§ 4404 — Health maintenance organizations; continuance of certificate of authority

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