{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-137.5.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-137.5.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-137.5.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-137.5.html"}],"law_id":61098,"edition_id":1,"section_id":61098,"structure_id":15832,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","history":"1998, c. 891.","full_text":"A\n\nIn accordance with applicable regulations of the Board and in consultation with the Bureau of Insurance, the Commissioner (i) may impose civil penalties, which shall not exceed $1,000 per incident of noncompliance, to a maximum of $10,000 for a series of related incidents of noncompliance, (ii) may place a certificate holder on probation, (iii) may temporarily suspend a certificate of quality assurance of a managed care health insurance plan licensee, (iv) may, with the concurrence of the Bureau of Insurance, temporarily restrict or prohibit new enrollments into a managed care health insurance plan, or (v) may revoke or not renew a certificate of quality assurance and certify to the State Corporation Commission that a managed care health insurance plan licensee or its managed care health insurance plan is unable to fulfill its obligations to furnish quality health care services as set forth in this article. Fines payable under this section shall be paid into the Literary Fund.B\n\nWhen examination or review or complaint investigation by the Department results in a finding of noncompliance with the provisions of this article or the regulations of the Board, the managed care health insurance plan licensee or applicant shall be provided written notice and a report specifying the findings of noncompliance and providing an opportunity to be heard in no fewer than thirty days by the Commissioner’s adjudication officer in a proceeding under § 2.2-4019. A copy of the notice and report shall be provided to the Bureau of Insurance. Such proceeding shall be separate from the regulatory office of the Department that conducted the examination, review, or investigation and shall be closed and confidential. The records of the proceedings shall be privileged and confidential and shall not be subject to subpoena.\n\t\t\tThe adjudication officer shall provide a recommendation to the Commissioner, including findings of fact, conclusions, and appropriate disciplinary action or sanction. The Commissioner shall promptly notify the Bureau of Insurance if 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 managed care health insurance plan. The Commissioner may affirm, modify, or reverse such recommendation and shall issue a final decision.\n\t\t\tThe Commissioner’s decision may be appealed directly to a circuit court under Article 4 (§ 2.2-4025 et seq.) of the Administrative Process Act. The only parties to the case shall be the managed care health insurance plan licensee and the Department. The Commissioner shall promptly notify the Bureau of Insurance of the commencement and final determination of an appeals proceeding.C\n\nIf a certificate of quality assurance has been revoked or suspended or a certificate holder has been placed on probation, a new certificate may be issued or the suspension may be terminated or the probation removed by the Commissioner after satisfactory evidence is submitted to him that the conditions upon which revocation, suspension, or probation was based have been corrected and after proper examination has been made and compliance with all provisions of this article and the regulations of the Board has been shown.","order_by":null,"text":{"0":{"id":223356,"text":"In accordance with applicable regulations of the Board and in consultation with the Bureau of Insurance, the Commissioner (i) may impose civil penalties, which shall not exceed $1,000 per incident of noncompliance, to a maximum of $10,000 for a series of related incidents of noncompliance, (ii) may place a certificate holder on probation, (iii) may temporarily suspend a certificate of quality assurance of a managed care health insurance plan licensee, (iv) may, with the concurrence of the Bureau of Insurance, temporarily restrict or prohibit new enrollments into a managed care health insurance plan, or (v) may revoke or not renew a certificate of quality assurance and certify to the State Corporation Commission that a managed care health insurance plan licensee or its managed care health insurance plan is unable to fulfill its obligations to furnish quality health care services as set forth in this article. Fines payable under this section shall be paid into the Literary Fund.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":223357,"text":"When examination or review or complaint investigation by the Department results in a finding of noncompliance with the provisions of this article or the regulations of the Board, the managed care health insurance plan licensee or applicant shall be provided written notice and a report specifying the findings of noncompliance and providing an opportunity to be heard in no fewer than thirty days by the Commissioner’s adjudication officer in a proceeding under § 2.2-4019. A copy of the notice and report shall be provided to the Bureau of Insurance. Such proceeding shall be separate from the regulatory office of the Department that conducted the examination, review, or investigation and shall be closed and confidential. The records of the proceedings shall be privileged and confidential and shall not be subject to subpoena.\n\t\t\tThe adjudication officer shall provide a recommendation to the Commissioner, including findings of fact, conclusions, and appropriate disciplinary action or sanction. The Commissioner shall promptly notify the Bureau of Insurance if 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 managed care health insurance plan. The Commissioner may affirm, modify, or reverse such recommendation and shall issue a final decision.\n\t\t\tThe Commissioner’s decision may be appealed directly to a circuit court under Article 4 (§ 2.2-4025 et seq.) of the Administrative Process Act. The only parties to the case shall be the managed care health insurance plan licensee and the Department. The Commissioner shall promptly notify the Bureau of Insurance of the commencement and final determination of an appeals proceeding.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":223358,"text":"If a certificate of quality assurance has been revoked or suspended or a certificate holder has been placed on probation, a new certificate may be issued or the suspension may be terminated or the probation removed by the Commissioner after satisfactory evidence is submitted to him that the conditions upon which revocation, suspension, or probation was based have been corrected and after proper examination has been made and compliance with all provisions of this article and the regulations of the Board has been shown.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B"}},"ancestry":[{"id":15832,"edition_id":1,"name":"Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees","identifier":"1.1","label":"article","depth":3,"order_by":1,"parent_id":12728,"metadata":{},"date_created":"2026-06-26 04:00:17","date_modified":"2026-06-26 04:00:17","permalink":{"id":203095,"object_type":"structure","relational_id":15832,"identifier":"1.1","token":"32.1\/5\/1.1","url":"\/32.1\/5\/1.1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12728,"edition_id":1,"name":"Regulation of Medical Care Facilities and Services","identifier":"5","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":202855,"object_type":"structure","relational_id":12728,"identifier":"5","token":"32.1\/5","url":"\/32.1\/5\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":61229,"structure_id":15832,"section_number":"32.1-137.1","catch_line":"Definitions","url":"\/32.1-137.1\/","token":"32.1\/5\/1.1\/32.1-137.1","metadata":false},{"id":80679,"structure_id":15832,"section_number":"32.1-137.2","catch_line":"Certification of quality assurance; application; issuance; denial; renewal","url":"\/32.1-137.2\/","token":"32.1\/5\/1.1\/32.1-137.2","metadata":false},{"id":84080,"structure_id":15832,"section_number":"32.1-137.3","catch_line":"Regulations","url":"\/32.1-137.3\/","token":"32.1\/5\/1.1\/32.1-137.3","metadata":false},{"id":80091,"structure_id":15832,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","url":"\/32.1-137.4\/","token":"32.1\/5\/1.1\/32.1-137.4","metadata":false},{"id":61098,"structure_id":15832,"section_number":"32.1-137.5","catch_line":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","url":"\/32.1-137.5\/","token":"32.1\/5\/1.1\/32.1-137.5","metadata":false},{"id":74118,"structure_id":15832,"section_number":"32.1-137.6","catch_line":"Complaint system","url":"\/32.1-137.6\/","token":"32.1\/5\/1.1\/32.1-137.6","metadata":false}],"previous_section":{"id":80091,"structure_id":15832,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","url":"\/32.1-137.4\/","token":"32.1\/5\/1.1\/32.1-137.4","metadata":false},"next_section":{"id":74118,"structure_id":15832,"section_number":"32.1-137.6","catch_line":"Complaint system","url":"\/32.1-137.6\/","token":"32.1\/5\/1.1\/32.1-137.6","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-137.5\/","history_text":"

This law was first created in 1998. The record of its establishment is cataloged in chapter 891<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":[{"id":60253,"section_number":"2.2-3705.5","catch_line":"Exclusions to application of chapter; health and social services records","order_by":null,"url":"\/2.2-3705.5\/"},{"id":84080,"section_number":"32.1-137.3","catch_line":"Regulations","order_by":null,"url":"\/32.1-137.3\/"},{"id":80091,"section_number":"32.1-137.4","catch_line":"Examination, review or investigation","order_by":null,"url":"\/32.1-137.4\/"},{"id":75727,"section_number":"38.2-5809","catch_line":"Suspension or revocation of license","order_by":null,"url":"\/38.2-5809\/"}],"refers_to":[{"id":85983,"section_number":"2.2-4019","catch_line":"Informal fact finding proceedings","order_by":null,"url":"\/2.2-4019\/"},{"id":69646,"section_number":"2.2-4025","catch_line":"Exemptions operation of this article; limitations","order_by":null,"url":"\/2.2-4025\/"}],"permalink":{"id":203113,"object_type":"law","relational_id":61098,"identifier":"32.1-137.5","token":"32.1\/5\/1.1\/32.1-137.5","url":"\/32.1-137.5\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-137.5\/","token":"32.1\/5\/1.1\/32.1-137.5","dublin_core":{"Title":"Civil penalties; probation; suspension; restriction or prohibition of new enrollments to managed care health insurance plan licensee; revocation or nonrenewal of certificate of quality assurance; appeal process; correction","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-137.5","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> In accordance with applicable regulations of the Board<\/span> and in consultation with the Bureau of Insurance, the Commissioner<\/span> (i) may impose civil penalties, which shall not exceed $1,000 per incident of noncompliance, to a maximum of $10,000 for a series of related incidents of noncompliance, (ii) may place a certificate holder on probation<\/span>, (iii) may temporarily suspend a certificate of quality assurance of a managed care health insurance plan licensee, (iv) may, with the concurrence of the Bureau of Insurance, temporarily restrict or prohibit new enrollments into a managed care health insurance plan, or (v) may revoke or not renew a certificate of quality assurance and certify to the State Corporation Commission that a managed care health insurance plan licensee or its managed care health insurance plan is unable to fulfill its obligations to furnish quality health care services as set forth in this article. Fines payable under this section shall be paid into the Literary Fund. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> When examination or review or complaint investigation by the Department<\/span> results in a finding<\/span> of noncompliance with the provisions of this article or the regulations of the Board<\/span>, the managed care health insurance plan licensee or applicant shall be provided written notice and a report specifying the findings<\/span> of noncompliance and providing an opportunity to be heard in no fewer than thirty days by the Commissioner<\/span>’s adjudication officer in a proceeding under § 2.2-4019<\/a>. A copy of the notice and report shall be provided to the Bureau of Insurance. Such proceeding shall be separate from the regulatory office of the Department<\/span> that conducted the examination, review, or investigation and shall be closed and confidential. The records of the proceedings shall be privileged and confidential and shall not be subject to subpoena<\/span>.\n\t\t\tThe adjudication officer shall provide a recommendation to the Commissioner<\/span>, including findings<\/span> of fact<\/span>, conclusions, and appropriate disciplinary action or sanction<\/span>. The Commissioner<\/span> shall promptly notify the Bureau of Insurance if the recommended disciplinary action or sanction<\/span> proposes probation<\/span>, suspension, nonrenewal, or revocation<\/span> of a certificate of quality assurance, or the temporary restriction or prohibition of new enrollments in a managed care health insurance plan. The Commissioner<\/span> may affirm<\/span>, modify, or reverse<\/span> such recommendation and shall issue<\/span> a final decision.\n\t\t\tThe Commissioner<\/span>’s decision may be appealed directly to a circuit<\/span> court<\/span> under Article 4 (§ 2.2-4025<\/a> et seq.) of the Administrative Process Act. The only parties to the case shall be the managed care health insurance plan licensee and the Department<\/span>. The Commissioner<\/span> shall promptly notify the Bureau of Insurance of the commencement and final determination of an appeals<\/span> proceeding. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> If a certificate of quality assurance has been revoked or suspended or a certificate holder has been placed on probation<\/span>, a new certificate may be issued or the suspension may be terminated or the probation<\/span> removed by the Commissioner<\/span> after satisfactory evidence<\/span> is submitted to him that the conditions upon which revocation<\/span>, suspension, or probation<\/span> was based have been corrected and after proper examination has been made and compliance with all provisions of this article and the regulations of the Board<\/span> has been shown. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCIVIL PENALTIES; PROBATION; SUSPENSION; RESTRICTION OR PROHIBITION OF NEW\nENROLLMENTS TO MANAGED CARE HEALTH INSURANCE PLAN LICENSEE; REVOCATION OR\nNONRENEWAL OF CERTIFICATE OF QUALITY ASSURANCE; APPEAL PROCESS; CORRECTION (\u00a7\n32.1-137.5)\n\nA. In accordance with applicable regulations of the Board and in consultation\nwith the Bureau of Insurance, the Commissioner (i) may impose civil penalties,\nwhich shall not exceed $1,000 per incident of noncompliance, to a maximum of\n$10,000 for a series of related incidents of noncompliance, (ii) may place a\ncertificate holder on probation, (iii) may temporarily suspend a certificate of\nquality assurance of a managed care health insurance plan licensee, (iv) may,\nwith the concurrence of the Bureau of Insurance, temporarily restrict or\nprohibit new enrollments into a managed care health insurance plan, or (v) may\nrevoke or not renew a certificate of quality assurance and certify to the State\nCorporation Commission that a managed care health insurance plan licensee or its\nmanaged care health insurance plan is unable to fulfill its obligations to\nfurnish quality health care services as set forth in this article. Fines payable\nunder this section shall be paid into the Literary Fund.\n\nB. When examination or review or complaint investigation by the Department\nresults in a finding of noncompliance with the provisions of this article or the\nregulations of the Board, the managed care health insurance plan licensee or\napplicant shall be provided written notice and a report specifying the findings\nof noncompliance and providing an opportunity to be heard in no fewer than\nthirty days by the Commissioner’s adjudication officer in a proceeding\nunder § 2.2-4019. A copy of the notice and report shall be provided to the\nBureau of Insurance. Such proceeding shall be separate from the regulatory\noffice of the Department that conducted the examination, review, or\ninvestigation and shall be closed and confidential. The records of the\nproceedings shall be privileged and confidential and shall not be subject to\nsubpoena.\n\t\t\tThe adjudication officer shall provide a recommendation to the Commissioner,\nincluding findings of fact, conclusions, and appropriate disciplinary action or\nsanction. The Commissioner shall promptly notify the Bureau of Insurance if the\nrecommended disciplinary action or sanction proposes probation, suspension,\nnonrenewal, or revocation of a certificate of quality assurance, or the\ntemporary restriction or prohibition of new enrollments in a managed care health\ninsurance plan. The Commissioner may affirm, modify, or reverse such\nrecommendation and shall issue a final decision.\n\t\t\tThe Commissioner’s decision may be appealed directly to a circuit court\nunder Article 4 (§ 2.2-4025 et seq.) of the Administrative Process Act. The\nonly parties to the case shall be the managed care health insurance plan\nlicensee and the Department. The Commissioner shall promptly notify the Bureau\nof Insurance of the commencement and final determination of an appeals\nproceeding.\n\nC. If a certificate of quality assurance has been revoked or suspended or a\ncertificate holder has been placed on probation, a new certificate may be issued\nor the suspension may be terminated or the probation removed by the Commissioner\nafter satisfactory evidence is submitted to him that the conditions upon which\nrevocation, suspension, or probation was based have been corrected and after\nproper examination has been made and compliance with all provisions of this\narticle and the regulations of the Board has been shown.\n\nHISTORY: 1998, c. 891.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}