Page 4

UNOFFICIAL 1735.2-4

pertinent to the care and management of an eligible individual to the department. [Eff 09/30/13] (Auth: HRS §346-14) (Imp: HRS §346-14; 42 C.F.R. §430.25)

§17-1735.2-5 Capitated payments. (a) Each participating health plan shall be paid on a capitated basis, as negotiated with the department, for an eligible individual enrolled in that health plan. (b) The department shall provide the capitated payment, as stipulated in the contract between the department and each health plan, in return for the health plan's provision of all contracted coverage for the health plan's eligible individuals. [Eff 09/30/13] (Auth: HRS §346-14) (Imp: HRS §346-14; 42 C.F.R. §430.25)

§17-1735.2-6 Enforcement of contracts with participating health plan. (a) The department may monitor a participating health plan’s performance during any contract period. (b) The department may impose civil or administrative monetary penalties not to exceed the maximum amount established by federal and state statutes and regulations if the health plan: (1) Fails to provide medically necessary items and services that are required under law or under contract; (2) Imposes upon beneficiaries excess premiums and charges; (3) Acts to discriminate among an eligible individual; (4) Misrepresents or falsifies information; (5) Violates marketing guidelines established by the department; (6) Violates other contract provisions and requirements; or (7) Violates federal or state statutes or regulations.

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Page 4

Official source

UNOFFICIAL 1735.2-4

pertinent to the care and management of an eligible individual to the department. [Eff 09/30/13] (Auth: HRS §346-14) (Imp: HRS §346-14; 42 C.F.R. §430.25)

§17-1735.2-5 Capitated payments. (a) Each participating health plan shall be paid on a capitated basis, as negotiated with the department, for an eligible individual enrolled in that health plan. (b) The department shall provide the capitated payment, as stipulated in the contract between the department and each health plan, in return for the health plan's provision of all contracted coverage for the health plan's eligible individuals. [Eff 09/30/13] (Auth: HRS §346-14) (Imp: HRS §346-14; 42 C.F.R. §430.25)

§17-1735.2-6 Enforcement of contracts with participating health plan. (a) The department may monitor a participating health plan’s performance during any contract period. (b) The department may impose civil or administrative monetary penalties not to exceed the maximum amount established by federal and state statutes and regulations if the health plan: (1) Fails to provide medically necessary items and services that are required under law or under contract; (2) Imposes upon beneficiaries excess premiums and charges; (3) Acts to discriminate among an eligible individual; (4) Misrepresents or falsifies information; (5) Violates marketing guidelines established by the department; (6) Violates other contract provisions and requirements; or (7) Violates federal or state statutes or regulations.