Termination by MCO Sample Clauses
The 'Termination by MCO' clause grants the Managed Care Organization (MCO) the right to end the agreement under specified circumstances. Typically, this clause outlines the conditions under which the MCO may terminate, such as breach of contract, regulatory changes, or failure to meet performance standards, and may require the MCO to provide advance written notice to the other party. Its core practical function is to provide the MCO with a clear and structured mechanism to exit the contract when necessary, thereby managing risk and ensuring operational flexibility.
Termination by MCO. (a) Failure to pay. MCO may terminate this Contract if HHSC fails to pay the MCO undisputed charges when due as required under this Contract. Retaining premium, recoupment, sanctions, or penalties that are allowed under this Contract or that result from the MCO’s failure to perform or the MCO’s default under the terms of this Contract is not cause for termination. Termination for failure to pay does not release HHSC from the obligation to pay undisputed charges for services provided prior to the termination date. If HHSC fails to pay undisputed charges when due, then the MCO may submit a notice of intent to terminate for failure to pay in accordance with the requirements of Subsection 12.04(d). If HHSC pays all undisputed amounts then due within 30 days after receiving the notice of intent to terminate, the MCO cannot proceed with termination of the Contract under this Article.
Termination by MCO. 47 Section 12.05 Termination by mutual agreement...........................................................................................48 Section 12.06 Effective date of termination....................................................................................................48 Section 12.07 Extension of termination effective date...................................................................................48 Section 12.08 Payment and other provisions at Contract termination............................................................48 Section 12.09 Modification of Contract in the event of remedies...................................................................48 Section 12.10 Turnover assistance................................................................................................................48 Section 12.11 Rights upon termination or expiration of Contract...................................................................48 Section 12.12 MCO responsibility for associated costs.................................................................................48 Section 12.13 Dispute resolution...................................................................................................................49
Termination by MCO. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.5.4.1.
3.5.4.1 Optional termination includes the circumstances listed in 42 CFR §422.74(b)(1) as follows:
(1) The MSHO Enrollee has engaged in disruptive behavior, and the request for disenrollment meets the requirements listed in 42 CFR §422.74(d)(2). Disenrollment will be allowed only upon review and approval by CMS.
(2) The Enrollee provided fraudulent information on his or her enrollment form or permits abuse of his or her enrollment card.
Termination by MCO. The MCO may not request disenrollment of an Enrollee for any reason, except a SNBC SNP Enrollee as described in section 3.7.2.2.
Termination by MCO. For PMAP and MinnesotaCare, the MCO may not request disenrollment of an Enrollee for any reason. Notification and Termination of Enrollment. Notification and termination of MCO enrollment shall become effective at the following times:
Termination by MCO. The MCO may not request disenrollment of an Enrollee for any reason.
Termination by MCO. For MSHO and MSC+ the MCO may not request disenrollment of an Enrollee for any reason except as described in section 3.2.3(B).
Termination by MCO. 46 3.4.3 Notification and Termination of Coverage. 46 3.5 Reporting Requirements. 47 3.5.1 Encounter Data. 47 3.5.2 Other Reporting Requirements. 51 3.5.3 Electronic Reporting Data Capability. 56 3.5.4 E-Mail Encryption. 56
Termination by MCO. The MCO may not request disenrollment of an Enrollee for any reason, nor orally or in writing or by any action or inaction encourage a MnDHO Enrollee to disenroll.
Termination by MCO. For PMAP and MinnesotaCare, the MCO may not request disenrollment of an Enrollee for any reason.