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MARVIN MANDEL, Governor 1385
(C) A HEALTH MAINTENANCE ORGANIZATION, BEFORE IT
MAY ISSUE ANY CONTRACT OR CERTIFICATE TO A MEMBER OR
PROVIDE ANY HEALTH CARE SERVICES TO MEMBERS, SHALL OBTAIN
A CERTIFICATE OF AUTHORITY FROM THE COMMISSIONER. EACH
APPLICATION TO THE COMMISSIONER SHALL BE MADE IN THE FORM
REQUIRED BY THE COMMISSIONER AND SHALL INCLUDE, OR BE
ACCOMPANIED BY, THE FOLLOWING INFORMATION:
(1) A COPY OF THE BASIC ORGANIZATIONAL
DOCUMENT OF THE ORGANIZATION AND ANY AMENDMENTS THERETO,
CERTIFIED, WHERE APPLICABLE, BY THE DEPARTMENT OF
ASSESSMENTS AND TAXATION;
(2) A COPY OF THE ORGANIZATION'S CURRENT
BY-LANS (IF ANY), CERTIFIED BY THE APPROPRIATE OFFICER OF
THE ORGANIZATION;
(3) A LIST OF THE NAMES, ADDRESSES, AND
OFFICIAL CAPACITY WITH THE ORGANIZATION OF THE PERSONS
WHO ARE TO BE RESPONSIBLE FOR THE CONDUCT OF ITS AFFAIRS,
INCLUDING ALL MEMBERS OF THE GOVERNING BODY, THE OFFICERS
AND DIRECTORS IN THE CASE OF A CORPORATION, AND THE
PARTNERS OR ASSOCIATES IN THE CASE OF A PARTNERSHIP OR
ASSOCIATION. THESE PERSONS SHALL DISCLOSE FULLY TO THE
COMMISSIONER AND THE GOVERNING BODY OF THE ORGANIZATION
THE EXTENT AND NATURE OF ANY CONTRACTS OR ARRANGEMENTS
BETWEEN THEM AND THE ORGANIZATION, INCLUDING ANY POSSIBLE
CONFLICTS OF INTEREST;
(4) A RESUME OF THE QUALIFICATIONS OF THE
ADMINISTRATOR, THE MEDICAL DIRECTOR, THE ENROLLMENT
DIRECTOR, AND OF OTHER PERSONS ASSOCIATED WITH THE
ORGANIZATION THE COMMISSIONER AND THE DEPARTMENT OF
HEALTH AND MENTAL HYGIENE REQUESTS IN ACCORDANCE WITH
JOINT INTERNAL ADMINISTRATIVE RULES AND PROCEDURES;
(5) A STATEMENT GENERALLY DESCRIBING:
(I) THE ORGANIZATION;
(II) THE ORGANIZATION'S OPERATIONS;
(III) THE ORGANIZATION'S ENROLLMENT
PROCESS;
(IV) THE ORGANIZATION'S QUALITY
ASSURANCE MECHANISM;
(V) THE ORGANIZATION'S INTERNAL
GRIEVANCE PROCEDURES;
(VI) THE METHODS THE ORGANIZATION
PROPOSES TO USE TO OFFER ITS MEMBERS OR PUBLIC
REPRESENTATIVES AN OPPORTUNITY TO PARTICIPATE IN MATTERS
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