Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 191 - HEALTHMAINTENANCE ORGANIZATIONS › Section 031-191-6 - Application Submission Requirements

Current through 2024-29, July 17, 2024
In addition to the requirements of
				  24-A
				  M.R.S.§4203(3), an
				  application for an HMO certificate of authority shall include the information
				  and documents set forth in this section.All data submitted by an applicant to
				  the Commissioner of the Department of Health and Human Services must also be
				  submitted to the Superintendent.
[Drafting Note:Any request for confidential handling of
				  specific portions of the application is subject to the confidentiality protocol
				  established by the Superintendent.]
A.
Certification
The certification required by
				  24-A M.R.S.
				  §4203(3) must include a
				  statement that the applicant is aware of the requirements of Title 24-A Chapter
				  56 and this rule and agrees to conform to those requirements and any other
				  prospectively applicable enacted or adopted requirements of which it has notice
				  or should have cause to notice.
B.
HMOs Affiliated With Insurers
An insurer operating in this State under a current
				  Certificate of Authority may directly or through a subsidiary or affiliate
				  corporation or other business entity, organize and operate an HMO in this
				  State.If such joint affiliation is effected and the HMO is controlled by, under
				  common control with, or exerts control over such affiliate, these corporations
				  and the HMO, if a distinct entity, shall be subject to the law applicable to
				  insurance holding companies, including 24-A M.R.S. §222and Bureau of
				  Insurance Rule Chapter 180.
C.
Power of Attorneyand Agent for
				Service of Process
A power of attorney must be filed by all foreign applicants
				  to the extent required by
				  24-A M.R.S.
				  §4203(3)(J).In
				  addition, all foreign and domestic health maintenance organizations are subject
				  to and must comply with the requirements of
				  24-A
				  M.R.S.§421.At the time of application
				  for a certificate of authority, the applicant shall appoint an agent for
				  service of process and file the appointment with the Superintendent.
D.
Organizational Structure
				and Operations
Applications must include:
1) An organizational chart for the HMO
				setting out the position classifications of personnel responsible for various
				phases of health care delivery and administrative responsibility.
2) Biographical sketches and independent
				third party reviews using the National Association of Insurance Commissioners
				(NAIC) form current at the time of application of the applicant's directors and
				officers, or, if the applicant is an association or a society, its partners or
				members.
3) Disclosure by all
				principal officers and directors of the HMO, in statements attested under oath,
				of any real or potential conflict of interest, including pertinent employment
				contracts, deferred compensation contracts or other pecuniary interests.Such
				disclosure shall extend to any provider under contract with the HMO to provide
				health care services who also has managerial or directorship responsibilities
				with the HMO that permit the provider to influence the HMO's decision-making.
4) A description of any physical
				treatment centers such as clinics or satellite medical facilities owned or
				leased by the HMO.