Corrective and Remedial Actions. a) If the Contractor’s Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s approved Marketing plan, the SDOH and/or the DOHMH, may take the actions described in (i), (ii) and (iii) below to protect the interests of Enrollees and the integrity of the Program. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes. i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s approved Marketing plan, and the SDOH and/or the DOHMH deem the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH may issue a warning letter to the Contractor. ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s approved Marketing plan, or a pattern of minor breaches, SDOH and/or the DOHMH may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law. iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, in consultation with the SDOH, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity: A) Direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period; B) Suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or C) Terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
Appears in 2 contracts
Samples: Hiv Special Needs Plan Model Contract, Hiv Special Needs Plan Model Contract
Corrective and Remedial Actions. a) If the Contractor’s Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s approved Marketing plan, the SDOH and/or SDOH, in consultation with the DOHMHLDSS, may take any of the following actions described as it, in (i)its sole discretion, (ii) and (iii) below deems necessary to protect the interests of Enrollees and the integrity of the ProgramMMC Programs. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes.
i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s approved Marketing plan, and the SDOH and/or SDOH, in consultation with the DOHMH deem LDSS, deems the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH LDSS may issue a warning letter to the Contractor.
ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its it sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s approved Marketing plan, or a pattern of minor breaches, SDOH and/or SDOH, in consultation with the DOHMH LDSS, may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law.
iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, in consultation with the SDOHLDSS, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity:
A) Direct direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period;
B) Suspend suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or
C) Terminate terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
b) The corrective and remedial actions described in Section 11.5 a) apply to violations of the reporting requirements in Section 18.5 a) ix).
Appears in 1 contract
Samples: Primary Care Partial Capitation Provider (Pcpcp) Medicaid Managed Care Model Contract
Corrective and Remedial Actions. a) If the Contractor’s 's Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s 's approved Marketing plan, the SDOH and/or the DOHMH, may take the actions described in (i), (ii) and (iii) below to protect the interests of Enrollees and the integrity of the ProgramMMC and FHPlus Programs. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes.
i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s 's approved Marketing plan, and the SDOH and/or the DOHMH deem the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH may issue a warning letter to the Contractor.
ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its it sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s 's approved Marketing plan, or a pattern of minor breaches, SDOH and/or the DOHMH may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law.
iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, in consultation with the SDOH, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity:
A) Direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period;
B) Suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or
C) Terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
Appears in 1 contract
Corrective and Remedial Actions. a) If the Contractor’s 's Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s 's approved Marketing plan, the SDOH and/or SDOH, in consultation with the DOHMHLDSS, may take any of the following actions described as it, in (i)its sole discretion, (ii) and (iii) below deems necessary to protect the interests of Enrollees and the integrity of the ProgramMMC and FHPlus Programs. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes.
i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s 's approved Marketing plan, and the SDOH and/or SDOH, in consultation with the DOHMH deem LDSS, deems the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH LDSS may issue a warning letter to the Contractor.
ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its it sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s 's approved Marketing plan, or a pattern of minor breaches, SDOH and/or SDOH, in consultation with the DOHMH LDSS, may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law.
iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, in consultation with the SDOHLDSS, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity:
A) Direct direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period;
B) Suspend suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or
C) Terminate terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
b) The corrective and remedial actions described in Section 11.5 a) apply to violations of the reporting requirements in Section 18.5 a) xiii).
2. Amend Section 18.5 "Reporting Requirements" to read as follows:
Appears in 1 contract
Samples: Contract Modification (Wellcare Health Plans, Inc.)
Corrective and Remedial Actions. a) If the Contractor’s 's Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s 's approved Marketing plan, the SDOH and/or the DOHMH, DOHMH may take any of the actions described in (i), (ii) and (iii) below to protect the interests of Enrollees and the integrity of the ProgramMMC and FHPlus Programs. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes.
i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s 's approved Marketing plan, and the SDOH and/or the DOHMH deem the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH may issue a warning letter to the Contractor.
ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s 's approved Marketing plan, or a pattern of minor breaches, SDOH and/or the DOHMH may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law.
iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, DOHMH in consultation with the SDOH, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity:
A) Direct direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period;
B) Suspend suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or
C) Terminate terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
b) The corrective and remedial actions described in Section 11.5 a) apply to violations of the reporting requirements in Section 18.5 a) xiii).
2. Amend Section 18.5 "Reporting Requirements" to read as follows:
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Corrective and Remedial Actions. a) If the Contractor’s 's Marketing activities do not comply with the Marketing Guidelines set forth in Appendix D of this Agreement or the Contractor’s 's approved Marketing plan, the SDOH and/or SDOH, in consultation with the DOHMHLDSS, may take any of the following actions described as it, in (i)its sole discretion, (ii) and (iii) below deems necessary to protect the interests of Enrollees and the integrity of the ProgramMMC and FHPlus Programs. The Contractor shall take the corrective and remedial actions directed by the SDOH and/or the DOHMH within the specified timeframes.
i) If the Contractor or its representative commits a first time infraction of the Marketing Guidelines and/or the Contractor’s 's approved Marketing plan, and the SDOH and/or SDOH, in consultation with the DOHMH deem LDSS, deems the infraction to be minor or unintentional in nature, the SDOH and/or the DOHMH LDSS may issue a warning letter to the Contractor.
ii) If the Contractor engages in Marketing activities that SDOH and/or the DOHMH determines, in its it sole discretion, to be an intentional or serious breach of the Marketing Guidelines or the Contractor’s 's approved Marketing plan, or a pattern of minor breaches, SDOH and/or SDOH, in consultation with the DOHMH LDSS, may require the Contractor to, and the Contractor shall, prepare and implement a corrective action plan acceptable to SDOH and/or DOHMH within a specified timeframe. In addition, or alternatively, SDOH and the DOHMH, in consultation with SDOH, may impose sanctions, including monetary penalties, as permitted by law.
iii) If the Contractor commits further infractions, fails to pay monetary penalties within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the SDOH, or DOHMH, in consultation with the SDOHLDSS, may in addition to any other legal remedy available to SDOH and/or DOHMH in law or equity:
A) Direct direct the Contractor to suspend its Marketing activities for a period up to the end of the Agreement period;
; SECTION 11 (MARKETING) October 1, 2005 B) Suspend suspend new Enrollments, other than newborns, for a period up to the remainder of the Agreement period; or
C) Terminate this Agreement pursuant to termination procedures described in Section 2.7 of this Agreement.
Appears in 1 contract
Samples: Medicaid Managed Care Contract (Wellcare Health Plans, Inc.)