<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".01" citation="COMAR 10.67.10.01" title_num="10" subtitle_num="67" chapter_num="10" heading="Sanction by the Department.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Fines;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Suspension of further enrollment;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Withholding all or part of the capitation payment;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Termination of the current HealthChoice Managed Care Organization Agreement;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Disqualification from future participation in the Maryland Medicaid Managed Care Program;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Orders to provide a benefit or service to enrollees; and</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Those outlined in 42 CFR §§438.700—438.708, as amended.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Corrective Action.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The MCO shall submit a corrective action plan within a time frame specified by the Department.</text>
    </paragraph>
  </paragraph>
</regulation>