Submits contract management reports, Care Management reports, or Quality Improvement Goal reports that are either late or missing a significant amount of information or data; Fails to meet any of the standards for data submission described in this Contract, including accuracy, completeness, timeliness, and other standards for Encounter Data described in Section 2.14 and Appendix E. Sanctions for such failure are further described in Section 6.3.K.5 below; or Fails to comply with any other requirements of this Contract. Such sanctions may include, but are not limited to: Civil money penalties in accordance with 42 CFR 438.704 and Section 6.3.K.4. below; Financial measures EOHHS determines are appropriate to address the violation; The appointment of temporary management to oversee the operation of the Contractor in those circumstances set forth in 42 U.S.C. §1396u-2(e)(2)(B) and 42 CFR 438.706; Notifying the affected Enrollees of their right to disenroll; Suspension of enrollment (including assignment of Enrollees); Suspension of payment to the Contractor for Enrollees enrolled after the effective date of the sanction and until CMS or EOHHS is satisfied that the reason for imposition of the sanction no longer exists and is not likely to recur; Disenrollment of Enrollees; Limitation of the Contractor’s coverage area; Additional sanctions allowed under federal law or state statute or regulation that address areas of noncompliance; and Such other measures as EOHHS determines appropriate to address the violation. For any Contractor responsibilities for which the Contractor utilizes a Material Subcontractor, if EOHHS identifies any deficiency in the Contractor’s performance under the Contract for which the Contractor has not successfully implemented an approved corrective action plan in accordance with Section 6.3.L, EOHHS may:
Submits contract management reports, Care Management reports, or Quality Improvement Goal reports that are either late or missing a significant amount of information or data; Fails to meet any of the standards for data submission described in this Contract, including accuracy, completeness, timeliness, and other standards for Encounter Data described in Section 2.14 and Appendix E. Sanctions for such failure are further described in Section 6.3.K.5 below; or Fails to comply with any other requirements of this Contract. Such sanctions may include, but are not limited to: Civil money penalties in accordance with 42 CFR 438.704 and Section 6.3.K.4. below; Financial measures EOHHS determines are appropriate to address the violation; The appointment of temporary management to oversee the operation of the Contractor in those circumstances set forth in 42 U.S.C. §1396u-2(e)(2)(B) and 42 CFR 438.706; Notifying the affected Enrollees of their right to disenroll; Suspension of enrollment (including assignment of Enrollees); Suspension of payment to the Contractor for Enrollees enrolled after the effective date of the sanction and until CMS or EOHHS is satisfied that the reason for imposition of the sanction no longer exists and is not likely to recur; Disenrollment of Enrollees; Limitation of the Contractor’s coverage area; Additional sanctions allowed under federal law or state statute or regulation that address areas of noncompliance; and Such other measures as EOHHS determines appropriate to address the violation. For any Contractor responsibilities for which the Contractor utilizes a Material Subcontractor, if EOHHS identifies any deficiency in the Contractor’s performance under the Contract for which the Contractor has not successfully implemented an approved corrective action plan in accordance with Section 6.3.L, EOHHS may:
accountable-care-partnership-plan-model-contract.docx