Sec. 10.09.44.04. Term of the Provider Agreement

A. The duration or term of the agreement between the Department and the PACE provider is specified in the provider agreement.

B. The provider agreement shall provide for automatic amendment, renegotiation, or termination, or all of the above, of the provider agreement by either party if any part of the provider agreement's provider benefit package is changed under the State Plan.

C. Termination.

(1) The Department may terminate immediately the provider agreement upon notification:

(a) By the U. S. Department of Health and Human Services, that it is withdrawing federal financial participation in all or part of the cost of the PACE benefit package;

(b) By the Department of Budget and Management, of the unavailability of sufficient State funds for the PACE benefit package; or

(c) That the owners or managers of the PACE provider, or other persons with substantial provider agreement relationships with the PACE provider, have been convicted of certain crimes or received certain sanctions as specified in §1128 of the Social Security Act.

(2) The Department may, at its sole discretion, offer to renegotiate any provision of the provider agreement if renegotiation would remove any of the causes of termination specified in §C(1) of this regulation. This offer is not a waiver of the Department's right of immediate termination.

(3) The provider agreement may be terminated by either the Department or the PACE provider if the other party fails to meet a provision of:

(a) This chapter;

(b) The provider agreement; or

(c) Applicable laws, rules, regulations, or guidelines effective as of the date of the provider agreement or enacted or established during the provider agreement's term.

(4) A provider agreement's termination is effective only after the terminating party has notified the breaching party in writing of the cause or causes of termination and has allowed 60 days for the correction or alleviation of the cause or causes by the breaching party.

(5) Termination of Agreement by PACE. The PACE provider may terminate an agreement after timely notice to CMS, the Department, and participants, as follows:

(a) To CMS and the Department, 90 days before termination; and

(b) To participants, 60 days before termination.

D. Default by PACE.

(1) The Department may immediately terminate the provider agreement if the PACE provider defaults, as specified in §D(3) of this regulation.

(2) If the PACE provider defaults, the Department may recover any capitation payments issued to the PACE provider for periods after the termination effective date of the provider agreement.

(3) The following are defaults by the PACE provider:

(a) Inability to provide the services described in the PACE provider benefit package and in Regulation .09 of this chapter; or

(b) Insolvency.

E. Nonexclusivity of Remedy.

(1) This regulation's provisions supplement, rather than replace, any other sanctions or remedies available to the Department under the provisions of Regulation .24 of this chapter, the provider agreement, or applicable law or regulations.

(2) If the provider agreement is terminated under this regulation, the PACE provider shall furnish to the Department, within 45 days of the termination's effective date, all information necessary for the reimbursement of any outstanding claims for services rendered to the PACE provider's participants, including claims of its contractors.