N.J.S.A 17:48H-5 Review of application.

17:48H-5 Review of application.

5. Following receipt of an application for certification, the Commissioner of Banking and Insurance shall review it and notify the applicant of any deficiencies contained therein.

a. The Commissioner of Banking and Insurance shall issue a certification to an organized delivery system if the commissioner finds that the system meets the standards provided for in this act, including, but not limited to:

(1) All of the material required by section 4 of this act has been filed;

(2) The persons responsible for conducting the applicant’s affairs are competent, trustworthy, and possess good reputations, and have had appropriate experience, training, and education;

(3) The persons who are to perform the health care services are properly qualified;

(4) The organized delivery system has demonstrated the ability to assure that health care services will be provided in a manner which will assure the availability and accessibility of the services;

(5) The standard forms of provider agreements to be used by the organized delivery system are acceptable; and

(6) The organized delivery system’s contracts to provide services do not entail or will not result in the assumption of financial risk by the system.

b. The commissioner may deny an application for certification if the applicant fails to meet any of the standards provided in this act or on any other reasonable groundS.If certification is denied, the commissioner shall notify the applicant and shall set forth the reasons for the denial in writing. The applicant may request a hearing by notice to the commissioner within 30 days of receiving the notice of denial. Upon such denial, the applicant shall submit to the commissioner a plan for bringing the organized delivery system into compliance or providing for the closing down of its businesS.

L.1999, C. 409, S.5; amended 2012, C. 17, S.41.


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