California Code of Regulations (Last Updated: August 6, 2014) |
Title 22. Social Security |
Division 3. Health Care Services |
Subdivision 1. California Medical Assistance Program |
Chapter 4.1. Two-Plan Model Managed Care Program |
Article 6. Operational Requirements |
§ 53872. Civil Penalties.
Latest version.
- (a) The Director may, except as provided in section 53873, impose one or more of the civil penalties specified in (b) upon a plan which fails to comply with the provisions of Article 2.7 of Chapter 7, Part 3, of Division 9 of the Welfare and Institutions Code, the provisions of this Chapter, or the terms of the plan contract.(b) Civil penalties imposed by the Director shall be in the amounts specified below with respect to violation of any provision of:(1) Article 2, excluding section 53862.(A) First violation: $1,000.(B) Second violation: $5,000.(C) Third and each subsequent violation: $10,000.(2) Article 3.(A) First violation: $5,000.(B) Second and each subsequent violation: $10,000.(3) Section 53862.(A) First violation: $1,000, plus $500 per day for each day that the item to be submitted is late, not to exceed $10,000 total for each violation.(B) Second and each subsequent violation: $5,000, plus $500 per day for each day that the item to be submitted is late, not to exceed $10,000 total for each violation.(4) The contract, which is not specifically governed by regulation in this Chapter.(A) First violation: $5,000.(B) Second and each subsequent violation: $10,000.(5) Article 2.7, Chapter 7, Part 3, Division 9 of the Welfare and Institutions Code, which is not specifically addressed by regulations in this Chapter.(A) First violation: $5,000.(B) Second and each subsequent violation: $10,000.(c) The counting of violations for the purposes of this section shall:(1) Be done without regard to contract term.(2) Commence with violations occurring on or after the effective date of this section.(d) Imposition of penalties, under the provisions of subsection (a) shall follow administrative proceedings held in accordance with the provisions of Chapter 5 (commencing with Section 11500), Part 1, Division 3, Title 2, Government Code.(e) The department shall issue a letter of noncompliance to a plan found by the administrative proceedings addressed in subsection (d) to be in violation of any provision of law, regulation or the contract. The letter of noncompliance shall include the violation, sanctions to be imposed and corrective action to be taken within stated time limits. Failure to comply with corrective actions within the time limits given shall be deemed to be subsequent violation for the purposes of subsection (c).HISTORY1. New section filed 7-1-96 as an emergency; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 96, No. 28).2. Repealer of section and Note and new section and Note filed 3-4-97; operative 3-4-97. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 97, No. 10).
Note
Note: Authority cited: Sections 10725, 14105, 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14087.3, 14087.4 and 14304, Welfare and Institutions Code.