§ 27-41-17. Suspension or revocation of license.
(a) The director may suspend or revoke any license issued to a health maintenance organization
under this chapter if the director finds that any of the following conditions exist:
(1) 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 § 27-41-3, unless amendments to those submissions have been filed with and approved by the
director;
(2) The health maintenance organization issues evidence of coverage or uses a schedule
of charges for healthcare services that does not comply with the requirements of § 27-41-8;
(3) The health maintenance organization does not provide or arrange for basic healthcare
services;
(4) 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;
(5) The health maintenance organization has failed to implement a mechanism affording
the enrollees an opportunity to participate in matters of policy and operation under
§ 27-41-6;
(6) The health maintenance organization has failed to implement the complaint system required
by § 27-41-11 in a manner to reasonably resolve valid complaints;
(7) 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;
(8) The continued operation of the health maintenance organization would be hazardous
to its enrollees; or
(9) The health maintenance organization has failed to substantially comply with this chapter.
(b) The director of business regulation shall suspend or revoke any license issued to
a health maintenance organization upon certification by the director of health to
the director of business regulation that:
(1) The health maintenance organization does not meet the requirements of § 27-41-4(a)(2); or
(2) The health maintenance organization is unable to fulfill its obligations to furnish
healthcare services.
(c) A license shall be suspended or revoked only after compliance with the requirements
of § 27-41-20.
(d) When the license of a health maintenance organization is suspended, the health maintenance
organization shall not, during the period of that 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.
(e) When the license 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. The director of business regulation may, by written
order, permit any further operation of the organization that the director 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 healthcare coverage.