20-1065

20-1065. Suspension or revocation of
certificate of authority; civil penalties

A. The director may suspend or revoke any certificate of authority issued to a
health care services organization under this article if the director finds that any of
the following conditions exists:

1. The health care services organization is operating significantly in
contravention of its basic organizational documents or in a manner contrary to that
described in, and reasonably inferred from, any other information submitted under section
20-1053.

2. The health care services organization issues evidences of coverage that do not
comply with the requirements of section 20-1057.

3. The health care plan does not constitute an appropriate mechanism to achieve an
effective health care plan pursuant to this title or any rule that is adopted by the
director.

4. The health care services organization can no longer be expected to meet its
obligations to enrollees or prospective enrollees.

5. The health care services organization, or any authorized person on its behalf,
has advertised or merchandised its services in a materially untrue, misleading, deceptive
or unfair manner.

6. The health care services organization has failed to substantially comply with
this article or any rule that is adopted pursuant to this article.

7. The health care services organization is in unsound condition or in such
condition as to render its further transaction of business in this state hazardous to its
enrollees or to the residents of this state.

B. If the certificate of authority of a health care services organization is
suspended, the health care services organization shall not enroll, during the
period of such suspension, any additional enrollees except newborn children or other
newly acquired dependents of existing enrollees and shall not engage in any advertising
or solicitation.

C. If the certificate of authority of a health care services organization is
revoked, the organization shall proceed, immediately following the effective date of the
order of revocation, to conclude its affairs and shall conduct no further business except
as may be essential to the orderly conclusion of solicitation. The director, by written
order, may permit such further operation of the organization as the director may find to
be in the best interest of enrollees to the end that enrollees shall be afforded the
greatest practical opportunity to obtain continuing health care coverage.

D. Notwithstanding subsections B and C of this section, a health care services
organization that has had its certificate of authority denied, suspended or revoked is
entitled to a hearing pursuant to title 41, chapter 6, article 10 and, except as provided
in section 41-1092.08, subsection H, is entitled to judicial review pursuant to title 12,
chapter 7, article 6.

E. If, after a hearing, the director finds grounds pursuant to subsection A of this
section to suspend or revoke a health care services organization's certificate of
authority, the director may impose, in lieu of or in addition to that suspension or
revocation, the following civil penalties that shall be remitted to the state treasurer
for deposit, pursuant to sections 35-146 and 35-147, in the state general fund:

1. For an unintentional violation, not more than one thousand dollars for each
violation and not more than an aggregate of ten thousand dollars in any six month period.

2. For an intentional violation, not more than five thousand dollars for each
violation and not more than an aggregate of fifty thousand dollars in any six month
period.

F. Unless preempted under federal law or unless federal law imposes greater
requirements than this section, this section applies to a provider sponsored health care
services organization.