§ 31-3403 — Issuance of certificate of authority.

District of Columbia § 31-3403

• Jurisdiction: District of Columbia
• Title 31: Insurance and Securities.
• Ch. 34: Health Maintenance Organizations.

Text

(a) Upon receipt of an application for issuance of a certificate of authority, the Commissioner, in consultation with the Director of the Department of Health, shall determine whether the applicant, with respect to the health care services to be provided, has complied with § 31-3406 .

(b) Within 45 days of receipt of the application for issuance of a certificate of authority, the Commissioner, in consultation with the Director of the Department of Health, shall certify that the proposed health maintenance organization meets the requirements of § 31-3406 or notify the applicant that it does not meet such requirements and specify in what respects it is deficient.

(c) The Commissioner shall issue a certificate of authority to any person filing a completed application upon receiving the prescribed fees and upon the Commissioner being satisfied that:

(1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;

(2) Any deficiencies identified by the Commissioner have been corrected and the health maintenance organization’s proposed plan of operation meets the requirements of § 31-3406 ;

(3) The health maintenance organization will effectively provide or arrange for basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments or deductibles, or both; and

(4) The health maintenance organization is in compliance with §§ 31-3412 and 31-3414 .

(d) A certificate of authority may be denied only after the Commissioner complies with the requirements of § 31-3419 .

(e) The Commissioner, in carrying out his obligations under this chapter, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. Recommendations may be accepted in full or in part by the Commissioner.

(f) Repealed.

(g) Repealed.

(h) Each certificate of authority to do business in the District of Columbia shall renew on May 1 of each year following the date of its issuance unless it has been revoked or the renewal fee under subsection (h) of this section has not been paid.

(i) The Commissioner may charge a renewal license fee to health maintenance organizations licensed to do business in the District of Columbia. The renewal fee shall be paid before April 2 of each renewal year. The fee shall be remitted in a manner prescribed by the Commissioner.

(j) After receiving its certificate of authority, a health maintenance organization shall submit to the Commissioner information concerning any modification or amendment to its application for a certificate of authority or supporting documentation prior to the effectuation of the modification or amendment or provide this information or documentation to the Commissioner when the health maintenance organization files its annual report.

Legislative History

Apr. 9, 1997, D.C. Law 11-235, § 4, 44 DCR 818; Oct. 21, 2000, D.C. Law 13-190, § 4(a), 47 DCR 7261; Oct. 1, 2002, D.C. Law 14-190, § 604(a), 49 DCR 6968; Mar. 27, 2003, D.C. Law 14-252, § 2(b), 50 DCR 225; Mar. 2, 2007, D.C. Law 16-191, §§ 66, 134, 53 DCR 6794; Mar. 8, 2007, D.C. Law 16-232, § 204(a), 54 DCR 368