 5}, {"size": 2, "snippet_links": [{"key": "with-advance-notice", "type": "clause", "offset": [26, 45]}, {"key": "the-model", "type": "clause", "offset": [56, 65]}, {"key": "participation-agreement", "type": "definition", "offset": [69, 92]}, {"key": "implementation-period", "type": "clause", "offset": [98, 119]}, {"key": "period-of", "type": "definition", "offset": [138, 147]}, {"key": "sole-discretion", "type": "clause", "offset": [192, 207]}, {"key": "the-state", "type": "clause", "offset": [229, 238]}, {"key": "to-submit", "type": "definition", "offset": [250, 259]}, {"key": "terms-of", "type": "definition", "offset": [331, 339]}, {"key": "required-by", "type": "definition", "offset": [346, 357]}, {"key": "triggering-event", "type": "clause", "offset": [406, 422]}, {"key": "enforcement-action-required", "type": "definition", "offset": [514, 541]}, {"key": "pursuant-to-section", "type": "definition", "offset": [549, 568]}, {"key": "terminate-this-agreement", "type": "clause", "offset": [745, 769]}, {"key": "the-pre", "type": "clause", "offset": [777, 784]}, {"key": "to-receive", "type": "definition", "offset": [844, 854]}, {"key": "approval-by", "type": "clause", "offset": [855, 866]}, {"key": "a-proposed", "type": "clause", "offset": [875, 885]}, {"key": "medicare-ffs", "type": "definition", "offset": [901, 913]}, {"key": "global-budget", "type": "definition", "offset": [923, 936]}, {"key": "april-1", "type": "definition", "offset": [952, 959]}], "snippet": "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:\n1. 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\n2. 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\nii. 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.", "samples": [{"hash": "3KUvMm0imXj", "uri": "/contracts/3KUvMm0imXj#termination-by-cms", "label": "Cooperative Agreement", "score": 32.7524168201, "published": true}, {"hash": "kXFqxh2NRVA", "uri": "/contracts/kXFqxh2NRVA#termination-by-cms", "label": "Cooperative Agreement", "score": 32.7021930107, "published": true}], "hash": "c88bc8c7a17dc0fcd88de96c308c040f", "id": 6}, {"size": 2, "snippet_links": [{"key": "an-agreement", "type": "clause", "offset": [22, 34]}, {"key": "meets-the-requirements", "type": "definition", "offset": [88, 110]}, {"key": "compliance-with", "type": "definition", "offset": [168, 183]}, {"key": "provisions-of-the-agreement", "type": "clause", "offset": [193, 220]}, {"key": "applicable-regulations", "type": "clause", "offset": [273, 295]}, {"key": "applicable-provisions", "type": "definition", "offset": [317, 338]}, {"key": "title-xviii", "type": "definition", "offset": [342, 353]}, {"key": "the-act", "type": "clause", "offset": [357, 364]}], "snippet": "(1) CMS may terminate an agreement with a FQHC if it finds that the FQHC\u2014\n(i) No longer meets the requirements specified in this subpart; or\n(ii) Is not in substantial compliance with\u2014\n(A) The provisions of the agreement; or\n(B) The requirements of this subpart, any other applicable regulations of this part, or any applicable provisions of title XVIII of the Act.", "samples": [{"hash": "eSWX6F0lwA3", "uri": "/contracts/eSWX6F0lwA3#termination-by-cms", "label": "FQHC Agreement", "score": 29.8554206039, "published": true}, {"hash": "gVvj5qFOUYJ", "uri": "/contracts/gVvj5qFOUYJ#termination-by-cms", "label": "FQHC Agreement", "score": 22.765229295, "published": true}], "hash": "23d502b1c8d3a6396fb5ed860edfe5cb", "id": 7}, {"size": 2, "snippet_links": [{"key": "at-any-time", "type": "clause", "offset": [8, 19]}, {"key": "terminate-this-agreement", "type": "clause", "offset": [20, 44]}, {"key": "as-a-service", "type": "definition", "offset": [95, 107]}, {"key": "engaged-in", "type": "definition", "offset": [160, 170]}, {"key": "breach-of", "type": "definition", "offset": [189, 198]}, {"key": "agreement-or", "type": "definition", "offset": [246, 258]}, {"key": "safeguard-against-fraud", "type": "clause", "offset": [262, 285]}, {"key": "corrective-action", "type": "definition", "offset": [350, 367]}], "snippet": "CMS may at any time terminate this Agreement if CMS determines it will no longer offer the MTF as a service or if CMS determines that the Dispensing Entity has engaged in conduct that is a breach of the Dispensing Entity\u2019s obligations under this Agreement or to safeguard against fraud or similar fault.\nA. Notice and, as applicable, opportunity for corrective action.", "samples": [{"hash": "haBrbiVaN9I", "uri": "/contracts/haBrbiVaN9I#termination-by-cms", "label": "Medicare Transaction Facilitator Data Module User Agreement", "score": 36.2793156243, "published": true}], "hash": "3bd24e4888128461ad54af078a3cb947", "id": 8}, {"size": 2, "snippet_links": [{"key": "terminate-the-agreement", "type": "clause", "offset": [8, 31]}, {"key": "state-or-local-government-agency", "type": "definition", "offset": [39, 71]}, {"key": "days-or-more", "type": "clause", "offset": [155, 167]}, {"key": "advance-notice", "type": "definition", "offset": [214, 228]}, {"key": "the-state", "type": "clause", "offset": [237, 246]}, {"key": "agreement-or", "type": "definition", "offset": [312, 324]}, {"key": "best-interest", "type": "definition", "offset": [499, 512]}, {"key": "for-any-reason", "type": "clause", "offset": [542, 556]}, {"key": "at-any-time", "type": "clause", "offset": [655, 666]}], "snippet": "CMS may terminate the agreement with a State or local government agency as follows:\n(1) If a State or local government agency\u2019s payments are delinquent 30 days or more, CMS may terminate the agreement with 30 days advance notice.\n(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.\n(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.", "samples": [{"hash": "9UBW2v70bYg", "uri": "/contracts/9UBW2v70bYg#termination-by-cms", "label": "State Buy in Agreement", "score": 31.141240919, "published": true}], "hash": "118ac6bad82f75810a0e383f44fbaf87", "id": 9}, {"size": 1, "snippet_links": [{"key": "with-advance-notice", "type": "clause", "offset": [77, 96]}, {"key": "terminate-this-agreement", "type": "clause", "offset": [97, 121]}, {"key": "remedial-action", "type": "clause", "offset": [168, 183]}, {"key": "amended-and-restated", "type": "definition", "offset": [378, 398]}, {"key": "offered-by", "type": "definition", "offset": [425, 435]}, {"key": "pursuant-to-section", "type": "definition", "offset": [440, 459]}, {"key": "day-of", "type": "clause", "offset": [480, 486]}, {"key": "performance-period", "type": "clause", "offset": [491, 509]}, {"key": "action-by", "type": "clause", "offset": [616, 625]}, {"key": "office-of-inspector-general", "type": "definition", "offset": [645, 672]}, {"key": "department-of-justice", "type": "definition", "offset": [689, 710]}, {"key": "allegation-of-fraud", "type": "definition", "offset": [721, 740]}, {"key": "significant-misconduct", "type": "definition", "offset": [744, 766]}, {"key": "subject-to-the", "type": "definition", "offset": [784, 798]}, {"key": "criminal-charge", "type": "definition", "offset": [834, 849]}, {"key": "false-claims-act", "type": "clause", "offset": [915, 931]}, {"key": "the-federal-government", "type": "clause", "offset": [956, 978]}, {"key": "program-integrity", "type": "definition", "offset": [1003, 1020]}, {"key": "state-party", "type": "definition", "offset": [1031, 1042]}, {"key": "prior-written-consent", "type": "clause", "offset": [1055, 1076]}, {"key": "for-the-hospital", "type": "clause", "offset": [1114, 1130]}, {"key": "terms-of-this-agreement", "type": "clause", "offset": [1160, 1183]}, {"key": "notice-to-cms", "type": "clause", "offset": [1266, 1279]}, {"key": "grounds-for-termination", "type": "definition", "offset": [1295, 1318]}, {"key": "effective-date-of-termination", "type": "clause", "offset": [1333, 1362]}, {"key": "other-state", "type": "definition", "offset": [1376, 1387]}, {"key": "party-consents", "type": "clause", "offset": [1388, 1402]}, {"key": "the-termination", "type": "clause", "offset": [1406, 1421]}, {"key": "if-applicable", "type": "clause", "offset": [1427, 1440]}, {"key": "consent-to", "type": "clause", "offset": [1489, 1499]}, {"key": "the-notice", "type": "clause", "offset": [1543, 1553]}, {"key": "the-state", "type": "clause", "offset": [1609, 1618]}, {"key": "in-writing", "type": "clause", "offset": [1683, 1693]}, {"key": "the-effective-date", "type": "clause", "offset": [1718, 1736]}], "snippet": "Except as set forth in paragraph (b) of this section, CMS may immediately or with advance notice terminate this Agreement if CMS determines that any of the grounds for remedial action set forth in sections 15.1 or 15.2 continue to exist after remedial action has been taken. CMS may immediately or with advance notice terminate this Agreement if the Hospital \u2013 Fails to sign an amended and restated version of this Agreement offered by CMS pursuant to Section 1.3(a) by the first day of the Performance Period in which such amended and restated version of this Agreement takes effect. Is subject to investigation or action by HHS (including HHS Office of Inspector General and CMS) or the Department of Justice 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 federal government; or Has past or present program integrity issues. A State Party must obtain prior written consent from CMS to terminate this Agreement for the Hospital\u2019s failure to comply with the terms of this Agreement. If a State Party so wishes to terminate this Agreement, it shall provide written notice to CMS specifying the grounds for termination, the proposed effective date of termination, whether the other State Party consents to the termination, and if applicable, the reasons why the other State Party does not consent to the termination. CMS shall promptly review the notice and either approve or reject the proposed termination. The State may terminate this Agreement if either State Party notifies CMS in writing at least 90 days before the effective date.", "samples": [{"hash": "kqMjObjOg3u", "uri": "/contracts/kqMjObjOg3u#termination-by-cms", "label": "Participation Agreement", "score": 23.4421629021, "published": true}], "hash": "6ba8d07b8775232e3c3a4c29b5760c93", "id": 10}], "next_curs": "ClsSVWoVc35sYXdpbnNpZGVyY29udHJhY3RzcjcLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2Iht0ZXJtaW5hdGlvbi1ieS1jbXMjMDAwMDAwMGEMogECZW4YACAA", "clause": {"children": [["notice", "Notice"], ["general", "General"], ["appeal-rights", "Appeal rights"], ["exception", "Exception"], ["corrective-action-plan", "Corrective Action Plan"]], "size": 69, "parents": [["notice-of-appeal-rights", "Notice of appeal rights"], ["risk-adjustment-data", "Risk Adjustment data"], ["program-integrity", "PROGRAM INTEGRITY"], ["termination", "Termination"], ["cms-payment-to-ma-organization", "CMS Payment to MA Organization"]], "title": "Termination by CMS", "id": "termination-by-cms", "related": [["termination-by-\u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587"], ["termination-by-\u2587\u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587\u2587"], ["termination-by-caiso", "Termination by CAISO", "Termination by CAISO"], ["termination-by-\u2587\u2587\u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587\u2587\u2587", "Termination by \u2587\u2587\u2587\u2587\u2587\u2587\u2587"], ["termination-by-mps", "TERMINATION BY MPS", "TERMINATION BY MPS"]], "related_snippets": [], "updated": "2025-07-07T12:36:18+00:00"}, "json": true, "cursor": ""}}