Section 26-A3517. DENIAL, SUSPENSION OR REVOCATION OF THE CERTIFICATE OF AUTHORITY

 

3517.1The Commissioner may deny an application for a certificate of authority, and suspend or revoke a certificate of authority issued under the Act and these rules, for the following reasons:

 

(a)The HMO is operating in a manner that is significantly inconsistent with its basic organizational documentation;

 

(b)The HMO fails to comply with section 8 of the Act, D.C. Code § 35-4507 (requirements for group contract, individual contract, and evidence of coverage) and section 16 of the Act, D.C. Code § 35-4515 (filing requirements for rating information);

 

(c)The HMO does not provide or arrange for basic health care services;

 

(d)The Commissioner certifies that the HMO does not meet the requirements for issuance of a certificate of authority under section 3501.5, or it is unable to meet its obligations to provide health care services;

 

(e)The HMO is no longer financially sound;

 

(f)The HMO does not correct any deficiency occurring due to the HMO's prescribed minimum net worth being impaired;

 

(g)The HMO has failed to implement the grievance procedure as required under section 11 of the Act, D.C. Code § 35-4510, in reasonable manner to resolve legitimate complaints;

 

(h)The HMO or any person authorized to act on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;

 

(i)The HMO's continued operation would be dangerous to its enrollees; or

 

(j)The HMO has otherwise failed substantially to comply with the Act and these rules.

 

3517.2In addition to, or in lieu of suspension or revocation of a certificate of authority, the applicant or HMO may be subject to an administrative penalty up to $ 1,000 a day for each cause for suspension or revocation.

 

source

Final Rulemaking published at 46 DCR 7291(September 17, 1999).