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Title: Section 1003.12 - Termination

Effective Date


1003.12 Termination

The Commissioner may limit, suspend or terminate the certificate of authority of an ACO after written notice and an opportunity for review and/or hearing based on, but not limited to, the following:

(a) Unsatisfactory performance by the ACO, ACO participants, providers/suppliers or other individuals or entities performing functions or services related to ACO activities;

(b) Unsatisfactory performance may include but is not limited to:

(1) Imminent harm to patients;

(2) Financial fraud and abuse;

(3) Fiscal insolvency of the ACO;

(4) The imposition of sanctions or other actions taken against the ACO by the accrediting organization, state, federal or local government agency leading to inability of the ACO to comply with the requirements under this Part;

(5) Violations of the physician self-referral prohibition, civil monetary penalties (CMP) law, federal or state anti-kickback statute, antitrust laws, or any other applicable federal or state laws, rules, or regulations that are relevant to ACO operations; and

(6) Failure to adhere to established quality measures or comply with corrective action plans related to poor performance on established quality of care standards.


VOLUME E (Title 10)