18 Del. Admin. Code § 1403-3.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1403-3.0 - Certificate of Authority

3.1 Each application for a Certificate of Authority as a Managed Care Organization shall be made on Form No. H-1 entitled "Application for Certificate of Authority as a Managed Care Organization" (Exhibit A to this regulation). The application shall be accompanied by the following:

3.1.1 The information specified in 18 Del.C. § 6404 (a);

3.1.2 Evidence of accreditation by a nationally-recognized managed care accrediting organization such as the National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or similar organization;

3.1.3 For Staff Model MCOs, evidence that the MCO satisfies the physical plant requirements of a hospital as specified by the Delaware Department of Health and Social Services;

3.1.4 Copies of management, agency or administrative contracts;

3.1.5 Equifax Reports on Officers/Directors; and/or NAIC biographical or other similar biographical forms, as directed by the Department;

3.1.6 Proof of $50,000 bond for each officer, director, partner, or other individual who receives, collects or invests money;

3.1.7 "Admittance Questionnaire for Certificate of Authority for Managed Care Organization," Form No. H-2 (Exhibit B to this regulation);

3.1.8 "Designation of official authorized to appoint and remove agents," Form No. H-3 (Exhibit C to this regulation);

3.1.9 "Designation of person to receive bulletins, regulations, etc.," Form No. H-4 (Exhibit D to this regulation);

3.1.10 "Designation of person to receive service of process," Form No. H-5 (Exhibit E to this regulation);

3.1.11 "Biographical Affidavit of Officers and Directors" (Exhibit F to this regulation); and

3.1.12 "Power of Attorney Form" (Exhibit G to this regulation).

3.2 Each application for a Certificate of Authority as a Managed Care Organization shall be accompanied by a $750 filing fee in accordance with 18 Del.C. § 6409.

3.3 Each application for a Certificate of Authority as a Managed Care Organization shall be accompanied by a deposit of $100,000 in accordance with 18 Del.C. § 513 (f).

3.4 All of the items and information specified in the foregoing sections 3.1 through 3.3 must be submitted in order for the Department to review an application for a Certificate of Authority.

3.5 Denial of Application for Certificate of Authority

3.5.1 If, within 60 days after a complete application for a Certificate of Authority has been filed, the Department has not issued such certificate, the Department shall immediately notify the applicant, in writing, of the reasons why such certificate has not been issued, and the applicant shall be entitled to request a hearing on the application.

3.5.2 The hearing shall be held within 60 days of the Department's receipt of the applicant's written request therefor. Proceedings in regard to such hearing shall be conducted in accordance with provisions for case decisions as set forth in the Administrative Procedures Act, Chapter 101 of Title 29, and in accordance with applicable rules and regulations of the Department.

18 Del. Admin. Code § 1403-3.0