Section 22-B4109. HEALTH MAINTENANCE ORGANIZATIONS

 

4109.1A Health Maintenance Organization (HMO), or combination of HMOs, shall obtain a CON before undertaking any activity for which a CON is required unless it applies for and receives an exemption from SHPDA under this section.

 

4109.2In its application for exemption, the HMO, or combination of HMOs, shall provide information to demonstrate the following:

 

(a)The facility in which the service will be provided is or will be geographically located in a place that is reasonably accessible to the enrolled individuals; and

 

(b)At least seventy-five percent (75%) of the patients who can reasonably be expected to receive the health service will be individuals enrolled in the HMO (or HMOs in combination).

 

4109.3SHPDA shall grant a HMO an exemption under this section after a review of not more than fifteen (15) days if it has not begun to provide health care services on the date an application is submitted for an exemption and it satisfies the criteria in Subsection 4109.2.

 

4109.4Any decision by SHPDA to approve or deny an application for an HMO exemption shall be based solely on the record established in the administrative proceedings held with respect to the application.

 

4109.5No exemption shall be granted solely because SHPDA failed to reach a decision within the fifteen (15) day review period. 

 

 

authority

§ 22 of the Health Services Planning Program Re-establishment Act of 1996 (Act), effective April 9, 1997 (D.C. Law 11-191; D.C. Official Code § 44-421 (2012 Repl.)).

source

Final Rulemaking published at 29 DCR 5569 (December 17, 1982), enacting Proposed Rulemaking published at 29 DCR 4742 (October 29, 1982); as amended by Final Rulemaking published at 61 DCR 1666 (February 28, 2014).