§ 23-17.12-6 - Denial, suspension, or revocation of certificate. - Rhode Island Statutes

SECTION 23-17.12-6

   § 23-17.12-6  Denial, suspension, orrevocation of certificate. – (a) The department may deny a certificate upon review of the application if,upon review of the application, it finds that the applicant proposing toconduct utilization review does not meet the standards required by this chapteror by any regulations promulgated pursuant to this chapter.

   (b) The department may revoke a certificate and/or imposereasonable monetary penalties not to exceed five thousand dollars ($5,000) perviolation in any case in which:

   (1) The review agent fails to comply substantially with therequirements of this chapter or of regulations adopted pursuant to this chapter;

   (2) The review agent fails to comply with the criteria usedby it in its application for a certificate; or

   (3) The review agent refuses to permit examination by thedirector to determine compliance with the requirements of this chapter andregulations promulgated pursuant to the authority granted to the director inthis chapter; provided, however, that the examination shall be subject to theconfidentiality and "need to know" provisions of subdivisions 23-17.12-9(c)(4)and (5). These determinations may involve consideration of any writtengrievances filed with the department against the review agent by patients orproviders.

   (c) Any applicant or certificate holder aggrieved by an orderor a decision of the department made under this chapter without a hearing may,within thirty (30) days after notice of the order or decision, make a writtenrequest to the department for a hearing on the order or decision pursuant to§ 42-35-15.

   (d) The procedure governing hearings authorized by thissection shall be in accordance with §§ 42-35-9 – 42-35-13 asstipulated in § 42-35-14(a). A full and complete record shall be kept ofall proceedings, and all testimony shall be recorded but need not betranscribed unless the decision is appealed pursuant to § 42-35-15. A copyor copies of the transcript may be obtained by any interested party uponpayment of the cost of preparing the copy or copies. Witnesses may besubpoenaed by either party.