La. Admin. Code tit. 50 § I-1307

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-1307 - Health Plan Sanctions

A. If the department determines the Health Plan or its subcontractors has participated in provider steering, the department, at its sole discretion, may impose the following sanctions.

1. The member(s) may be dis-enrolled from the health plan at the earliest effective date allowed.

2. Up to 100 percent of the monthly capitation payment or care management fee for the month(s) the member(s) was enrolled in the health plan may be recouped.

3. The health plan may be assessed a monetary penalty of up to $5,000 per member.

4. The health plan may be required to submit a letter to each member notifying he member of their imposed sanction and of their right to choose another health plan.

La. Admin. Code tit. 50, § I-1307

Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 40:2589 (12/1/2014).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.