§ 27-41-17 - Suspension or revocation of license. - Rhode Island Statutes

SECTION 27-41-17

   § 27-41-17  Suspension or revocation oflicense. – (a) The director may suspend or revoke any license issued to a healthmaintenance organization under this chapter if the director finds that any ofthe following conditions exist:

   (1) The health maintenance organization is operatingsignificantly in contravention of its basic organizational document, or in amanner contrary to that described in and reasonably inferred from any otherinformation submitted under § 27-41-3, unless amendments to thosesubmissions have been filed with and approved by the director;

   (2) The health maintenance organization issues evidence ofcoverage or uses a schedule of charges for health care services that do notcomply with the requirements of § 27-41-8;

   (3) The health maintenance organization does not provide orarrange for basic health care services;

   (4) The health maintenance organization is no longerfinancially responsible and may reasonably be expected to be unable to meet itsobligations to enrollees or prospective enrollees;

   (5) The health maintenance organization has failed toimplement a mechanism affording the enrollees an opportunity to participate inmatters of policy and operation under § 27-41-6;

   (6) The health maintenance organization has failed toimplement the complaint system required by § 27-41-11 in a manner toreasonably resolve valid complaints;

   (7) The health maintenance organization, or any person on itsbehalf, has advertised or merchandised its services in an untrue,misrepresentative, misleading, deceptive, or unfair manner;

   (8) The continued operation of the health maintenanceorganization would be hazardous to its enrollees; or

   (9) The health maintenance organization has failed tosubstantially comply with this chapter.

   (b) The director of business regulation shall suspend orrevoke any license issued to a health maintenance organization uponcertification by the director of health to the director of business regulationthat:

   (1) The health maintenance organization does not meet therequirements of § 27-41-4(a)(2); or

   (2) The health maintenance organization is unable to fulfillits obligations to furnish health care services.

   (c) A license shall be suspended or revoked only aftercompliance with the requirements of § 27-41-20.

   (d) When the license of a health maintenance organization issuspended, the health maintenance organization shall not, during the period ofthat suspension, enroll any additional enrollees except newborn children orother newly acquired dependents of existing enrollees, and shall not engage inany advertising or solicitation.

   (e) When the license of a health maintenance organization isrevoked, the organization shall proceed, immediately following the effectivedate of the order of revocation, to wind up its affairs, and shall conduct nofurther business except as may be essential to the orderly conclusion of theaffairs of the organization. It shall engage in no further advertising orsolicitation. The director of business regulation may, by written order, permitany further operation of the organization that the director may find to be inthe best interest of enrollees, to the end that enrollees will be afforded thegreatest practical opportunity to obtain continuing health care coverage.