D.C. Mun. Regs. tit. 22, r. 22-B5504

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B5504 - REQUIRED INFORMATION

5504.1

Each QO shall submit the following information to the Department, at the time of application for a contract:

(a) A copy of the basic organizational documents of the QO, such as articles of incorporation, and each amendment;

(b) A copy of the by-laws or similar documents regulating conduct of the internal affairs of the QO;

(c) A description of the organization's ownership and a list of major owners (stockholders having five percent (5%) or more of outstanding shares);

(d) A list of board members and their affiliations;

(e) A roster of key personnel and their qualifications;

(f) A list of subcontracts and a copy of each type of subcontract;

(g) The number of clinical, administrative and marketing employees;

(h) The form of evidence of coverage to be issued to enrollees;

(i) For on-going organizations, financial statements showing the organizations assets, liabilities and sources of financial support, including the most recent audited financial statement;

(j) For start-up organizations, pro forma operating statements and balance sheets and a statement as to sources of working capital and other sources of funding;

(k) A description of the proposed method of marketing;

(l) A description of the enrollee grievance process;

(m) A description of the procedures and programs to assure the availability and accessibility of high quality services;

(n) A description of the enrollment process;

(o) A statement of policies and procedures governing claim payments to providers and distribution of revenues to owners;

(p) A written description of the medical record, and statistical reporting systems;

(q) A statement on the organization's background and experience in serving low income, diversified population groups in the District; and

(r) A statement of the proposed methods of handling out-of-plan emergency and out-of-area coverage.

5504.2

The QO shall notify the Department's Office of Health Care Financing in writing within thirty (30) days of any material modifications cited under § 5504.1 on file.

D.C. Mun. Regs. tit. 22, r. 22-B5504

Final Rulemaking published at 34 DCR 1550, 1555 (March 6, 1987)