Md. Code Regs. 10.67.10.01

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.10.01 - Sanction by the Department

A. If the Department determines, after a sufficient investigation, that an MCO or any agent or employee of the MCO, or any person with an ownership interest in an MCO, or related party of the MCO, has failed to comply with any applicable law, regulation, or contract term, or for other good cause shown, the Department may impose sanctions on the MCO, including but not limited to:

(1) Fines;

(2) Suspension of further enrollment;

(3) Withholding all or part of the capitation payment;

(4) Termination of the current HealthChoice Managed Care Organization Agreement;

(5) Disqualification from future participation in the Maryland Medicaid Managed Care Program;

(6) Orders to provide a benefit or service to enrollees; and

(7) Those outlined in 42 CFR §§ 438.700- 438.708, as amended.

B. Corrective Action.

(1) Subject to §B(2) of this regulation, before imposing a sanction pursuant to §A of this regulation, the Department may permit an MCO an opportunity to take corrective action in accordance with a plan approved by the Department.

(2) The MCO shall submit a corrective action plan within a time frame specified by the Department.

Md. Code Regs. 10.67.10.01

Regulations .01 recodified from 10.09.73.01 effective 46:22 Md. R. 976, eff. 11/1/2019