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304.38-130 Revocation or suspension of certificate of authority.
(1)
(2)
(3)
The commissioner may suspend or revoke any certificate of authority issued to
a health maintenance organization under this subtitle if the commissioner finds
that any of the conditions exist for which the commissioner could suspend or
revoke a certificate of authority as provided in Subtitles 2 and 3 of this chapter
or if the commissioner finds that any of the following conditions exist:
(a) The health maintenance organization is operating significantly in
contravention of its basic organizational document or in a manner
contrary to that described in and reasonably inferred from any other
information submitted under KRS 304.38-040, unless amendments to
such submissions have been filed with and approved by the
commissioner;
(b) The health maintenance organization issues evidence of coverage or
uses a schedule of charges for health care services which do not comply
with the requirements of KRS 304.38-050 or Subtitle 17A of this chapter;
(c) The health maintenance organization does not provide or arrange for
health care services as approved by the commissioner in KRS
304.38-050(1)(a);
(d) The certificate of need and licensure board certifies to the commissioner
that the health maintenance organization fails to meet the requirements of
the board or that the health maintenance organization is unable to fulfill its
obligations to furnish health care services;
(e) The health maintenance organization is no longer financially responsible
and may reasonably be expected to be unable to meet its obligations to
enrollees or prospective enrollees;
(f) The health maintenance organization, or any person on its behalf, has
advertised or merchandised its services in an untrue, misrepresentative,
misleading, deceptive, or unfair manner;
(g) The continued operation of the health maintenance organization would be
hazardous to its enrollees; or
(h) The health maintenance organization has otherwise failed to substantially
comply with this subtitle.
If the certificate of authority of a health maintenance organization is
suspended, the health maintenance organization shall not, during the period of
the suspension, enroll any additional enrollees except newborn children or
other newly acquired dependents of existing enrollees, and shall not engage in
any advertising or solicitation whatsoever.
If the certificate of authority of a health maintenance organization is revoked,
the organization shall proceed, immediately following the effective date of the
order of revocation, to wind up its affairs, and shall conduct no further business
except as may be essential to the orderly conclusion of the affairs of the
organization. It shall engage in no further advertising or solicitation whatsoever.
The commissioner may, by written order, permit the further operation of the
organization as the commissioner may find to be in the best interest of
enrollees, to the end that enrollees will be afforded the greatest practical
opportunity to obtain continuing health care coverage. If the commissioner
permits such further operation the health maintenance organization will
continue to collect the periodic prepayments required of enrollees.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1509, effective July 15, 2010. -Amended 2004 Ky. Acts ch. 24, sec. 43, effective July 13, 2004. -- Created 1974
Ky. Acts ch. 357, subtit. 38, sec. 13, effective June 21, 1974.
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