                                 CODE OF VIRGINIA

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 (§
32.1-137.5)

A. 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.

B. 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&#8217;s adjudication officer in a proceeding
under &#xA7; 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.
			The 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.
			The Commissioner&#8217;s decision may be appealed directly to a circuit court
under Article 4 (&#xA7; 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. 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.

HISTORY: 1998, c. 891.