1. 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. (1) Fines;
   2. (2) Suspension of further enrollment;
   3. (3) Withholding all or part of the capitation payment;
   4. (4) Termination of the current HealthChoice Managed Care Organization Agreement;
   5. (5) Disqualification from future participation in the Maryland Medicaid Managed Care Program;
   6. (6) Orders to provide a benefit or service to enrollees; and
   7. (7) Those outlined in 42 CFR §§438.700—438.708, as amended.

2. B. Corrective Action.

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

Authority: Health-General Article, §15-103(b)(9), Annotated Code of Maryland

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 permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .01C repealed effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .01-1 adopted as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); adopted permanently effective November 10, 2003 (30:22 Md. R. 1580)

Regulation .02 repealed and new Regulation .02 adopted effective December 31, 2018 (45:26 Md. R. 1244)

Regulation .03 adopted effective February 18, 2002 (29:3 Md. R. 220)

Regulation .03C amended as an emergency provision effective July 1, 2003 (30:21 Md. R. 1527); amended permanently effective November 10, 2003 (30:22 Md. R. 1580)

Chapter transferred from COMAR 10.09.73 effective November 1, 2019 (46:22 Md. R. 977)

Regulation .02B amended effective April 28, 2025 (52:8 Md. R. 359)