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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XXII CORPORATIONS
  • CHAPTER 176T RISK-BEARING PROVIDER ORGANIZATIONS
  • Section 5 Threat of financial insolvency due to risk-bearing provider organization’s alternative payment contracts with downside risk; notice; suspension or cancellation of risk certificate; hearing

Section 5. (a) If upon examination or at any other time the commissioner determines that the risk-bearing provider organization’s existing or proposed alternative payment contracts with downside risk are likely to threaten the financial solvency of the risk-bearing provider organization, the commissioner shall provide notice to the risk-bearing provider organization.

(b) The commissioner may suspend, cancel, non-renew or refuse to issue a risk-bearing provider organization’s risk certificate upon a determination that the risk-bearing provider organization has not cured a threat to financial solvency, that the risk-bearing provider organization’s application for a risk certificate is incomplete or contains or is based on fraudulent information, or that the risk-bearing provider organization has otherwise failed to comply with the requirements of this chapter. The commissioner shall notify the risk-bearing provider organization and advise, in writing, of the reason for any refusal to issue or non-renew a risk certificate under this chapter. A copy of the notice shall be forwarded to the commission and center. The applicant or certified risk-bearing provider organization may make written demand upon the commissioner within 30 days of receipt of such notification for a hearing before the commissioner to determine the reasonableness of the commissioner’s action. The hearing shall be held pursuant to chapter 30A.

(c) The commissioner shall not suspend or cancel a risk certificate unless the commissioner has first afforded the risk-bearing provider organization an opportunity for a hearing pursuant to chapter 30A.

(d) Upon a ruling by the commissioner to suspend or cancel a risk-I bearing provider organization’s certification, a written notice shall be forwarded to the commission and the center.