<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".11" citation="COMAR 14.35.16.11" title_num="14" subtitle_num="35" chapter_num="16" heading="Qualified Health Plan Denial, Suspension, and Revocation of Certification and Other Remedies.">
  <paragraph num="A.">
    <text>If the Exchange determines that a carrier has failed to comply with this chapter, Insurance Article, Title 31, Annotated Code of Maryland, or any other federal or State laws or regulations applicable to carrier offerings in the Exchange that are not otherwise specified in Insurance Article, §31-115(k), Annotated Code of Maryland, the Exchange may initiate one or more of the following actions against the carrier:</text>
    <paragraph num="(1)">
      <text>Deny certification for participation in the Exchange;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Suspend the carrier’s certification for participation in the Exchange;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Revoke the carrier’s certification for participation in the Exchange; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Another remedy defined under §D of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Subject to the contested case hearing provisions of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland, and the limitations stated in Insurance Article, §31-115(k), Annotated Code of Maryland, the Exchange may deny certification to a health benefit plan, or suspend or revoke the certification of a qualified health plan, based on a finding that the health benefit plan or qualified health plan does not satisfy requirements or has otherwise violated standards for certification that are established under this regulation and interim policies adopted by the Exchange, and not otherwise under the regulatory and enforcement authority of the Commissioner, including requirements and standards related, but not limited, to:</text>
    <paragraph num="(1)">
      <text>Enrollment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Essential community providers;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Complaints and grievances involving the Individual Exchange;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Network adequacy;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Quality;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Transparency;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Race, ethnicity, language, interpreter need, and cultural competency (RELICC);</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Plan service area, including demographics;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Accreditation;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Authorization of the plan’s sponsoring carrier; and</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Fair marketing standards developed jointly by the Individual Exchange and the Commissioner.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Instead of or in addition to denying, suspending, or revoking plan certification, the Exchange may impose other remedies or take other actions, and to the extent not otherwise under the regulatory and enforcement authority of the Commissioner, including:</text>
    <paragraph num="(1)">
      <text>Requiring a corrective action to remedy a violation of or failure to comply with standards for certification; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Imposing a penalty not exceeding $5,000 for each violation of or failure to comply with standards for certification.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>In determining the amount of a penalty under §C of this regulation, the Exchange shall consider:</text>
    <paragraph num="(1)">
      <text>The type, severity, and duration of the violation;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Whether the plan or carrier knew or should have known of the violation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The extent to which the plan or carrier has a history of violations; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Whether the plan or carrier corrected the violation as soon as they knew or should have known of the violation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The penalties available to the Exchange under this regulation shall be in addition to any criminal or civil penalties imposed for fraud or other violation under any other State or federal law.</text>
  </paragraph>
</regulation>