Specific Sanctions Clause Samples
The 'Specific Sanctions' clause defines particular penalties or corrective actions that will be imposed if a party breaches certain terms of the agreement. This clause typically outlines the types of sanctions, such as monetary fines, suspension of services, or other remedial measures, and specifies the circumstances under which they will be enforced. By clearly detailing the consequences of non-compliance, the clause serves to deter breaches and provides a predictable framework for addressing violations, thereby promoting accountability and reducing disputes.
Specific Sanctions. As described in 42 CFR 438.700, the Agency may impose any of the following sanctions against a Health Plan if it determines that a Health Plan has violated any provision of this Contract, or any applicable statutes.
1. Suspension of the Health Plan’s Voluntary Enrollments and participation in the Mandatory Assignment process for Enrollment.
2. Suspension or revocation of payments to the Health Plan for Enrollees during the sanction period.
3. For any nonwillful violation of the Contract, the Agency shall impose a fine, not to exceed $2,500 per Violation. In no event shall such fine exceed an aggregate amount of $10,000 for all nonwillful Violations arising out of the same action.
4. With respect to any knowing and willful violation of the Contract the Agency shall impose a fine upon the Health Plan in an amount not to exceed $20,000 for each such violation. In no event shall such fine exceed an aggregate amount of $100,000 for all knowing and willful violations arising out of the same action.
5. If the Health Plan fails to carry out substantive terms of the Contract or fails to meet applicable requirements in 42 CFR 438.700, the Agency shall terminate the Contract. After the Agency notifies the Health Plan that it intends to terminate the Contract, the Agency shall give the Health Plan's Enrollees written notice of the State's intent to terminate the Contract and allow the Enrollees to disenroll immediately without Cause.
6. The Agency may impose intermediate sanctions in accordance with 42 CFR 438.702, including, but not limited to:
a. Civil monetary penalties in the amounts specified in this contract.
b. Appointment of temporary management for the Health Plan. Rules for temporary management pursuant to 42 CFR 438.706 are as follows:
(1) The State may impose temporary management only if it finds (through on-site survey, Enrollee Grievances, financial audits, or any other means) that:
Specific Sanctions. In accordance with 42 CFR 438.700, the Agency may impose intermediate sanctions against a Health Plan if it determines that a Health Plan has violated any provision of this Contract, or any applicable statutes. The Agency may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.
Specific Sanctions. 1. The Commission may impose any of the following sanctions against the STP if the Commission, in its sole discretion, determines that the STP and/or a Transportation Provider has violated any provision of this Agreement, or any applicable statutes:
a. Suspension or revocation of payments to the STP for Medicaid Beneficiaries during the sanction period;
b. For any nonwillful Violation of the Agreement, the Commission shall impose a fine, not to exceed $2,500 per Violation. In no event shall such fine exceed an aggregate amount of $10,000 for all nonwillful Violations arising out of the same action;
c. With respect to any knowing and willful Violation of the Agreement, the Commission shall impose a fine upon the STP in an amount not to exceed $20,000 for such Violation. In no event shall such fine exceed an aggregate amount of $100,000 for all knowing and willful Violations arising out of the same action;
d. If the STP fails to carry out substantive terms of the Agreement, the Commission shall terminate the Agreement. After the Commission notifies the STP that it intends to terminate the Agreement, the Commission shall give the STP’s Medicaid Beneficiaries written notice of the State’s intent to terminate the Agreement.
e. The Commission may impose intermediate sanctions, including, but not limited to civil monetary penalties in the amounts specified in this Agreement.
f. Suspension of payment for Medicaid Beneficiaries after the effective date of the sanction and until the Commission is satisfied that the reason for imposition of the sanction no longer exists and is not likely to recur; and/or
g. Before imposing any intermediate sanctions, the Commission must give the STP timely notice. This Exhibit defines the limits of compensation to be made to the contractor for the services set forth in Exhibit “A” and the method by which payments shall be made.
Specific Sanctions. 1. In accordance with 42 CFR 438.700, the Agency may impose intermediate sanctions against a Health Plan if it determines that a Health Plan has violated any provision of this Contract, or any applicable statutes. The Agency may base its determinations on findings from onsite surveys, enrollee or other complaints, financial status, or any other source.
2. The Agency determines whether the Health Plan acts or fails to act as follows:
a. Fails substantially to provide medically necessary services the Health Plan is required to provide, under law or its Contract with the Agency, to an enrollee covered under the Contract.
b. Imposes on enrollees’ premiums or charges that exceed the premiums or charges permitted under the Medicaid program.
c. Acts to discriminate among enrollees on the basis of health status or need for health care services. This includes termination of enrollment or refusal to re-enroll a recipient, except as permitted by the Agency, or any practice that would reasonably be expected to discourage enrollment by a recipient whose medical condition or history indicates probable need for substantial future medical services.
d. Misrepresents or falsifies information it furnishes to federal or state officials.
e. Misrepresents or falsifies information it furnishes to an enrollee, potential enrollee, or provider.
f. Fails to comply with the requirements for physician incentive plans.
g. Distributes directly or indirectly through any agent or independent contractor, marketing materials that have not been approved by the Agency or contain false or materially misleading information.
h. Violates any of the other requirements of federal or state law and any implementing regulations. For a violation under this subparagraph, only the sanctions specified in Item D., Intermediate Sanctions, sub-items 3., 4., or 5., may be imposed. HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract
Specific Sanctions. 1. The COUNTY may impose any of the following sanctions against RIDE RIGHT if the COUNTY, in its sole discretion, determines that RIDE RIGHT and/or a transportation provider has violated any provision of this Agreement, or any applicable statutes:
a. Suspension or revocation of payments to RIDE RIGHT for services provided to Medicaid beneficiaries during the sanction period;
b. For any nonwillful violation of the Agreement, the COUNTY shall impose a fine, not to exceed $2,500 per violation. In no event shall such fine exceed an aggregate amount of $10,000 for all nonwillful violations arising out of the same action;
c. With respect to knowingly and willfully violating any aspect of this Agreement, the COUNTY shall impose a fine upon RIDE RIGHT in an amount not to exceed $20,000 for such violation. In no event shall such fine exceed an aggregate amount of $100,000 for all knowing and willful violations arising out of the same action;