N.J. Admin. Code § 11:24-2.12

Current through Register Vol. 57, No. 1, January 6, 2025

Section 11:24-2.12 - Examinations

(a) The Department may conduct an examination of the HMO annually, but in no case less than once every three years, concerning the quality of health care services and other affairs of the HMO, including providers with whom such organization has contracts, agreements, or other arrangements. This examination may include, but not be limited to, the review of documents, patient records, information required in N.J.A.C. 11:24-3.6, and conferences with providers and members. The HMO shall be assessed an amount authorized at N.J.S.A. 26:2J-18, as may be amended, to offset the expenses of examination under this section. The fee shall be remitted within 90 days following the date of the assessment.

(b) The Department shall incorporate the annual examination process as described above into the comprehensive assessment review process.

(c) The Department may conduct special examinations at any time to ascertain whether the HMO is in compliance with this chapter and all applicable State and Federal statutes and regulations. A report of this examination shall be provided to the HMO within 30 business days of completion of the special examination. Any violations resulting from this examination shall be identified and responded to in accordance with N.J.A.C. 11:24-2.1 3.

N.J. Admin. Code § 11:24-2.12

Amended by R.2000 d.183, effective 5/1/2000.
See: 31 N.J.R. 953(a), 32 N.J.R. 1544(a).
In (a), deleted "annual fee of $ 1000" following "assessed an" in the third sentence, and rewrote the fourth sentence.