Section 21.86.020. Issuance of certificate of authority; approval of changes.

   (a) Within 10 days after receipt of an application for a certificate of authority, the director shall forward a copy of the application to the commissioner of health and social services.  Within 60 days after the commissioner of health and social services receives the copy of the application, the commissioner shall make a recommendation regarding the granting of the certificate of authority.
   (b) The director shall either issue or deny a certificate of authority within 30 days after receipt of the commissioner of health and social services' recommendation.  However, the director may extend the time for issuance or denial of a certificate of authority if additional information is needed in order to make a decision, and notice of the extension is provided to the applicant by the 90th day after the director received the application.  A certificate of authority shall be issued if the director determines that the following conditions are met:
        (1) the persons responsible for the conduct of the affairs of the applicant are competent and trustworthy;
        (2) the applicant will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments;
        (3) the applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees; in determining if this condition is met, the director may consider
             (A) the financial soundness of the arrangements for health care services and the schedule of charges used in connection with those services;
             (B) the adequacy of working capital;
             (C) an agreement with an insurer, a hospital or medical service corporation, a government, or other organization for ensuring the payment of the cost of health care services or providing for automatic applicability of an alternative coverage if the health maintenance organization is discontinued;
             (D) an agreement with providers for the provision of health care services; and
             (E) a deposit of cash or securities submitted under AS 21.86.140;
        (4) the enrollees will be afforded an opportunity to participate in matters of policy and operation as provided in AS 21.86.040;
        (5) nothing in the proposed method of operation, as shown by the information submitted under AS 21.86.010 or by independent investigation, is contrary to the public interest;
        (6) the information submitted under AS 21.86.010(b)(12) indicates that the applicant will be able to comply with state and federal statutes and regulations regarding the quality of health care.
   (c) If a certificate of authority is denied under this section, the applicant may request a hearing under AS 21.86.200.

Authorities

21.86.010

Notes

References

AS 21.86.010 Establishment of health maintenance organizations.

History

(Sec. 1 ch 95 SLA 1990)