Managed Care Organization Sanctions

The contracts HHSC has with managed care organizations include standards for service delivery. If those standards are not met, HHSC is required by statute (Senate Bill 1188, Texas Legislature, 79th Regular Session, 2005) to impose sanctions. Sanctions include the assessment or imposition of any or all of the following contract remedies:

• Liquidated damages.
• Consequential damages.
• Corrective action plan.
• Debarment.
• Involuntary suspension of a contract or portion of a contract.
• Involuntary termination of a contract or portion of a contract.
• Any other remedy intended to correct deficient activities or contract non-compliance.

For the purposes of this report, a sanction does not include:

• A vendor hold or similar temporary delay in payment.
• An agreed temporary remedial measure intended to facilitate contract compliance.

The sanction will remain posted for one year from the date posted, or from the date of completion of the contract remedy, whichever is later.  Sanctions are posted monthly, and shall contain the following information:

• Name and address of the managed care organization.
• Issue of noncompliance.
• Noncompliance determination date.
• Sanction imposition date.
• Internet posting date.
• Noncompliance correction date.
• Maximum sanction allowable.
• Actual sanction imposed.

Managed Care Organization Sanctions

Aetna

Amerigroup Texas, Inc.

Bravo

Community First

Community Health Choice, Inc.

Cook Children’s Health Plan

Delta Dental

Driscoll Health Plan

Evercare of Texas

Evercare Integrated Care Management

HealthSpring

Mercy Health Plans of Missouri

Molina Healthcare of Texas

Molina (CHIP RSA)

Parkland Community Health Plan

Seton

Superior (CHIP RSA)

Superior EPO

Superior HealthPlan

Superior STAR Health

Texas Children’s Health Plan

Unicare Health Plans of Texas

United Healthcare