Common use of Intermediate Sanctions Clause in Contracts

Intermediate Sanctions. The department may impose intermediate sanctions on the PM (short of termination of this agreement) pursuant to the following: A. The intermediate sanctions that the department may impose under this agreement are the following: 1. Recovery of patient management fees paid 2. A period of probation, subject to a plan of corrective action. B. Intermediate sanctions other than appointment of temporary management may be imposed if the department determines that the PM has acted or failed to act as follows: 1. Has failed substantially to provide medically necessary services that the PM is required to provide, under law or under this agreement, to an enrollee; 2. Has acted to discriminate among enrollees on the basis of their health status or need for health care services, including termination of enrollment (except as permitted under section V E) or any practice that would reasonably be expected to discourage enrollment by members whose medical condition or history indicates probable need for substantial future medical services; 3. Has misrepresented or falsified information furnished to the Centers for Medicare and Medicaid Services or to the department; 4. Has misrepresented or falsified information furnished to an enrollee, potential enrollee, or health care provider; 5. Has distributed, directly or indirectly through any agent or independent contractor, marketing materials that have not been approved by the department or that contain false or materially misleading information; 6. Has otherwise failed to adhere to terms of this agreement, including but not limited to failure to properly notify the department of changes in status or failure to maintain proper records and documentation; or 7. Has violated any of the other requirements of ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ Code sections 1396b(m), 1396d(t)(3), 1396u- 2, or any implementing federal regulations (grounds for sanctions listed in A (5)-(7) only). C. Before imposing any intermediate sanction the department will give the PM written notice that explains the following: 1. The basis and nature of the sanction; and 2. The date the sanction will take effect, which shall be at least ten (10) days following notification. D. The department retains the authority to impose sanctions against the PM under 441 Iowa Admin. Code 79.

Intermediate Sanctions. The department Department may impose intermediate sanctions on the PM (short of termination of this agreement) pursuant to the following: A. The intermediate sanctions that the department Department may impose under this agreement are the following: (1. ) Recovery of patient management fees paid paid (2. ) A period of probation, subject to a plan of corrective action. B. Intermediate sanctions other than appointment of temporary management may be imposed if the department Department determines that the PM has acted or failed to act as follows: (1. Has ) has failed substantially to provide medically necessary services that the PM is required to provide, under law or under this agreement, to an enrollee; (2. Has ) has acted to discriminate among enrollees on the basis of their health status or need for health care services, including termination of enrollment (except as permitted under section V E) or any practice that would reasonably be expected to discourage enrollment by members recipients whose medical condition or history indicates probable need for substantial future medical services; (3. Has ) has misrepresented or falsified information furnished to the Centers for Medicare and & Medicaid Services or to the departmentDepartment; (4. Has ) has misrepresented or falsified information furnished to an enrollee, potential enrollee, or health care provider; (5. Has ) has distributed, directly or indirectly through any agent or independent contractor, marketing materials that have not been approved by the department Department or that contain false or materially misleading information; (6. Has ) has otherwise failed to adhere to terms of this agreement, including but not limited to failure to properly notify the department Department of changes in status or failure to maintain proper records and documentation; or (7. Has ) has violated any of the other requirements of ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ Code sections 1396b(m), 1396d(t)(3), 1396u- 21396u-2, or any implementing federal regulations (grounds for sanctions listed in A (5)-(7) only). C. Before imposing any intermediate sanction the department Department will give the PM written notice that explains the following: (1. The ) the basis and nature of the sanction; and (2. The ) the date the sanction will take effect, which shall be at least ten (10) days following notification. D. The department Department retains the authority to impose sanctions against the PM under 441 Iowa Admin. Code 79.

Intermediate Sanctions. The department may impose intermediate sanctions on the PM (short of termination of this agreement) pursuant to the following: A. The intermediate sanctions that the department may impose under this agreement are the following: 1. Recovery of patient management fees paid 2. A period of probation, subject to a plan of corrective action. B. Intermediate sanctions other than appointment of temporary management may be imposed if the department determines that the PM has acted or failed to act as follows: 1. Has failed substantially to provide medically necessary services that the PM is required to provide, under law or under this agreement, to an enrollee; 2. Has acted to discriminate among enrollees on the basis of their health status or need for health care services, including termination of enrollment (except as permitted under section V E) or any practice that would reasonably be expected to discourage enrollment by members whose medical condition or history indicates probable need for substantial future medical services; 3. Has misrepresented or falsified information furnished to the Centers for Medicare and Medicaid Services or to the department; 4. Has misrepresented or falsified information furnished to an enrollee, potential enrollee, or health care provider; 5. Has distributed, directly or indirectly through any agent or independent contractor, marketing materials that have not been approved by the department or that contain false or materially misleading information; 6. Has otherwise failed to adhere to terms of this agreement, including but not limited to failure to properly notify the department of changes in status or failure to maintain proper records and documentation; or 7. Has violated any of the other requirements of ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ 42 United States Code sections 1396b(m), 1396d(t)(3), 1396u- 21396u-2, or any implementing federal regulations (grounds for sanctions listed in A (5)-(7) only). C. Before imposing any intermediate sanction the department will give the PM written notice that explains the following: 1. The basis and nature of the sanction; and 2. The date the sanction will take effect, which shall be at least ten (10) days following notification. D. The department retains the authority to impose sanctions against the PM under 441 Iowa Admin. Code 79.

Intermediate Sanctions. The department HSD/MAD may impose issue an intermediate sanctions on sanction in the PM (short form of termination administrative order requiring the CONTRACTOR to cease or modify any specified conduct or practice engaged in by it or its employees, subcontractors or agents to fulfill its contractual obligations in the manner specified in the order; to provide any services that have been denied or take steps to provide or arrange for the provision of this agreement) pursuant any services that it has agreed to the following: A. The intermediate sanctions that the department may impose under this agreement are the following: 1. Recovery of patient management fees paid 2. A period of probation, subject or is otherwise obligated to a plan of corrective actionmake available. B. Intermediate i. Basis for imposition of Sanctions: HSD/MAD will impose the foregoing sanctions other than appointment of temporary management may be imposed if the department HSD/MAD determines that the PM has acted CONTRACTOR acts or failed fails to act as follows: 1. Has failed (a) fails substantially to provide medically necessary services and items that the PM CONTRACTOR is required to provide, under law or under this agreementits contract with HSD/MAD, to an enrolleea member covered under the contract; 2. Has acted (b) imposes on members’ premiums or charges that are in excess of the premiums or charges permitted under the Medicaid program; (c) acts to discriminate among enrollees members on the basis of their health status or need for health care services, including . This includes termination of enrollment (or refusal to reenroll a member, except as permitted under section V E) by the Medicaid program, or any practice that would reasonably be expected to discourage enrollment by members whose medical condition or history indicates indicate probable need for substantial future medical services; 3. Has misrepresented (d) intentionally misrepresents or falsified falsifies information furnished that it furnishes to the Centers for Medicare and Medicaid Services HSD/MAD or to the departmentCMS; 4. Has misrepresented (e) intentionally misrepresents or falsified falsifies information furnished that it furnishes to an enrolleea member, potential enrolleemember, or health care provider; 5. Has distributed(f) fails to comply with Federal requirements for physician incentive plans, directly including disclosures; (g) has distributed directly, or becomes aware of material distributed indirectly through any agent or independent contractorsubcontractor, marketing materials that have not been approved by the department HSD/MAD or that contain false or materially misleading information; 6. Has otherwise failed to adhere to terms of this agreement, including but not limited to failure to properly notify the department of changes in status or failure to maintain proper records and documentation; or 7. Has violated any of the other requirements of ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ Code sections 1396b(m), 1396d(t)(3), 1396u- 2, or any implementing federal regulations (grounds for sanctions listed in A (5)-(7) only). C. Before imposing any intermediate sanction the department will give the PM written notice that explains the following: 1. The basis and nature of the sanction; and 2. The date the sanction will take effect, which shall be at least ten (10) days following notification. D. The department retains the authority to impose sanctions against the PM under 441 Iowa Admin. Code 79.

Intermediate Sanctions. The department State may impose issue an intermediate sanctions on sanction in the PM (short form of termination administrative order requiring the CONTRACTOR to cease or modify any specified conduct or practice engaged in by it or its employees, subcontractors or agents to fulfill its contractual obligations in the manner specified in the order; to provide Covered Services that have been denied or take steps to provide or arrange for the provision of this agreement) pursuant any services that it has agreed to the following: A. The intermediate sanctions that the department may impose under this agreement are the following: 1. Recovery of patient management fees paid 2. A period of probation, subject or is otherwise obligated to a plan of corrective actionmake available. B. Intermediate (a) Basis for imposition of sanctions. The State will impose the foregoing sanctions other than appointment of temporary management may be imposed if the department State determines that the PM has acted CONTRACTOR acts or failed fails to act as follows: 1. Has failed (i) fails substantially to provide medically necessary Medically Necessary services and items that the PM CONTRACTOR is required to provide, under law or under this agreementAgreement with the State, to an enrolleea Member; 2. Has acted (ii) imposes on Members’ premiums or charges that are in excess of the premiums or charges permitted under the CLTS program; (iii) acts to discriminate among enrollees Members on the basis of their health status or need for health care services, including . This includes termination of enrollment (or refusal to reenroll a Member, except as permitted under section V E) this Agreement, or any practice that would reasonably be expected to discourage enrollment by members Members whose medical condition or history indicates indicate probable need for substantial future medical services; 3. Has misrepresented (iv) intentionally misrepresents or falsified falsifies information furnished that it furnishes to the Centers for Medicare and Medicaid Services State, or to the departmentCMS; 4. Has misrepresented (v) intentionally misrepresents or falsified falsifies information furnished that it furnishes to an enrolleea Member, potential enrolleeMember, or health care provider; 5. Has distributed(vi) fails to comply with Federal requirements for physician incentive plans, directly including disclosures; (vii) has distributed directly, or becomes aware of and fails to make efforts to correct material distributed indirectly through any agent or independent contractorsubcontractor, marketing materials that have not been approved by the department HSD/MAD or ALTSD or that contain false or materially misleading information; 6. Has otherwise failed to adhere to terms of this agreement, including but not limited to failure to properly notify the department of changes in status or failure to maintain proper records and documentation; or 7. Has violated (viii) fails to perform a material part of this Agreement. (b) The State’s determination of any of the above may be based on findings from onsite reviews; surveys or audits; member or other requirements of ▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇ Code sections 1396b(m), 1396d(t)(3), 1396u- 2, complaints; financial status; or any implementing federal regulations (grounds for sanctions listed in A (5)-(7) only)other source. C. Before imposing any intermediate sanction the department will give the PM written notice that explains the following: 1. (c) The basis and nature of the sanction; and 2. The date the sanction will take effect, which shall be at least ten (10) days following notification. D. The department State retains the authority to impose additional sanctions against the PM under 441 Iowa Admin. Code 79state statutes or state regulations that address areas of noncompliance specified in 42 C.F.R. § 438.700, as well as additional areas of noncompliance.