Mandatory Sanction Clause Samples
Mandatory Sanction. Failure of the contractor to achieve the minimum screening rate shall require the following refund of capitation paid:
i. Achievement of a 50 percent to less than 60 percent EPSDT screening, dental visit and immunization rate (the lowest measured rate of each of the components of EPSDT screening, i.e., periodic exam, immunization rate, and dental screening rate, shall be considered to be the rate for EPSDT participation and the basis for the sanction): refund of $1 per enrollee for all enrollees under age 21 not screened.
ii. Achievement of a 40 percent to less than 50 percent EPSDT screening, dental visit, and immunization rate: refund of $2 per enrollee for all enrollees under age 21 not screened.
iii. Achievement of a 30 percent to less than 40 percent EPSDT screening, dental visit and immunization rate: refund of $3 per enrollee for all enrollees under age 21 not screened.
iv. Achievement of less than 30 percent: refund of $4 per enrollee for all enrollees under age 21 not screened.
Mandatory Sanction. Failure of the contractor to achieve sixty (60) percent screening rate shall require the following refund of capitation paid: i Achievement of a 50 percent to less than 60 percent lead screening rate: refund of $2 per enrollee for all enrollees under age 3 not screened. ii Achievement of a 40 percent to less than 50 percent lead screening rate: refund of $3 per enrollee for all enrollees under age 3 not screened. iii Achievement of a 30 percent to less than 40 percent lead screening rate: refund of $4 per enrollee for all enrollees under age 3 not screened. iv Achievement of less than 30 percent lead screening rate: refund of $5 per enrollee for all enrollees under age 3 not screened.
Mandatory Sanction. Failure of the contractor to achieve an annual improvement rate shall require the following refund of capitation paid:
i. Achievement of a 35 percent to less than 50 percent improvement dental screening rate over the previous year: refund of $1 per enrollee for all enrollees age 3 years to age 21 years who did not receive a dental visit.
ii. Achievement of a 25 percent to less than 35 percent improvement dental visit rate: refund of $2 per enrollee for all enrollees age 3 years to age 21 years who did not receive a dental visit.
iii. Achievement of a 15 percent to less than 25 percent improvement dental visit rate: refund of $3 per enrollee for all enrollees age 3 years to age 21 years who did not receive a dental visit.
iv. Achievement of less than 15 percent: refund of $4 per enrollee for all enrollees age 3 years to age 21 years who did not receive a dental visit.
Mandatory Sanction. Failure of the contractor to achieve sixty (60) percent screening rate shall require the following refund of capitation paid:
Mandatory Sanction. Failure of the contractor to achieve sixty (60) percent screening rate shall require the following refund of capitation paid: ii Achievement of a 40 percent to less than 50 percent lead screening rate: refund of $3 per enrollee for all enrollees under age 3 not screened. iii Achievement of a 30 percent to less than 40 percent lead screening rate: refund of $4 per enrollee for all enrollees under age 3 not screened. iv Achievement of less than 30 percent lead screening rate: refund of $5 per enrollee for all enrollees under age 3 not screened.