2024 Iowa Code
Title XIII - COMMERCE
Chapter 514B - HEALTH MAINTENANCE ORGANIZATIONS
Section 514B.4 - Applicant for certificate of authority.

514B.4 Applicant for certificate of authority. 1. The commissioner shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished: a. Has demonstrated the willingness and potential ability to assure the availability, accessibility, and continuity of service through adequate personnel and facilities. b. Has arrangements established in accordance with rules adopted by the commissioner for a continuous review of health care processes and outcomes. If a health maintenanceorganization is accredited by the national committee on quality assurance, or anotheraccreditation entity approved by the commissioner, an external peer review under rules ofthe commissioner shall not be applicable. However, at the discretion of the commissioner,an on-site inspection of the health maintenance organization may be conducted. c. Has a procedure established in accordance with rules adopted by the commissioner to develop, compile, evaluate, and report statistics relating to the cost of its operations, thepattern of utilization of its services, the availability and accessibility of its services, and othermatters as may be reasonably required by the commissioner. 2. The commissioner, in administering this section and sections 514B.25 and 514B.26, may contract with qualified persons to make recommendations concerning the determinationsrequired to be made by the commissioner. Such recommendations may be accepted in full orin part by the commissioner. [C75, 77, 79, 81, §514B.4]92 Acts, ch 1162, §21; 99 Acts, ch 165, §11; 2012 Acts, ch 1023, §157Referred to in §514B.3, 514B.5 Sat Dec 23 00:44:37 2023 Iowa Code 2024, Section 514B.4 (17, 0)

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