New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter B - Public Assistance
Article 2 - Determination of Eligibility-Categorical
Part 360 - MEDICAL ASSISTANCE
Subpart 360-10 - MEDICAID MANAGED CARE PROGRAMS
Section 360-10.11 - MMCO sanctions and due process

(a) Upon a determination that an MMCO has committed an unacceptable practice, the department may impose one or more of the following sanctions:

(b) Before imposing a sanction pursuant to this section, the department shall provide the MMCO with a notice of proposed agency action. The written notice shall specify the proposed action and the reason for such action, and shall provide the MMCO with a reasonable opportunity to submit documentation or written arguments objecting to the sanction which the department shall give due consideration.

(c) The department shall provide the social services district with notice of its intent to impose a sanction.

(d) When the department imposes one of the sanctions described in subdivision (a) of this section, the MMCO will be afforded due process in accordance with 18 NYCRR Parts 515, 516, and 519, and 42 CFR 438.710.

(e) Nothing in this section shall be deemed to prevent the commissioner from appointing temporary management of an MMCO pursuant to subdivision 23 of section 364-j of the Social Services Law upon a determination that an MMCO has repeatedly failed to meet the substantive requirements of sections 1903(m) and 1932 of the Federal Social Security Act.

(f) Nothing in this section limits other remedies available to the State under the contract.