Suspension or freezing new enrollment

AZ | CT | DC | IL | IA | KS | KY | ME | MA | MI | MO | MT | NE | NEBH | NH
NM | NY | ND | OH | OK | OR | PA | RI | TN | TX | VA | WA | WV | WI

"60. SANCTIONS...
In addition to the above remedies, AHCCCSA may, at its option, impose partial or full enrollment caps on the Contractor. Among the contract violations that may result in an enrollment cap are, but are not limited to, the following:
   a. Marketing violations
   b. Failure to meet AHCCCS financial viability standards
   c. Material deficiency in the Contractor’s provider network
   d. Quality of care and quality management issues
   e. Failure to meet AHCCCS encounter standards" Arizona Contract, page 53.

"XII. REMEDIAL ACTIONS…
E. The Executive Director of the Department or designee may exercise the following remedial actions should she/he find the Contractor substantially failed to satisfy the scope of work found in this Contract as determined by the results of monitoring activities or audits described in Section VIII. These remedial actions are as follows: ...
3. Suspend the Enrollment of Clients." Colorado Contract, page 43.

"3.9 Network Adequacy And Maximum Enrollment Levels...
d. In the event the DEPARTMENT deems that the MCO's provider network is not capable of accepting additional enrollments, the DEPARTMENT may exercise its rights under Section 7 of this contract, including but not limited to the rights under Section 7.3 Suspension of New Enrollments…" Connecticut Contract, pages 20-21.

"7. CORRECTIVE ACTION AND CONTRACT TERMINATION...
7.3 Suspension of New Enrollment
Whenever the DEPARTMENT determines that the MCO is out of compliance with this contract, unless corrective action is taken to the satisfaction of the DEPARTMENT, the DEPARTMENT may suspend enrollment of new Members under this contract. The DEPARTMENT, when exercising this option, must notify the MCO in writing of its intent to suspend new enrollment at least 30 days prior to the beginning of the suspension period. The suspension period may be for any length of time specified by the DEPARTMENT, or may be indefinite. The suspension period may extend up to the contract expiration date as provided under PART I. (The DEPARTMENT may also notify existing Members of MCO non-compliance and provide an opportunity to disenroll from the MCO and to re-enroll in another MCO.)

7.4 Sanctions...
b. Class C Sanctions. Sanctions Related to Noncompliance Potentially Resulting In Harm To An Individual Member...
(ii) Class C sanctions for noncompliance with the contract under this subsection include the following: ...
3. freeze on new enrollment and/or alter the current enrollment...

7.6 Emergency Services Denials
If the MCO has a pattern of inappropriately denying payments for emergency related services may be subject to suspension of new enrollments…" Connecticut Contract, pages 81-85.

"2. Voluntary Enrollment and Default Providers...
c. Except as described in paragraph 'd' of this section, each month, Provider shall receive one-seventh of the available automatic assignments made by the District on the fifteenth of each month. The effective date for enrollment for person automatically assigned to Provider is the first day of the month following the month that the automatic assignment was made. Available automatic assignments shall be defined as persons who received appropriate notice under the conditions of the Health Care Financing Administration's approval of the District's Medicaid Managed Care Program, and failed to make a voluntary selection.

d. The District reserves the right to adjust the rate of automatic assignments set forth in paragraph 'c' of this section if Provider fails to comply with terms of this contract." District of Columbia Contract, page 16.

"ARTICLE XI - SANCTIONS FOR NON COMPLIANCE
A. In addition to its rights under the Default Clause of the Standard Contract Provisions, if the District determines that Provider has failed to comply with terms of this contract or had violated applicable federal of District law or regulation, the District may after written notice of intent to Provider: ...
2. freeze enrollment.." District of Columbia Contract, page 39.

"(j) Sanctions
Sanctions, which may include termination under Article VIII of this Contract, shall be imposed by the Department for failure of the Contractor to substantially comply with the terms of this Contract as set forth in this Section and, as applicable, Section 1932(e) of the Social Security Act. The noncompliant conduct and the sanctions for such conduct are set forth herein. Upon such determination by the Department of the Contractor's substantial noncompliance or failures, the Department shall, within its discretion and in addition to any other monetary sanctions, demand immediate payment of the sanction, suspend or limit Enrollment...

(B) Marketing Failures. All Marketing shall be monitored by the Department. Should the Department determine that any of the following have occurred, the sanctions identified for such Marketing failures shall be immediately imposed...
(iii) Where the Department determines a pattern of Marketing failures, the Department shall immediately suspend Enrollment of Eligible Enrollees into the Contractor's Plan...

(C) Discrimination related to Pre-Existing Conditions... Enrollment with the Contractor shall be suspended by the Department for a pattern of conduct which is discriminatory by the Contractor or its personnel...

(E) Failure to Meet Access to Care Standards... For any days thereafter that the ratio continues to fall below requirement, the Department shall freeze Enrollment..." Illinois HMO Contract, pages 68, 71-73.

"10.2 Suspension of Enrollment
If the Department determines that the HMO is out of compliance with this Contract, the Department shall notify the HMO in writing of such non compliance. The HMO shall have 60 days after such notice to cure its non compliance. If the HMO fails to cure its noncompliance within the specified time frame, the Department may suspend enrollment of new Enrollees and reserves the right to allow previously enrolled Enrollees to enroll in another Managed Care Entity until the HMO cures its non compliance. Exercising either or both of these options shall not act as an implied waiver of the Department's right to terminate this Contract in accordance with Article 10.4 and 10.5, withhold capitation payment in accordance with Article 10.3, or to pursue any other remedy available to the Department under this Contract." Iowa Contract, page 53.

"2. PENALTY OPTIONS...
b. Enrollment suspensions: Suspension of new beneficiary enrollments as specified in VIII, C...

C. SUSPENSION OF NEW ENROLLMENT
Whenever SRS determines that the HMO is out of compliance with this contract, SRS may suspend enrollment of new members under this contract. SRS, when exercising this option, must notify the HMO in writing of its intent to suspend new enrollment at least 30 days prior to the beginning of the suspension period. The suspension period may be for any length of time specified by SRS, or may be indefinite. The suspension period may extend up to the contract expiration date as provided under Section I. (SRS may also notify existing members of HMO non-compliance and provide an opportunity to disenroll from the HMO or to re-enroll in another HMO)." Kansas Contract, pages 70-72.

"XII. REMEDIES FOR VIOLATION, BREACH, OR NONPERFORMANCE OF CONTRACT...
B. Notice of Contractor Breach
If the Contractor fails to cure a default in accordance with a plan of correction under Section A, the Department shall issue a written notice to the Contractor indicating the violation(s) and advising the Contractor that failure to cure the violation(s) within a defined time period not less than thirty (30) days, to the satisfaction of the Department, may lead to the imposition of any sanction or combination of sanctions provided by the terms of this contract, or otherwise provided by law, including but not limited to the following:
(a) Suspension of further enrollment for a defined time period...

D. Intermediate Sanction and Civil Money Penalties
In the event the Contractor fails to comply with the terms and conditions of 42 United States Code Section 1396b(m) , the Department may do any of the following: ...
• Suspend default enrollment…" Kentucky Contract, pages 40-42.

"VI. REMEDIES, PENALTIES, AND CORRECTIVE ACTION...
B. SUSPENSION OF NEW ENROLLMENT
1. Out of Compliance. The Department may suspend the Contractor's right to enroll new participants under this Contract if the Department determines the Contractor is out of compliance with this Contract...

2. Enrollment Level. The Department may also suspend new enrollment or disenroll recipients if it believes that the Contractor is or will be unable to comply with federal or state law at its current enrollment level...The Department may also notify Enrollees of the Contractor's non-compliance and provide Enrollees with an opportunity to enroll in another HMO...

C. DEPARTMENTAL INITIATED DISENROLLMENT
Upon at least thirty (30) days written notice, the Department may reduce the Contractor's maximum enrollment level and/or number of current Enrollees whenever it determines that the Contractor has failed (i) to provide one or more of the Contract services required, or (ii) to maintain or make available any records or reports required under this Contract...

E. INAPPROPRIATE PAYMENT DENIALS
If the Department determines that the Contractor has demonstrated a pattern of inappropriately denying payments for services, the Department may suspend new enrollments...or take any other actions against the Contractor available at law or in equity." Maine Contract, pages 51-52.

"SECTION 5.3 General Terms and Conditions...
K. Intermediate Sanctions...
2. Such sanctions may include: ...
c. Suspension of enrollment (including assignment of Enrollees)…" Massachusetts Contract, pages 126-129.

"II-S MARKETING...
3. Marketing Materials...
DCH may impose… restricted enrollment penalties should the contractor or any of its subcontractors or providers be found to use marketing materials which have not been approved in writing by DCH or engage in prohibited marketing practices. DCH reserves the right to suspend all enrollment of new Enrollees into the Contractor's plan. Such suspensions may be imposed for a period of sixty (60) days from notification of the violation by DCH to the Contractor." Michigan Contract, pages 46-47.

"II-W CONTRACT REMEDIES
The State will utilize a variety of means to assure compliance with Contract requirements…If remedial action or improvement plans are not appropriate or are not successful, Contract remedies including, but not limited to, enrollment freezes…" Michigan Contract, page 54.

"2.3 Payments to providers
If the state agency determines that the health plan is noncompliant with the conditions below, the health plan may be subject to suspension of new enrollments…" Missouri RFP, page 29.

"2.3.5 Inappropriate Payment Denials: Health plans that have a pattern of inappropriately denying payments for services may be subject to suspension of new enrollments…" Missouri RFP, page 30.

"2.26.3 Suspension of New Enrollment: Whenever the State determines that the health plan is out of compliance with this contract, the State may suspend the health plan's right to enroll new members under this contract…

2.26.5 The State may reduce the maximum enrollment level or number of current members or halt future enrollment whenever the State determines that the health plan failed to provide one or more of the contract services required under the contract or that the health plan failed to maintain or make available any records or reports required under the contract which the State needs to determine whether the health plan is providing contract services as required." Missouri RFP, pages 94-95.

"SECTION 7 INTERMEDIATE SANCTIONS FOR FAILURE TO PERFORM...
B. Intermediate sanctions include the following:
1. Suspend enrollment of new ENROLLEES in the CONTRACTOR'S plan, notify existing ENROLLEES of the CONTRACTOR of noncompliance and provide an opportunity to disenroll from the CONTRACTOR'S plan or disenroll any or all ENROLLEES. The suspension period may be for any length of time specified by the DEPARTMENT, or may be indefinite. The suspension period may extend up to the contract expiration date as provided under Section 3. The DEPARTMENT shall rescind such suspension if and when the CONTRACTOR cures the default for which the suspension was imposed. The CONTRACTOR may notify RECIPIENTS they may call the ADMINISTRATIVE CONTRACTOR FOR MANAGED CARE to re-enroll with the CONTRACTOR once the CONTRACTOR cures the default." Montana Contract, page 6.

"8.23.5 Intermediate Sanctions: Whenever the Department determines that the plan is substantially and materially out of compliance with the contract provisions, the Department may take any or all of the following actions:
(a) Suspend enrollment…" Nebraska Contract, page 21.

NEBH

"8.23.5 Intermediate Sanctions: Whenever the Department determines that the PHP is substantially and materially out of compliance with any contract provisions, the Department may take any or all of the following actions: ...
(a) Suspend enrollment…" Nebraska Behavioral Health Contract, page 21.

"13.14 Corrective Action: ...
13.14.2 Final Actions by the QAC: The QAC is responsible for communicating a summary of the case, findings and corrective action recommended to the Department’s contract manager for any additional action. The QAC can recommend/initiate the following actions: ...
(f) Plan/provider be closed to new members…" Nebraska Behavioral Health Contract, page 95.

"Article VIII
Corrective Action Plans and Sanctions

8.1 If the Contractor fails to fulfill its duties and obligations under this Agreement. the State may impose any of the following: ...

8.2 Suspension of further enrollments except newborns, case additions and auto-reenrollments." New Hampshire General Service Agreement, page 33.

"ARTICLE 9/ENFORCEMENT
9.A HSD SANCTIONS
If HSD determines, after notice and opportunity by CONTRACTOR to be heard in accordance with Article 16, that the CONTRACTOR or any agent or employee of the CONTRACTOR, or any persons with an ownership interest in the CONTRACTOR, or related party of the CONTRACTOR has failed to comply with any applicable law, regulation, term of the Agreement, policy, standard, rule or for other good cause, HSD may impose any or all of the following in accordance with applicable law. Unless otherwise required by law, the level or extent of sanctions shall be based on the frequency or pattern of conduct, or the severity or degree of harm posed to (or incurred by) members, or to the integrity of the Medicaid program...

9.A.4 Adjustment of automatic assignment formula. HSD may selectively assign clients who have not selected an MCO to an alternative MCO in response to CONTRACTOR's failure to fulfill its duties;
9.A.5 Suspension of new enrollment. HSD may suspend new enrollment to the CONTRACTOR." New Mexico Contract, page 77.

"3. COMPENSATION...
3.12 Enrollment Limitations
b) LDSS shall have the right, upon consultation with and notice to the SDOH, to limit, suspend, or terminate enrollment activities by the Contractor and/or enrollment into the Contractor's plan upon ten (10) days written notice to the Contractor, specifying the actions contemplated and the reason(s) for such action(s)…" New York Contract, pages 3-1-3-5.

"11. MARKETING...
11.4 Marketing Infractions
Infractions of the Marketing Guidelines may result in the following actions being taken by the LDSS to protect the interests of the program and its clients. These actions shall be taken at the sole discretion of the LDSS...
d) If the MCO commits further infractions, fails to pay liquidated damages within the specified timeframe, fails to implement a corrective action plan in a timely manner or commits an egregious first-time infraction, the LDSS may: ...
ii) suspend new enrollments, other than newborns, for a period up to the remainder of the contract…" New York Contract, pages 11-1-11-2.

"6 WITHHOLDING OF PAYMENT FOR FAILURE TO PERFORM
A. In the event the Contractor fails to perform in accordance with the requirements of this contract, and such failure shall not be cured within 30 days after written notice thereof is given by the Department to the Contractor, then the Department may, at its election:
(1) Suspend enrollment of new enrollees in the Contractor's plan or notify existing enrollees of the Contractor of noncompliance and provide an opportunity to disenroll from the Contractor's plan. The suspension period may be for any length of time specified by the Department, or may be indefinite. The suspension period may extend up to the contract expiration date as provided under Section 3. The Department shall rescind such suspension if and when the Contractor cures the default for which the suspension was imposed." North Dakota Contract, pages 4-5.

"PROVIDER AGREEMENT
APPENDIX E
COMPLIANCE ASSESSMENT SYSTEM

BACKGROUND
The Bureau of managed Health Care (BMHC) currently has the ability to request 'corrective action plans' and implement sanctions for MCP failures to meet program requirements. This ability can include enrollment freezes...

REMEDIES
Progressive remedies will be based on the number of points accumulated at the time of the most recent incident...
20-29 Points/CAP + $5000 fine + 1 month enrollment freeze in all counties where any violation(s) have occurred during the accumulation period.
30-39 Points/CAP + $10,000 fine + 2 month enrollment freeze in all counties where any violation(s) have occurred during the accumulation period.
40-59 Points/CAP + $15,000 fine + 3 months enrollment freeze in all counties of enrollment.

ODHS may freeze an MCP's new enrollment in one or more counties if:
(1) the MCP has accumulated a total of 20 or more points during the accrual period;
(2) the MCP fails to fully implement a CAP within the designated time frame; or (3) if circumstances exist which potentially jeopardize the MCP's enrollees' access to care." Ohio RFP, Provider Agreement Appendix E, pages 1-5.

"5101:3-26-10 MANAGED CARE PLAN: CORRECTIVE ACTION PLANS (CAPS), SANCTIONS AND PROVIDER AGREEMENT ACTIONS.
(A) IF THE MCP FAILS TO FULFILL ITS DUTIES AND OBLIGATIONS UNDER CHAPTER 5101:3-26 OF THE ADMINISTRATIVE CODE AND/OR THE MCP PROVIDER AGREEMENT, ODHS MAY IMPOSE ANY OF THE FOLLOWING REMEDIES IN ADDITION TO OR INSTEAD OF ANY REMEDIES SPECIFIED IN THE PROVIDER AGREEMENT: ...
(2) SUSPENSION OF FURTHER ENROLLMENTS EXCEPT NEWBORNS, CASE ADDITIONS AND AUTO-REENROLLMENTS." Ohio RFP, Appendix E, OAC 5101:3-26-10, page 1.

"3.7 Performance Standards and Damages...
3.7.2 Suspension of New Enrollment
Whenever the Authority determines that Health Plan is failing to meet the performance standards described in Section 3.7.1, it may suspend Health Plan's right to enroll new SoonerCare Plus members…The suspension period may be for any length of time specified by the Authority, or may be indefinite...

3.7.4 Damages and Sanctions...
3.7.4.1 Non-Compliance with Participation Standards...
In addition to or instead of the financial penalties described herein, the Authority, upon a finding of non-compliance with SoonerCare Plus performance standards, may halt the enrollment of SoonerCare Plus members into Health Plan, either in whole or in part, at its discretion…" Oklahoma RFP, pages 86-87.

"C. Intermediate sanctions may include the following, but the use of one sanction by OMAP does not preclude the implementation of any other sanction(s) for the same deficiencies. OMAP may: ...
6. Suspend enrollment or reduce the maximum enrollment level and/or the number of Contractor's current enrollees…" Oregon Contract, pages 23-24.

"6. Insolvency Protection...
If the HMO fails to comply with the requirements of this section, the Department may take any or all of the following actions: ...
• Suspend some or all enrollment of recipients into the HMO…" Pennsylvania RFP, pages 97-98.

"E. PERFORMANCE STANDARDS AND DAMAGES...
2. Sanctions and Penalties...
Sanctions and Penalties may be imposed by the Department in a variety of ways to include but not limited to:
• Limiting the HMO's right to enroll new MA recipients…" Pennsylvania RFP, page 109.

"3.07.02 Suspension Of New Enrollment
Whenever the State determines that Contractor is in material breach of the performance standards described in Section 3.07.01, it may suspend Contractor's right to enroll new RIte Care members. The State, when exercising this option, shall notify Contractor in writing of its intent to suspend new enrollment. The suspension period may be for a reasonable length of time specified by the State, depending on the severity and circumstances of the breach. The State also may notify enrollees of Contractor non-performance and permit these enrollees transition to another Health Plan." Rhode Island RFP, page 68.

"2-5. Marketing...
Failure to comply with the marketing limitations contained in this Agreement may result in the imposition by TENNCARE of one or more of the following sanctions which shall remain in effect until such time as the deficiency is corrected: ...
2. Refusal of TENNCARE to accept new enrollments for a period specified by TENNCARE…" Tennessee Contract, pages 32-33.

"2-17. Changes Resulting From Monitoring and Audit
TENNCARE reserves the right to suspend enrollment in the plan if it is determined that quality of care is inadequate…" Tennessee Contract, page 56.

"16.3 DEFAULT BY HMO
16.3.1 FAILURE TO PERFORM AN ADMINISTRATIVE FUNCTION
Failure of HMO to perform an administrative function is a default under this contract. Administrative functions are any requirements under this contract that are not direct delivery of health care services, including claims payment; encounter data submission; filing any report when due...

16.3.1.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to perform an administrative function under this contract, TDH may: ...
• Suspend new enrollment as set out in Article 18.3...

16.3.2 ADVERSE ACTION AGAINST HMO BY TDI
Termination or suspension of HMO’s TDI Certificate of Authority or any adverse action taken by TDI that TDH determines will affect the ability of HMO to provide health care services to Members is a default under this contract.
16.3.2.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For an adverse action against HMO by TDI, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.3 INSOLVENCY
Failure of HMO to comply with state and federal solvency standards or incapacity of HMO to meet its financial obligations as they come due is a default under this contract.
16.3.3.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s insolvency, TDH may: ...
• Suspend new enrollment as set out in Article 18.3...

16.3.5 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to comply with federal laws and regulations, TDH may:
• Suspend new enrollment as set out in Article 18.3...
• Suspend or default all enrollment of individuals...

16.3.6 FAILURE TO COMPLY WITH APPLICABLE STATE LAW..
16.3.6.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to comply with applicable state law, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.7 MISREPRESENTATION OR FRAUD UNDER ARTICLE 4.8
HMO’s misrepresentation or fraud under Article 4.8 of this contract is a default under this contract.
16.3.7.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s misrepresentation or fraud under Article 4.8, TDH may: ...
• Suspend new enrollment as set out in Article 18.3...

16.3.8 EXCLUSION FROM PARTICIPATION IN MEDICARE OR MEDICAID...
16.3.8.3 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s exclusion from Medicare or Medicaid, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.9 FAILURE TO MAKE PAYMENTS TO NETWORK PROVIDERS AND SUBCONTRACTORS
HMO’s failure to make timely and appropriate payments to network providers and subcontractors is a default under this contract...
16.3.9.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to make timely and appropriate payments to network providers and subcontractors, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.10 FAILURE TO TIMELY ADJUDICATE CLAIMS
Failure of HMO to adjudicate (paid, denied, or external pended) at least ninety (90%) of all claims within thirty (30) days of receipt and ninety-nine percent (99%) of all claims within ninety days of receipt for the contract year is a default under this contract.
16.3.10.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT
For HMO’s failure to timely adjudicate claims, TDH may: ...
• Suspend new enrollment as set out in Article 18.3...

16.3.11 FAILURE TO DEMONSTRATE THE ABILITY TO PERFORM CONTRACT FUNCTIONS
Failure to pass any of the mandatory system or delivery functions of the Readiness Review required in Article I of this contract is a default under the contract.
16.3.11.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to demonstrate the ability to perform contract functions, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.12 FAILURE TO MONITOR AND/OR SUPERVISE ACTIVITIES OF CONTRACTORS OR NETWORK PROVIDERS...
16.3.12.4 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s failure to monitor and/or supervise activities of contractors or network providers, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.13 PLACING THE HEALTH AND SAFETY OF MEMBERS IN JEOPARDY
HMO’s placing the health and safety of the Members in jeopardy is a default under this contract.
16.3.13.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT...
For HMO’s placing the health and safety of Members in jeopardy, TDH may:
• Suspend new enrollment as set out in Article 18.3...

16.3.14 FAILURE TO MEET ESTABLISHED BENCHMARK
Failure of HMO to meet any benchmark established by TDH under this contract is a default under this contract.
16.3.14.1 REMEDIES AVAILABLE TO TDH FOR THIS HMO DEFAULT
For HMO’s failure to meet any benchmark established by TDH under this contract, TDH may:
• Suspend new enrollment as set out in Article 18.3…" Texas Contract, pages 121-128.

"18.3 SUSPENSION OF NEW ENROLLMENT
18.3.1 TDH must give HMO 30 days notice of intent to suspend new enrollment in the Notice of Default other than for default for fraud and abuse or imminent danger to the health or safety of Members. The suspension date will be calculated as 30 days following the date that HMO receives the Notice of Default.

18.3.2 TDH may immediately suspend new enrollment into HMO for a default declared as a result of fraud and abuse or imminent danger to the health and safety of Members.

18.3.3 The suspension of new enrollment may be for any duration, up to the termination date of the contract. TDH will base the duration of the suspension upon the type and severity of the default and HMO’s ability, if any, to cure the default." Texas Contract, page 132.

"C. REMEDIES AVAILABLE TO THE DEPARTMENT...

(b) the State may suspend or default all enrollment of Medicaid/CMSIP beneficiaries after the date the Secretary of Health and Human Services or the State notifies the entity of a violation determination under section 1903(m) or Section 1932(e) or the Act...

b. Other Specified Remedies
If the Department determines that the Contractor failed to provide one (1) or more of the contract services require under the contract, or that the Contractor failed to maintain or make available any records or reports required under the Contract by the Department which the Department may use to determine whether the Contractor is providing contract services as required, the following remedies may be imposed.

i. Suspensions of New Enrollment
The Department may suspend the Contractor's right to enroll new Medicaid/CMSIP participants (voluntary, automatically assigned, or both) under this Contract. The Department may make this remedy applicable to specific populations served by the Contractor or the entire contracted area… The Department may also suspend new Medicaid/CMSIP enrollment or disenroll Medicaid/CMSIP recipients in anticipation of the Contractor not being able to comply with any requirements of this Contract or with federal or State laws or relations at its current enrollment level. Such suspension shall not be subject to the thirty (30) calendar day notification requirement…" Virginia Contract, pages 97-100.

"6.7 Intermediate Sanctions: DSHS may impose intermediate sanctions rather than terminate the agreement. Intermediate sanctions shall include… withholding assignment to the Contractor of clients who have not exercised their right to a voluntary choice of plans for such period of time as DSHS deems appropriate given the nature and severity of the default." Washington Contract, page 24.

"6.2 Sanctions
Sanctions as specified in the Medicaid Program Proposed Rule (63 FR 52074), 42 CFR 438 Subpart I may be imposed at the Department's or HCFA's recommendation. Additional sanctions that may be imposed include the following: ...
* suspension of further enrollments, except newborns and auto-reenrollments...

6.4 Suspension of New Enrollment
Whenever the Department determines that the Managed Care Plan is out of compliance with this contract, the Department may suspend enrollment of new enrollees under this contract. The Department, when exercising this option, must notify the Managed Care Plan in writing of its intent to suspend new enrollment at least ten (10) working days prior to the beginning of the suspension period. The suspension period may be for any length of time specified by the Department, or may be indefinite. The suspension period may extend up to the contract expiration date as provided under ARTICLE I. (The Department may also notify existing enrollees of the Managed Care Plan non-compliance and provide an opportunity to disenroll from the Managed Care Plan and to re-enroll in another Managed Care Plan." West Virginia Contract, pages 40-41.

"6.16 SANCTIONS
If the MCP fails to fulfill its duties and obligations as specified in this RFA, DHHR may impose any of the following: ...
2. Suspension of further enrollments except newborns and auto-re-enrollments…" West Virginia RFA, page 68.

"DHHR Marketing Guidelines...
A. Forbidden Activities...

DHHR may take corrective action against health plans for any violation of these guidelines, even in situations where the plan's provider (or a third party) directly conducts the forbidden activities. Corrective action could include any or all of the following steps: ...
* 'freezing' new enrollment into the plan, either on a plan-wide basis or for those PCP sites that are violating the program's marketing guidelines…" West Virginia RFA, Appendix D, pages D1-D2.

"IX. REMEDIES FOR VIOLATION, BREACH, OR NON-PERFORMANCE OF CONTRACT
A. SUSPENSION OF NEW ENROLLMENT - Whenever the Department determines that the HMO is out of compliance with this Contract, the Department may suspend the HMO's right to receive new enrollment under this Contract. The Department, when exercising this option, must notify the HMO in writing of its intent to suspend new enrollment at least 30 days prior to the beginning of the suspension period. The suspension will take effect if the non-compliance remains uncorrected at the end of this period. The Department may suspend new enrollment sooner than the time period specified in this paragraph if the Department finds that enrollee health or welfare is jeopardized. The suspension period may be for any length of time specified by the Department, or may be indefinite. The suspension period may extend up to the expiration of the Contract as provided under Article XV...

C. OTHER ENROLLMENT REDUCTIONS - The Department may also suspend new enrollment or disenroll recipients in anticipation of the HMO not being able to comply with federal or state law at its current enrollment level. Such suspension shall not be subject to the 30 day notification requirement...

E. INAPPROPRIATE PAYMENT DENIALS - HMOs that inappropriately fail to provide or deny payments for services may be subject to suspension of new enrollments... as determined by the Department. The Department will select among these sanctions based upon the nature of the services in question, whether the failure or denial was an isolated instance or a repeated pattern or practice, and whether the health of a recipient was injured, threatened or jeopardized by the failure or denial…" Wisconsin Contract, pages 61, 63.