New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 24B - ORGANIZED DELIVERY SYSTEMS › Subchapter 2 - CERTIFICATION AND REVIEW OF LICENSE APPLICATIONS › Section 11:24B-2.3 - CODS: Part A of the application for certification

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Every ODS shall submit the following information:
1. A completed Application Cover Sheet, which can be found on the Department's website:
www.state.nj.us/dobi/formlist.htm
;
2. A completed Irrevocable Consent to Jurisdiction of the Commissioner and New Jersey Courts, which can be found on the Department's website:
www.state.nj.us/dobi/formlist.htm
;
3. A completed Appointment of Attorney for the State of New Jersey, which can be found on the Department's website:
www.state.nj.us/dobi/formlist.htm
;
4. A completed Financial Risk Affidavit, which can be found on the Department's website:
www.state.nj.us/dobi/formlist.htm
;
5. A copy of the ODS's basic organizational documents;
6. A copy of the ODS's executed by-laws, plan of operation, rules and regulations, or similar documents intended to regulate the conduct of the ODS's internal affairs;
7. A Biographical Affidavit, which shall include the filer's name and address, education and employment history, licenses held (including identification of those suspended or revoked), ownership of insurers or similar health entities for the filer and his or her immediate family, any bankruptcies, and whether the filer was in a position of control or authority with respect to an health plan entity whose authority was suspended or revoked, the form of which can be found on the Department's website:
www.state.nj.us/dobi/formlist.htm
, completed for each of the individuals who are, or are intended to be, responsible for the conduct of the affairs of the ODS, including:
i. Members of the ODS's board of directors, executive committee or other governing board or committee;
ii. The ODS's principal officers, and medical director, if applicable;
iii. Any person who owns or has the right to acquire 10 percent or more of the voting securities of the ODS;
iv. Each person who has loaned funds to the ODS for the operation of the ODS's business; and
v. Partners or members, in the case of a partnership or association;
8. A business plan, consisting of:
i. An organizational chart of the ODS;
ii. A narrative description of the ODS, its facilities, and personnel, and the health care services to be offered by the ODS to a carrier;
iii. A list of the geographical areas in which the described health care services are to be performed and approximate number of each type of provider who will provide the health care services;
iv. A description of any administrative services for which the ODS shall be responsible on behalf of the carrier;
v. A list of any affiliate of the ODS that provides services to the ODS in New Jersey and a description of any material transaction between the affiliate and the ODS;
vi. A description of any arrangements between the ODS and any other ODS or subcontractor for services associated with the provisions of health care services;
vii. A description of the means by which the ODS will be compensated under contracts with carriers; and
viii. A description of the arrangement for the ODS reporting of data to the carriers and a description of the carrier's oversight responsibility;
9. A specimen copy of all provider agreements made or intended to be executed between the ODS and providers relative to the provision of health care services consistent with the standards of N.J.A.C. 11:24B-5;
i. The language of (a)9 above shall not be construed to prohibit an ODS from signing contracts prior to the date that the ODS is certified, but also shall not be construed to permit any ODS to execute any provider agreements for purposes of providing services as an ODS prior to the date of approval of the ODS' certification;
10. A specimen copy of all contracts made or intended to be executed between the ODS and any other ODS or subcontractor for services associated with the provision of health care services consistent with the standards of N.J.A.C. 11:24B-5;
11. A specimen copy of all management agreements made or to be executed between the ODS and one or more carriers, containing provisions establishing the respective duties of the ODS and carrier, and otherwise consistent with the standards of N.J.A.C. 11:24B-4.
i. The language of (a)11 above shall not be construed to permit any ODS or carrier to execute any contract for purposes of the ODS providing services as an ODS prior to the date of approval of the ODS's certification;
12. A list of all administrative, civil or criminal actions and proceedings to which the ODS, its affiliates, or persons who are responsible for the conduct of the affairs of the ODS or affiliate, have been subject, including a statement regarding the resolution of such actions and proceedings.
i. If the ODS has had its license, certificate or other authority to operate suspended or revoked by any jurisdiction, or its application for a license, certificate or other authority refused by any jurisdiction, the ODS shall include in its application a copy of any orders, proceedings and determinations related to such refusal, suspension or revocation;
13. A list of the carriers with which the ODS has contracted or intends to execute a contract pending the approval of the application.
i. The language of (a)13 above shall not be construed to permit any ODS or carrier to execute any contract for purposes of the ODS providing services as an ODS prior to the date of approval of the ODS's certification;
14. A list of all states in which the ODS has been or currently is doing business as described in the application; and
15. The information required pursuant to 11:24B-2.4.