C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 438—MANAGED CARE › Subpart I—Sanctions

42 C.F.R. § 438.708

Termination of an MCO, PCCM or PCCM entity contract

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A State has the authority to terminate an MCO, PCCM or PCCM entity contract and enroll that entity's enrollees in other MCOs, PCCMs or PCCM entities, or provide their Medicaid benefits through other options included in the State plan, if the State determines that the MCO, PCCM or PCCM entity has failed to do either of the following:

(a) Carry out the substantive terms of its contract.

(b) Meet applicable requirements in sections 1932, 1903(m), and 1905(t) of the Act.

Notes of Decisions
Cited in 3 cases (3 in the last 5 years), 2022–2024 · leading case: Saint Anthony Hosp. v. Theresa Eagleson, 40 F.4th 492 (7th Cir. 2022).
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Saint Anthony Hosp. v. Theresa Eagleson, 40 F.4th 492 (7th Cir. 2022). “See also 42 C.F.R. §§ 438.708 (when states can terminate an MCO contract), 438.”
Saint Anthony Hosp. v. Elizabeth M. Whitehorn, 100 F.4th 767 (7th Cir. 2024). “See also 42 C.F.R. § 438.708 (when states can termi- nate an MCO contract) and § 438.”
Saint Anthony Hosp. v. Elizabeth M. Whitehorn (7th Cir. 2024). “See also 42 C.F.R. § 438.708 (when states can termi- nate an MCO contract) and § 438.”
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