Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 408 - CERTIFICATE OF QUALITY ASSURANCE OF MANAGED CARE HEALTH INSURANCE PLAN LICENSEES › Part I - Definitions and General Information › Section 12VAC5-408-30 - Certificate of quality assurance

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				  A certificate for quality assurance shall be issued to managed care health
				  insurance plan licensees. The commissioner shall issue or renew a certificate
				  of quality assurance if the MCHIP licensee is in compliance with the applicable
				  law and this chapter. On behalf of the commissioner, and under a written
				  delegation of authority, the department shall examine the applicants and issue
				  the certificates for quality assurance.
B. No certificate of quality assurance may be
				  transferred or assigned without approval of the department.
C. Every certified MCHIP licensee shall file
				  for its certificate of quality assurance with the department biennially,
				  subject to payment of a fee and receipt of all material required by law and
				  this chapter.
D. Upon request, the
				  center will provide an application form for a certificate of quality assurance.
				  The center shall consider the application complete when all the information
				  requested and the application fee are submitted. If the center finds the
				  application incomplete, the applicant will be notified in writing of receipt of
				  the incomplete application.
E. The
				  department shall send an application for renewal of a certificate to the
				  licensee at least 90 days prior to the expiration date of the current
				  certificate.
F. The department
				  shall examine or review each applicant for an initial certificate of quality
				  assurance and periodically for renewal thereof.
G. Upon receipt of a written request from the
				  governing body of an MCHIP licensee, the commissioner, in her sole discretion,
				  may consider a modification and issue a temporary or permanent variance in the
				  application of one or more of these regulations provided patient safety, care,
				  or the ability of an MCHIP licensee to provide, arrange for, or reimburse the
				  cost of services will not be adversely affected. The written request shall
				  identify the reason the MCHIP licensee cannot immediately comply with the
				  specified regulation and how any proposed modification is equal to or will meet
				  the intent of the regulation for which a variance is requested. Upon review of
				  the request, the commissioner may grant a temporary variance for less than a
				  full period of certification, or a permanent variance for a full period of
				  certification, or deny the request. Any temporary or permanent variance granted
				  by the commissioner shall be subject to review and renewal before a certificate
				  renewal, extension or re-issuance is granted.
H. Upon the issuance or renewal of a
				  certificate, the department, on behalf of the commissioner and under a written
				  delegation of authority, shall provide a certificate of quality assurance to
				  the MCHIP licensee and a copy to the Bureau of Insurance.
I. Upon determining to deny or refuse to
				  renew a certificate, the department, on behalf of the commissioner and under a
				  written delegation of authority, shall notify the applicant in writing stating
				  the reasons for the denial of the certificate. A copy of the notification of
				  denial shall be provided to the Bureau of Insurance.
J. Appeals from a notification of denial
				  shall be brought by a certificate applicant pursuant to the process set forth
				  in 12VAC5-408-140.
Statutory Authority
§ 32.1-137.1 of the Code of Virginia.