Managed Care Organization Sanctions

Texas Government Code §533.0072 requires HHSC to post information regarding contract enforcement actions taken against Medicaid managed care organizations. Enforcement actions include monetary and other forms of remedies, such as:

  • Payment of liquidated damages;
  • Requiring corrective action plans;
  • Suspending all or part of new member enrollments; and
  • Suspending or terminating all or part of the contract.

Enforcement actions are posted quarterly, and contain the following information:

  • Name and address of the managed care organization;
  • A description of the contractual obligation the managed care organization failed to meet;
  • The date of determination of noncompliance;
  • The date the sanction or remedy was imposed;
  • The maximum sanction or remedy that may be imposed under the contract for the violation; and
  • The actual sanction or remedy imposed against the managed care organization.

Managed Care Organization Sanctions

Managed Care Corrective Action Plans

An incentive and disincentive system was created as a response to the Frew v. Smith Corrective Action Order: Managed Care and can be viewed at Medicaid Managed Care Incentives and Disincentives.