CMS Pub. 100-16, ch. 11, § 90

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.