32.1-137.5 - Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality as
§ 32.1-137.5. Civil penalties; probation; suspension; restriction orprohibition of new enrollments to managed care health insurance planlicensee; revocation or nonrenewal of certificate of quality assurance;appeal process; correction.
A. In accordance with applicable regulations of the Board and in consultationwith the Bureau of Insurance, the Commissioner (i) may impose civilpenalties, which shall not exceed $1,000 per incident of noncompliance, to amaximum of $10,000 for a series of related incidents of noncompliance, (ii)may place a certificate holder on probation, (iii) may temporarily suspend acertificate of quality assurance of a managed care health insurance planlicensee, (iv) may, with the concurrence of the Bureau of Insurance,temporarily restrict or prohibit new enrollments into a managed care healthinsurance plan, or (v) may revoke or not renew a certificate of qualityassurance and certify to the State Corporation Commission that a managed carehealth insurance plan licensee or its managed care health insurance plan isunable to fulfill its obligations to furnish quality health care services asset forth in this article. Fines payable under this section shall be paidinto the Literary Fund.
B. When examination or review or complaint investigation by the Departmentresults in a finding of noncompliance with the provisions of this article orthe regulations of the Board, the managed care health insurance plan licenseeor applicant shall be provided written notice and a report specifying thefindings of noncompliance and providing an opportunity to be heard in nofewer than thirty days by the Commissioner's adjudication officer in aproceeding under § 2.2-4019. A copy of the notice and report shall beprovided to the Bureau of Insurance. Such proceeding shall be separate fromthe regulatory office of the Department that conducted the examination,review, or investigation and shall be closed and confidential. The records ofthe proceedings shall be privileged and confidential and shall not be subjectto subpoena.
The adjudication officer shall provide a recommendation to the Commissioner,including findings of fact, conclusions, and appropriate disciplinary actionor sanction. The Commissioner shall promptly notify the Bureau of Insuranceif the recommended disciplinary action or sanction proposes probation,suspension, nonrenewal, or revocation of a certificate of quality assurance,or the temporary restriction or prohibition of new enrollments in a managedcare health insurance plan. The Commissioner may affirm, modify, or reversesuch recommendation and shall issue a final decision.
The Commissioner's decision may be appealed directly to a circuit court underArticle 4 (§ 2.2-4025 et seq.) of the Administrative Process Act. The onlyparties to the case shall be the managed care health insurance plan licenseeand the Department. The Commissioner shall promptly notify the Bureau ofInsurance of the commencement and final determination of an appealsproceeding.
C. If a certificate of quality assurance has been revoked or suspended or acertificate holder has been placed on probation, a new certificate may beissued or the suspension may be terminated or the probation removed by theCommissioner after satisfactory evidence is submitted to him that theconditions upon which revocation, suspension, or probation was based havebeen corrected and after proper examination has been made and compliance withall provisions of this article and the regulations of the Board has beenshown.
(1998, c. 891.)