28 CA ADC § 1300.86


      28 CCR s 1300.86

      Cal. Admin. Code tit. 28, s 1300.86


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 14. MISCELLANEOUS PROVISIONS
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.86. Assessment of Administrative Penalties.

      (a) When assessing administrative penalties against a health plan the 
      Director shall determine the appropriate amount of the penalty for each 
      violation of the Act based upon one or more of the factors set forth in 
      subsection (b).

      (b) The factors referred to in subsection (a) include, but are not limited 
      to the following:

      (1) The nature, scope, and gravity of the violation;

      (2) The good or bad faith of the plan;

      (3) The plan's history of violations;

      (4) The willfulness of the violation;

      (5) The nature and extent to which the plan cooperated with the 
      Department's investigation;

      (6) The nature and extent to which the plan aggravated or mitigated any 
      injury or damage caused by the violation;

      (7) The nature and extent to which the plan has taken corrective action to 
      ensure the violation will not recur;

      (8) The financial status of the plan;

      (9) The financial cost of the health care service that was denied, 
      delayed, or modified;

      (10) Whether the violation is an isolated incident; and/or

      (11) The amount of the penalty necessary to deter similar violations in 
      the future.


      


      Note: Authority cited: Sections 1341, 1344 and 1386, Health and Safety 
      Code. Reference: Section 1386, Health and Safety Code. 


       HISTORY 
         
      1. New section filed 11-8-2004; operative 12-8-2004 (Register 2004, No. 
      46).
      28 CA ADC s 1300.86

      END OF DOCUMENT

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