Title 42

SECTION 417.492

417.492 Nonrenewal of contract.

§ 417.492 Nonrenewal of contract.

(a) Nonrenewal by the HMO or CMP. (1) If an HMO or CMP does not intend to renew its contract, it must -

(i) Give written notice to CMS at least 90 days before the end of the current contract period; and

(ii) Notify each Medicare enrollee by mail at least 60 days before the end of the contract period.

(2) CMS may accept a nonrenewal notice submitted less than 90 days before the end of a contract period if -

(i) The HMO or CMP notifies its Medicare enrollees and the public in accordance with paragraph (a)(1) of this section; and

(ii) Acceptance would not otherwise jeopardize the effective and efficient administration of the Medicare program.

(b) Nonrenewal by CMS - (1) Notice of nonrenewal. If CMS decides not to renew a contract, it gives written notice of nonrenewal as follows:

(i) To the HMO or CMP at least 90 days before the end of the contract period.

(ii) To the HMO's or CMP's Medicare enrollees at least 60 days before the end of the contract period.

(2) Notice of appeal rights. CMS gives the HMO or CMP written notice of its right to appeal the nonrenewal decision, in accordance with part 422 subpart N of this chapter, if CMS's decision was based on any of the reasons specified in § 417.494(b).

[50 FR 1346, Jan. 10, 1985, as amended at 58 FR 38079, July 15, 1993; 60 FR 45681, Sept. 1, 1995; 75 FR 19803, Apr. 15, 2010; 77 FR 22166, Apr. 12, 2012]

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