Rule 120-2-80-.04 - Modification of Operation of Plan after Certification(1) A managed care entity shall file supporting documentation for any substantial modification of its managed care plan or plans with the Commissioner. Such documentation shall describe changes in operations and update any previous filings made by the managed care entity for the affected managed care plan or plans. Substantial modification includes, but is not limited to, the following: (a) Broad substitution, merger or other change in hospital, physician network or ancillary services provider or network;(b) Changes in subcontracting providers for utilization review or administrative services; or(c) Other changes affecting the content, rules or procedures of any of the above entities.(2) All proposed substantial modifications which are voluntary must be submitted for the Commissioner's approval at least sixty (60) days prior to proposed changes, and must clearly indicate the nature, level and scope of changes. Managed care entities may not adopt substantial modifications which are voluntary prior to receiving approval from the Commissioner.(3) Modifications reflecting changes not under the control of the managed care entity should be filed with the Commissioner as soon as possible.Ga. Comp. R. & Regs. R. 120-2-80-.04
O.C.G.A. Secs. 33-2-9, 33-20A-2, 33-20A-4, 33-20A-5.
Original Rule entitled "Modification of Operation of Plan after Certification" adopted. F. Mar. 20, 1998; eff. Apr. 9, 1998.