MARVIN MANDEL, Governor

1395

REGULATIONS, AS THEY MAY APPLY TO ANY HEALTH MAINTENANCE
ORGANIZATION OR A FACET THEREOF.

(2)                 UNDER THIS SUBTITLE, ONLY THE
COMMISSIONER MAY ISSUE, SUSPEND, OR REVOKE A CERTIFICATE
OF AUTHORITY OF A HEALTH MAINTENANCE ORGANIZATION.

(3)            UNDER THE JOINT INTERNAL ADMINISTRATIVE
RULES AND PROCEDURES, MEANS OF PROVIDING TIMELY
COMMUNICATION SHALL BE ESTABLISHED AND MAINTAINED BETWEEN
THE COMMISSIONER AND THE DEPARTMENT OF HEALTH AND MENTAL
HYGIENE ON MATTERS AFFECTING ANY HEALTH MAINTENANCE
ORGANIZATION, INCLUDING IMPORTANT ACTIONS, CHANGES OR
REARRANGEMENTS A HEALTH MAINTENANCE ORGANIZATION MAY
UNDERTAKE OR ANY REGULATORY PROBLEMS THAT MAY AFFECT ANY
FUNCTION OR FACET OF THE ORGANIZATION.

(4)            REGULATORY OR ADMINISTRATIVE ACTIONS
UNDER THE JURISDICTION OF THE DEPARTMENT OF HEALTH AND
MENTAL HYGIENE CONCERNING A FUNCTION OR FACET OF A HEALTH
MAINTENANCE ORGANIZATIONS OPERATION, IN TOE ABSENCE OF
THE ORGANIZATION'S ABILITY TO MAKE CORRECTIVE CHANGES OR
NEW ARRANGEMENTS SATISFACTORY TO THE DEPARTMENT, WHICH
ENTAIL A WRITTEN DIRECTIVE SETTING FORTH SUBSTANTIATED
REASONS AND RECOMMENDATIONS TO THE COMMISSIONER SHALL
REQUIRE THE COMMISSIONER TO ISSUE APPROPRIATE ORDERS
ACCORDINGLY, INCLUDING THE SUSPENSION OR REVOCATION OF
THE ORGANIZATION'S CERTIFICATE OF AUTHORITY[[.]] .
[[SHALL]] [[OBLIGE THE COMMISSIONER TO ISSUE APPROPRIATE
ORDERS ACCORDINGLY,        INCLUDING THE SUSPENSION OR
REVOCATION OF THE ORGANIZATION'S CERTIFICATE OF
AUTHORITY.]] [[THE COMMISSIONER SHALL BE REQUIRED TO
TAKE THE ACTION ORDERED BY THE SECRETARY OF HEALTH AND
MENTAL HYGIENE, INCLUDING THE SUSPENSION OR REVOCATION OF
THE ORGANIZATION'S CERTIFICATE OF AUTHORITY.]]

(5)                   FOR          EACH          HEALTH          MAINTENANCE
ORGANIZATION, ALL ULTIMATE ACTUARIAL AND FINANCIAL
EVALUATIONS AND DETERMINATIONS REPOSE WITH THE STATE
INSURANCE COMMISSIONER. FOR THE PROTECTION OF THE PUBLIC
AND OF THE ORGANIZATION'S SUBSCRIBERS AND MEMBERS, THE
COMMISSIONER HAS THE RESPONSIBILITY OF DETERMINING THAT
THE HEALTH MAINTENANCE ORGANIZATION IS OR WILL BE IN
POSITION TO PROVIDE A FISCALLY SOUND OPERATION AND
ADEQUATE PROVISION AGAINST THE RISK OF INSOLVENCY.

850.

(A) UPON SATISFACTORY EVIDENCE THAT ANY HEALTH
MAINTENANCE ORGANIZATION HAS: (1) VIOLATED ANY
PROVISION OF THIS SUBTITLE OR ANY RULE OR REGULATION
PROMULGATED HEREUNDER; (2) FAILED TO FULFILL ITS
OBLIGATIONS TO FURNISH THE HEALTH CARE SERVICES SPECIFIED
IN ITS CONTRACTS WITH SUBSCRIBERS; (3) MADE ANY FALSE