31.10.22.11

.11 Termination of Services.

A. Notice of Intent to Terminate. When a provider-sponsored organization desires to cease offering a service under the contract, the provider-sponsored organization shall provide written notice of the intent to terminate to the Commissioner at least 30 days before ceasing to offer the service.

B. Permissible Reasons for Cancellation or Nonrenewal of Enrollment. A provider-sponsored organization may cancel or nonrenew enrollment in the provider-sponsored organization only for the following reasons:

(1) Change of the place of residence of the member from the geographical area served by the provider-sponsored organization;

(2) Failure of the member to pay any deductible or co-payment charges permitted under a contract;

(3) Fraudulent use of the provider-sponsored organization's identification card on the part of the member or the alteration or sale of prescriptions by the member;

(4) Failure of the enrollee to pay a premium charge when due;

(5) Termination of the contract.

(6) Termination of the plan with respect to all individuals in the area in which the enrollee resides; or

(7) The enrollee has:

(a) Engaged in disruptive behavior as specified in standards under 42 U.S.C. §1395w-21,

(b) Lost entitlement to Part A or Part B of Title 42, Chapter 7, Subchapter XVIII of the U.S. Code, or

(c) Died.