42 C.F.R. § 422.506 Nonrenewal of contract.
Title 42 - Public Health
(a) Nonrenewal by an MA organization. (1) An MA organization may elect not to renew its contract with CMS as of the end of the term of the contract for any reason provided it meets the timeframes for doing so set forth in paragraphs (a)(2) and (a)(3) of this section. (2) If an MA organization does not intend to renew its contract, it must notify— (i) CMS in writing, by the first Monday in June of the year in which the contract would end; (ii) Each Medicare enrollee, at least 90 days before the date on which the nonrenewal is effective. This notice must include a written description of alternatives available for obtaining Medicare services within the service area, including alternative MA plans, Medigap options, and original Medicare and must receive CMS approval prior to issuance. (iii) The general public, at least 90 days before the end of the current calendar year, by publishing a notice in one or more newspapers of general circulation in each community located in the MA organization's service area. (3) CMS may accept a nonrenewal notice submitted after the first Monday in June if— (i) The MA organization notifies its Medicare enrollees and the public in accordance with paragraph (a)(2)(ii) and (a)(2)(iii) of this section; and (ii) Acceptance is not inconsistent with the effective and efficient administration of the Medicare program. (4) If an MA organization does not renew a contract under this paragraph (a), CMS will not enter into a contract with the organization for 2 years unless there are special circumstances that warrant special consideration, as determined by CMS. (b) CMS decision not to renew. (1) CMS may elect not to authorize renewal of a contract for any of the following reasons: (i) The MA organization has not fully implemented or shown discernable progress in implementing quality improvement projects as defined in §422.152(d). (ii) For any of the reasons listed in §422.510(a), which would also permit CMS to terminate the contract. (iii) The MA organization has committed any of the acts in §422.752(a) that would support the imposition of intermediate sanctions or civil money penalties under subpart O of this part. (2) Notice. CMS provides notice of its decision whether to authorize renewal of the contract as follows: (i) To the MA organization by May 1 of the contract year. (ii) If CMS decides not to authorize a renewal of the contract, to the MA organization's Medicare enrollees by mail at least 90 days before the end of the current calendar year. (iii) If CMS decides not to authorize a renewal of the contract, to the general public at least 90 days before the end of the current calendar year, by publishing a notice in one or more newspapers of general circulation in each community or county located in the MA organization's service area. (3) Notice of appeal rights. CMS gives the MA organization written notice of its right to appeal the decision not to renew in accordance with §422.644. [63 FR 35099, June 26, 1998, as amended at 65 FR 40328, June 29, 2000; 67 FR 13289, Mar. 22, 2002; 70 FR 4737, Jan. 28, 2005]
Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart K—Contracts With Medicare Advantage Organizations
§ 422.506 Nonrenewal of contract.
