D.C. Mun. Regs. tit. 26, r. 26-A3501

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

Rule 26-A3501 - ISSUANCE OF CERTIFICATE OF AUTHORITY

3501.1

The Commissioner, in consultation with the Director of the Department of Health, shall determine whether the applicant has complied with the District's quality assurance program, pursuant to section 7 of the Act, D.C. Code § 35-4506, with reference to health care services.

3501.2

Within forty-five (45) days of the receipt of an application for a certificate of authority, the Commissioner shall certify that the proposed HMO meets the District's quality assurance program.

3501.3

The forty-five (45) day review period to determine whether an applicant complies with the District's quality assurance program will be tolled when additional information is requested.

3501.4

Written notice shall be given informing an applicant when it does not meet the requirements of the District's quality assurance program. The notice shall specify the deficiencies.

3501.5

The Commissioner shall issue a certificate of authority when the following requirements are satisfied:

(a) A completed application is filed;

(b) Prescribed fees are paid;

(c) Persons responsible for the conduct of the affairs of the applicant are: competent, trustworthy, and operate an organization in good standing in the jurisdiction in which the organization currently conducts business; and have not been convicted of any criminal offense or engaged in fraudulent activity;

(d) All deficiencies identified by the Commissioner have been corrected and the HMO's proposed plan of operation meets the District's quality assurance program requirements;

(e) The HMO provides or arranges for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except for copayments and deductibles;

(f) The HMO is in compliance with the protection against insolvency provisions under section 13 of the Act, D.C. Code § 35-4512; and

(g) The HMO complies with the enrollment period and replacement coverage provisions under section 15 of the Act, D.C. Code § 35-4512, in the event of insolvency.

D.C. Mun. Regs. tit. 26, r. 26-A3501

Final Rulemaking published at 46 DCR 7291(September 17, 1999)