Medicare Managed Care Manual (Pub. 100-16), Ch. 11 § 90
Modification or Termination of an MA Contract by Mutual
90 - Modification or Termination of an MA Contract by Mutual
Consent
(Rev. 79, Issued 02-17-06, Effective Date 02-17-06)
There are circumstances under which an MA organization may agree to a termination by
mutual consent. Further, CMS may decide that it is in the best interests of tax payers,
Medicare beneficiaries and the Medicare program to agree to let an MA organization
terminate its contract midyear.
An MA contract may be modified or terminated by CMS or an MA organization at any
time by written mutual consent of both parties. MA organizations must provide notice to
their Medicare enrollees and the general public when mutually agreeing to terminate an
MA contract as follows:
•
To its Medicare enrollees, at least 60 days before the termination effective date.
This notice must include a written description of alternatives available for
obtaining Medicare services within the services area, including alternative MA
plans, Medigap options, original Medicare, and it must receive CMS approval.
•
To the general public, at least 60 days before the termination effective date by
publishing a CMS-approved notice in one or more newspapers of general
circulation in each community or county located in the MA organization's
geographic area.
The general exception to these notice requirements occurs when an MA contract that is
terminated by mutual consent, is replaced the day following such termination by a new
MA contract covering the same population. If the new contract is effective during a
calendar year, it must include benefits under the same terms as the old contract for this
exception to apply.