648.05 Permit. - Wisconsin Statutes

648.05

648.05 Permit.

648.05(1)

(1) Permit required. After December 31, 2009, no care management organization may provide services to its enrollees without a permit under this chapter.

648.05(2)

(2) Application. A care management organization applying for a permit shall submit all of the following information in the format required by the commissioner:

648.05(2)(a)

(a) The names, addresses and occupations of all controlling persons and directors and principal officers of the care management organization currently and for the preceding 10 years, unless the commissioner waives this requirement.

648.05(2)(b)

(b) Business organization documents, including articles and bylaws if applicable.

648.05(2)(c)

(c) A business plan approved by the department, including a projection of the anticipated operating results at the end of each of the next 3 years of operation, based on reasonable estimates of income and operating expenses.

648.05(2)(d)

(d) Any other relevant documents or information that the commissioner reasonably requires after consulting with the department.

648.05(3)

(3) Standards for issuing permit. The commissioner may issue a permit to the care management organization if the commissioner finds, after consulting with the department, all of the following:

648.05(3)(a)

(a) All requirements of law have been met.

648.05(3)(b)

(b) All the directors and principal officers or any controlling person are trustworthy and competent and collectively have the competence and experience to engage in the proposed services and are not excluded from participation under 42 USC 1320a-7 or 42 USC 1320a-7a.

648.05(3)(c)

(c) The business plan is consistent with the interests of the care management organization's enrollees and the public.

648.05(4)

(4) Suspension or revocation. The commissioner may suspend or revoke a permit issued under this chapter if the commissioner finds, after consulting with the department, any of the following:

648.05(4)(a)

(a) The permittee violated a law or rule, including a rule establishing standards for the financial condition of care management organizations.

648.05(4)(b)

(b) The permittee is in a financially hazardous condition.

648.05(4)(c)

(c) The permittee is controlled or managed by persons who are incompetent or untrustworthy.

648.05(4)(d)

(d) The permittee conceals records from the commissioner.

648.05(4)(e)

(e) The permittee's business plan is not in the public interest or is not prudent.

648.05(4)(f)

(f) The permittee ceases to be certified by or maintain a contract with the department.

648.05 - ANNOT.

History: 2009 a. 28.