State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_131E > GS_131E-279

§ 131E‑279. Approval.

(a)        Unless otherwise required by federal law, the Division shallbe the agency of the State that shall license provider sponsored organizationsthat seek to contract with the federal government to provide health careservices directly to Medicare beneficiaries under the Medicare+Choice program.

(b)        Provider sponsored organizations which have been granted awaiver pursuant to 42 U.S.C. § 1395w‑25(a)(2) and which otherwise meetthe requirements of the PSO's Medicare contract shall be deemed by the State tobe licensed under this Article for so long as the waiver or Medicare contractremains in effect. The foregoing shall not limit the Division's authority toregulate such PSOs and their respective sponsoring providers and affiliated providersas may be permitted in 42 U.S.C. § 1395w‑25(a)(2)(G) or the PSO'sMedicare contract.

(c)        The Division shall license a PSO as a risk‑bearingentity eligible to offer health benefits coverage in this State to Medicarebeneficiaries if the PSO complies with the requirements of this Article. Thislicense shall be granted or denied by the Division not longer than 90 daysafter the receipt of a substantially complete application for licensing. Within45 days after the Division receives an application for licensing, the Divisionshall either notify the applicant that the application is substantiallycomplete, or clearly and accurately specify in writing to the applicant alladditional specific information required by the applicant to make theapplication a substantially completed application. This agency response shallset forth a date and time for a meeting within 30 days after it is sent to theapplicant, at which a representative of the Division will explain withparticularity the additional information required by the Division in theresponse to make the application substantially complete. The Division shall bebound by the response unless the Division determines that it must be modifiedin order to meet the purposes of this Article. The Division shall not delegatethe authority to modify the response. If an applicant provides the additionalinformation set forth in the response, the application shall be consideredsubstantially complete. If the Division has not acted on an application within90 days after it is deemed substantially complete, the Division shallimmediately issue a license to the applicant, and the applicant shall beconsidered to have been licensed by the Division. Any reapplication whichcorrects the deficiencies which were specified by the Division in the responseshall be approved by the Division.

(d)        For purposes of determining, under 42 U.S.C. § 1395w‑25(a)(2)(B),or any successor thereof, the date of receipt by the State of a substantiallycomplete application, the date the Division receives the applicant's writtenresponse to the agency response or an earlier date considered by the Divisionshall be considered to be that date. The foregoing shall not limit theDivision's authority to consider an application not substantially complete undersubsection (c) of this section if the applicant's response to the response doesnot provide substantially the information specified in the response.

(e)        A license shall be denied only after the Division complieswith the requirements of G.S. 131E‑305. (1998‑227, s. 1.)