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					                                                                                        Contract Sanction/Actions Assessed



         Name and Address of                                                                               Sanction
Sanction     Managed Care                                                             Noncompliance       Imposition     Internet     Noncompliance      Maximum Sanction
Number        Organization                  Issue of Noncompliance                   Determination Date      Date      Posting Date   Correction Date       Action Allowed            Actual Sanction Imposed
   008   Community First       For the third quarter of State Fiscal Year 2009            8/27/2009        9/15/2009    10/8/2009        9/28/2009    Up to $250 per calendar      Contractor was assessed
         Health Plans          Community First submitted the Claims Summary                                                                           day                          liquidated damages in the
         4801 NW Loop 410,     Report with inaccurate information in the CHIP,                                                                                                     amount of $2,750
         Suite 1000.           CHIP Perinatal and STAR program in the Bexar
         San Antonio, Texas    service area.

  009    Community First       For the fourth quarter of State Fiscal Year 2009          12/17/2009       12/22/2009    1/14/2010       12/31/2009     Up to $250 per calendar     Contractor was assessed
         Health Plans          Community First submitted the Financial                                                                                 day                         liquidated damages in the
         4801 NW Loop 410,     Statistical Report late in the CHIP, CHIP Perinatal                                                                                                 amount of $6,500
         Suite 1000.           and STAR program in the Bexar service area.
         San Antonio, Texas

  010    Community First       For the second quarter of State Fiscal Year 2010:         5/28/2010        6/25/2010                      7/14/2010     (1) Up to $5,000 per        Contractor was assessed
         Health Plans          (1) Community First was not providing adverse                                                                           calander day for each       liquidated damages in the
         4801 NW Loop 410,     determination letters in Spanish.                                                                                       incident of non-compliance amount of $56,000
         Suite 1000.           (2) Community First had 115 suspended                                                                                   per Program and Service
         San Antonio, Texas    authorization requests dated from 3/5/10 to                                                                             Area.         (2) Up to
                               3/26/10.                                                                                                                $5,000 per calander day for
                               (3) Community First had 2 possible HIPAA                                                                                each incident of non-
                               violations of Member ID cards and bills being sent                                                                      compliance per Program
                               to the incorrect address.                                                                                               and Service Area.       (3)
                                                                                                                                                       Up to $5,000 per calander
                                                                                                                                                       day for each incident of
                                                                                                                                                       non-compliance per
                                                                                                                                                       Program and Service Area.

  011    Community First       For the fourth quarter of State Fiscal Year 2010          1/10/2011         2/3/2011                      2/15/2011     (1) Up to $2500 per quarter Contractor was assessed
         Health Plans          (1) Community First sent Member ID cards to                                                                             per program            (2) liquidated damages in the
         4801 NW Loop 410,     incorrect addresses for the STAR program in the                                                                         HHSC may assess up to       amount of $10,000
         Suite 1000.           Bexar service area.                                                                                                     $5,000.00 per calendar day
         San Antonio, Texas    (2) Community First's FSR to encounters                                                                                 for each incident of non-
                               reconciliation was 91% for the STAR and CHIP                                                                            compliance per HMO
                               programs in the Bexar service area. The standard                                                                        Program and SA.
                               is 98%
  012    Community First       For the first quarter of State Fiscal Year 2011:           5/2/2011         5/9/2011                      5/19/2011     (1) Up to $100 for each     Contractor was assessed
         Health Plans          (1) Community First was under-performance in                                                                            percentage point            liquidated damages in the
         4801 NW Loop 410,     the 80% standard of Member Hotline calls being                                                                          (2) Up to $2500 per         amount of $8,030.
         Suite 1000.           answered by a live person for the STAR & CHIP                                                                           quarter, per program, and
         San Antonio, Texas    Programs in the Bexar Service Area.                                                                                     up to $5,000 for each
                               (2) Community First's FSR to encounters                                                                                 additional quarter
                               reconciliation was 95% for the STAR Program in
                               the Bexar service area. The standard is 98%

				
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