§ 23-76-122 - Examinations.
23-76-122. Examinations.
(a) The Insurance Commissioner may make an examination of the affairs of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.
(b) The Director of the Department of Health may make an examination concerning the quality of health care services of any health maintenance organization as often as he or she deems it necessary for the protection of the interests of the people of this state but not less frequently than one (1) time every three (3) years.
(c) (1) Every health maintenance organization shall submit its books and records relating to the health care plan to the examinations and in every way facilitate them.
(2) For the purpose of examinations, the commissioner and the director may administer oaths to and examine the officers and agents of the health maintenance organization.
(3) Medical records of individuals and records of physicians and hospitals providing services under a contract to the health maintenance organization shall be subject to the examination.
(d) The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the commissioner or the director for whom the examination is being conducted.
(e) In lieu of the examination, the commissioner or the director may accept the report of an examination made by the commissioner or director of the department of health of another state.
(f) (1) Any examination under this section that is to commence within one (1) year prior to the date a health maintenance organization shall cease to provide health care services in this state, may be reduced in scope or waived in its entirety, upon application of the health maintenance organization and approval of the commissioner.
(2) The commissioner shall consider the following in determining whether a full or partial waiver may be granted:
(A) Claims payment history;
(B) Consumer complaint history with the department;
(C) Financial condition; and
(D) Compliance with 23-76-118.
(3) Any health maintenance organization requesting a waiver of an examination shall continue to comply with 23-76-118 until such time as it is no longer providing health care services in this state.