17:48H-13 - Review of application
17:48H-13. Review of application13. Following receipt of an application for licensure, the Commissioner of Banking and Insurance shall review it in consultation with the Commissioner of Health and Senior Services and notify the applicant of any deficiencies contained therein.
a.The Commissioner of Banking and Insurance shall issue a license to an organized delivery system if the commissioner finds that the system meets the standards provided for in this act, including, but not limited to:
(1) All of the material required by section 12 of this act has been filed;
(2) The persons responsible for conducting the applicant's affairs are competent, trustworthy and possess good reputations, and have had appropriate experience, training and education;
(3) The persons who are to perform the health care services are properly qualified;
(4) The organized delivery system has demonstrated the ability to assure that health care services will be provided in a manner which will assure the availability and accessibility of the services;
(5) The standard forms of provider agreements to be used by the organized delivery system are acceptable;
(6) The applicant is financially sound and may reasonably be expected to meet its obligations to enrollees, contract holders and carriers. In making this determination, the commissioner shall consider:
(a) The financial soundness of the applicant's compensation arrangements for the provision of health care services;
(b) The adequacy of working capital, other sources of funding and provisions for contingencies; and
(c) Whether any deposit of cash or securities, or any other evidence of financial protection submitted, meets the requirements set forth in this act or by the commissioner by regulation;
(7) Any deficiencies identified by the commissioner have been corrected; and
(8) Any other factors determined by the commissioner to be relevant have been addressed to the satisfaction of the commissioner.
b.The Commissioner of Banking and Insurance shall refer all standard forms of provider agreements, quality assurance programs and utilization management programs to be used by the organized delivery system to the Commissioner of Health and Senior Services for review. The Commissioner of Banking and Insurance shall consult with the Commissioner of Health and Senior Services regarding provider agreements, quality assurance programs and utilization management programs in determining whether the applicant for a license:
(1) Has demonstrated the potential ability to assure that health care services will be provided in a manner that will assure the availability and accessibility of the services;
(2) Has adequate arrangements for an ongoing quality assurance program, where applicable;
(3) Has established acceptable forms for provider agreements to be used by the system; and
(4) Has demonstrated that the persons who are to perform the health care services are properly qualified.
c.The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health and Senior Services, may deny an application for a license if the applicant fails to meet any of the standards provided in this act or on any other reasonable grounds. If the license is denied, the Commissioner of Banking and Insurance shall notify the applicant and shall set forth the reasons for the denial in writing. The applicant may request a hearing by notice to the commissioner within 30 days of receiving the notice of denial. Upon such denial, the applicant shall submit to the commissioner a plan for bringing the organized delivery system into compliance or providing for the closing down of its business.
L.1999,c.409,s.13.