N.J.S.A 17:48H-7 Suspension, revocation of certification, grounds.

17:48H-7 Suspension, revocation of certification, grounds.

7. The Commissioner of Banking and Insurance may suspend or revoke a certification issued to an organized delivery system pursuant to this act upon the commissioner’s determination that:

a. The certified organized delivery system is operating in contravention of its basic organizational documents;

b. The certified organized delivery system is unable to fulfill its obligations to the carriers with whom it contracts;

C. The continued operation of the certified organized delivery system would be hazardous to the health and welfare of the enrollees or contract holders to whom it is obligated to provide health care services or detrimental to a carrier with whom it has contracted to provide the services;

d. The certified organized delivery system is unable to maintain the standards as set forth by the commissioner by regulation;

e. The certified organized delivery system has failed, as provided by the contract, to comply with the provisions of Phamplet Law 1997, Chapter 192 (C. 26:2S-1 Short title et seq.);

f. The certified organized delivery system has failed to provide the health care services for which it has been certified or has provided health care services which are in contravention of the contract or contracts filed with the commissioner;

g. The certified organized delivery system has otherwise failed to comply with this act or with other applicable law; or

h. There are other reasonable grounds that warrant suspension or revocation.

L.1999, C. 409, S.7; amended 2012, C. 17, S.43.

Case(s):

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