Sanctions for Noncompliance with the Restricted Recipient Program (RRP). The MCO will administer and comply with the RRP’s rules and policies. The MCO will exercise due diligence to assure that temporary changes in provider designation are only made in appropriate circumstances. (1) The STATE may impose a sanction of up to $5,000 per Enrollee per occurrence (date of service) for inappropriate payments to non-designated providers and failure to enter appropriate designations into the MMIS system. Prior to imposing the sanction, the STATE will notify the MCO of the payments to non-designated providers. (2) The MCO will have ten (10) business days to explain the reasoning for the payments. If after reviewing the MCO’s explanations, the STATE confirms the payments are inappropriate, the MCO will be held in breach with an opportunity to cure. (3) If the cure does not rectify noncompliance, including action to prevent repeated breaches, then the $5,000 per Enrollee per occurrence will be imposed.
Appears in 3 contracts
Samples: Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services, Contract for Minnesota Senior Health Options and Minnesota Senior Care Plus Services, Contract for Medical Assistance and Minnesotacare Services
Sanctions for Noncompliance with the Restricted Recipient Program (RRP). The MCO will administer and comply with the RRP’s rules and policies. The MCO will exercise due diligence to assure that temporary changes in provider designation are only made in appropriate circumstances.
(1) The STATE may impose a sanction of up to $5,000 per Enrollee per occurrence (date of service) for inappropriate payments to non-designated providers and failure to enter appropriate designations into the MMIS system. Prior to imposing the sanction, the STATE will notify the MCO of the payments to non-designated providers.
(2) The MCO will have ten (10) business days to explain the reasoning for the payments. If after reviewing the MCO’s explanations, the STATE confirms the payments are inappropriate, the MCO will be held in breach with an opportunity to cure.
(3) If the cure does not rectify noncompliance, including action to prevent repeated breaches, then the $5,000 per Enrollee per occurrence will be imposed.imposed.
Appears in 1 contract
Samples: Contract for Special Needs Basiccare Program Services
