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10.09.73.00.htm 10.09.73.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 09 MEDICAL CARE PROGRAMS Chapter 73 Maryland Medicaid Managed Care Program: Sanctions Authority: Health-General Article, §15-103(b)9) Annotated Code of Maryland
10.09.73.01.htm 10.09.73.01. 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;.
10.09.73.01-1.htm 10.09.73.01-1. 01-1 Sanction by Center for Medicare and Medicaid Services (CMS). The Department shall comply with notification requirements of CMS at 42 CFR §438.730 for sanction determinations as specified in 42 CFR §438.700(b)1)b)6)
10.09.73.02.htm 10.09.73.02. 02 Appeal.. A. From the decisions set forth in §B(1)8) of this regulation, an MCO may exercise the appeal rights set forth in §C of this regulation.B. The following Department decisions are appealable by the MCO or MCO applicant:. 1) Denial of an entity’s completed application to become an MCO;. 2) Decision to terminate the MCO's participation in the Maryland Medicaid Managed Care Program;. 3) Decision to impose a fine or other sanction on the MCO as described in R
10.09.73.03.htm 10.09.73.03. 03 Incentives.. A. All monies collected from the MCOs as a result of the imposition of a financial sanction shall be deposited in the HealthChoice Performance Incentive Fund.B. This nonlapsing fund shall include all sanctions imposed on the MCOs starting in calendar year 1999.C. The fund shall be used to provide financial incentive awards to the MCOs that meet or exceed specific performance targets as established by the Department, unless otherwise directed by law.
10.09.73.9999.htm 10.09.73.9999. Administrative History Effective date:. Regulations .01 and .02 adopted as an emergency provision effective November 8, 1996 (23:25 Md. R. 1730) adopted permanently effective March 10, 1997 (24:5 Md. R. 408)Regulation .01A amended effective June 30, 2008 (35:13 Md. R. 1180) December 31, 2018 (45:26 Md. R. 1244)Regulation .01B amended effective June 30, 2008 (35:13 Md. R. 1180). Regulation .01B amended as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527) amended
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