2006 New York Code - Health Maintenance Organizations; Continuance Of Certificate Of Authority.

 
    §  4404.  Health maintenance organizations; continuance of certificate
  of authority. 1.  Continuance by the commissioner of  a  certificate  of
  authority  issued under section forty-four hundred three of this article
  shall be contingent upon satisfactory performance by the organization as
  to the delivery, continuity, accessibility and quality of  the  services
  to  which an enrolled member is entitled, compliance with the provisions
  of this article and rules and regulations  promulgated  thereunder,  and
  the  continuing  fiscal  solvency of the organization as set out in this
  section.
    2. Except as provided  in  subdivision  three  of  this  section,  the
  commissioner may revoke, limit or annul a certificate of authority as of
  the  termination  of  the  current  period of all then existing enrollee
  contracts, after a hearing, and only after a finding  of  unsatisfactory
  performance  or  fiscal  insolvency.  However,  in  the  event  of  such
  revocation,  limitation  or  annulment,  the   organization   shall   be
  prohibited  from entering into any new enrollee contracts as of the date
  of notification of such action by the commissioner. Notification of such
  action shall  be  given  by  the  organization  to  each  enrollee.  The
  commissioner   shall   give   prior   notice   of  such  action  to  the
  superintendent.
    3. The commissioner may revoke or limit a  certificate  of  authority,
  after  a  hearing, for violations of any applicable statute or rules and
  regulations which threatened to directly affect the  health,  safety  or
  welfare  of any enrollee. Upon notice of his intent to revoke or limit a
  certificate of authority, the commissioner may prohibit the organization
  from entering into any new enrollee contracts pending final  action  and
  may  require notification of such action to be given by the organization
  to each enrollee. The  commissioner  shall  give  prior  notice  to  the
  superintendent  of his intent to prohibit the organization from entering
  into any enrollee contracts. In any action pursuant to this subdivision,
  the commissioner and the superintendent shall take action to assure  the
  continued insurance coverage of enrollees of the organization.
    4.  In  addition  to,  or  in  lieu  of, any revocation, limitation or
  annulment, the commissioner may assess a  penalty  pursuant  to  section
  twelve  of  this  chapter for any violation of this chapter or rules and
  regulations promulgated pursuant to this article.
    5. All orders or determinations made in accordance with the provisions
  of this section shall be  subject  to  review  as  provided  in  article
  seventy-eight  of the civil practice law and rules. Application for such
  review must be made within sixty days after  service  in  person  or  by
  registered  mail  of  a  copy  of  the  order  or determination upon the
  organization.