# 12 Va. Admin. Code § 30-120-410: 12VAC30-120-410. Sanctions

> Virginia · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_410

## Section

- **Citation:** 12 Va. Admin. Code § 30-120-410
- **Heading:** 12VAC30-120-410. Sanctions
- **Jurisdiction:** Virginia
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Virginia Administrative Code / Title 12 Health / Agency 30 Department of Medical Assistance Services / Chapter 120 / 12VAC30-120-410

## Text

A. If DMAS determines that an MCO is not in compliance with applicable state or federal laws or regulations (including the requirements of or pursuant to § 1932(e)(1) of the Social Security Act (the Act), 12VAC30-120-380 , or 42 CFR 438 Subpart I) or the MCO contract, DMAS may impose sanctions on the MCO pursuant to § 1932(e) of the Act and this section. The sanctions may include:
1. Limiting enrollments in the MCO by freezing voluntary member enrollments;
2. Freezing DMAS assignment of members to the MCO;
3. Limiting MCO enrollment to specific areas;
4. Denying, withholding, or retracting payments to the MCO;
5. Terminating the MCO's contract as provided in § 1932(e)(4) of the Act;
6. Civil monetary penalties as specified in 42 CFR 438.704; and
7. Appointment of temporary management for an MCO as provided in 42 CFR 438.706.
B. In the case of an MCO that has repeatedly failed to meet the requirements of §§ 1903(m) and 1932(e) of the Social Security Act, DMAS shall, regardless of what other sanctions are imposed, impose the following sanctions:
1. Appoint a temporary manager to:
a. Oversee the operation of the Medicaid managed care organization upon a finding by DMAS that there is continued egregious behavior by the organization or there is a substantial risk to the health of members; or
b. Ensure the health of the organization's members if there is a need for temporary management while (i) there is an orderly termination or reorganization of the organization or (ii) improvements are made to remedy the violations found under subsection A of this section. Temporary management under this subdivision may not be terminated until DMAS has determined that the MCO has the capability to ensure that the violations shall not recur.
2. Permit members who are enrolled with the MCO to disenroll without cause. If this sanction is imposed, DMAS shall be responsible for notifying such members of the right to disenroll.
C
found under subsection A of this section. Temporary management under this subdivision may not be terminated until DMAS has determined that the MCO has the capability to ensure that the violations shall not recur.
2. Permit members who are enrolled with the MCO to disenroll without cause. If this sanction is imposed, DMAS shall be responsible for notifying such members of the right to disenroll.
C. Prior to terminating a contract as permitted under § 1932(e)(4) of the Act, DMAS shall provide the MCO with a hearing. DMAS shall not provide an MCO with a predetermination hearing before the appointment of a temporary manager under subdivision B 1 of this section.
D. Prior to imposing any sanction other than termination of the MCO's contract, DMAS shall provide the MCO with notice, develop procedures with which the MCO must comply to eliminate specific sanctions, and provide such other due process protections as the Commonwealth may provide.

## Nearby sections

- [12 Va. Admin. Code § 30-120-360 12VAC30-120-360. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_360.md)
- [12 Va. Admin. Code § 30-120-370 12VAC30-120-370. Medallion mandatory managed care members](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_370.md)
- [12 Va. Admin. Code § 30-120-380 12VAC30-120-380. Medallion MCO responsibilities](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_380.md)
- [12 Va. Admin. Code § 30-120-390 12VAC30-120-390. Payment rate for MCOs](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_390.md)
- [12 Va. Admin. Code § 30-120-395 12VAC30-120-395. Preauthorized, emergency, and post-stabilization services and payment rate for care provided by out-of-network providers](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_395.md)
- [12 Va. Admin. Code § 30-120-400 12VAC30-120-400. Quality control and utilization review](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_400.md)
- [12 Va. Admin. Code § 30-120-410 12VAC30-120-410. Sanctions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_410.md)
- [12 Va. Admin. Code § 30-120-420 12VAC30-120-420. Member grievances and appeals](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_420.md)
- [12 Va. Admin. Code § 30-120-430 12VAC30-120-430. Provider grievances, reconsiderations, and appeals](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_430.md)
- [12 Va. Admin. Code § 30-120-600 12VAC30-120-600. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_600.md)
- [12 Va. Admin. Code § 30-120-610 12VAC30-120-610. CCC Plus mandatory managed care members enrollment process](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_610.md)
- [12 Va. Admin. Code § 30-120-615 12VAC30-120-615. CCC Plus providers; Medicaid enrollment process](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_615.md)
- [12 Va. Admin. Code § 30-120-620 12VAC30-120-620. MCO responsibilities; sanctions](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_620.md)
- [12 Va. Admin. Code § 30-120-625 12VAC30-120-625. Continuity of care](https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_625.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_VA_ADC_12_30_120_410. Check the current official text before relying on it. Not legal advice.