State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_131E > GS_131E-280

§ 131E‑280. Applicants for license.

Each application for licensing as a provider sponsored organizationauthorized to do business in North Carolina shall be certified by an officer orauthorized representative of the applicant, shall be in a form prescribed bythe Division, and shall be set forth or be accompanied by the following:

(1)        A copy of the basic organizational document, if any, of theapplicant and each sponsoring organization that holds greater than a fivepercent (5%) interest in the PSO, such as the articles of incorporation,articles of organization, partnership agreement, trust agreement, or otherapplicable documents, and all amendments thereto;

(2)        A copy of the respective bylaws, rules and regulations, orsimilar documents, if any, regulating the conduct of the internal affairs ofthe applicant and each sponsoring provider which holds greater than a fivepercent (5%) interest in the PSO;

(3)        Copies of the document evidencing the arrangements betweenthe applicant and each sponsoring provider that create the relationships andobligations described in G.S. 131E‑276(1);

(4)        A list of the names, addresses, and official positions ofpersons who are to be responsible for the conduct of the affairs of theapplicant and of each sponsoring provider that holds greater than a fivepercent (5%) interest in the PSO, respectively, including all members of therespective boards of directors, boards of trustees, executive committees, orother governing boards or committees, the principal officers in the case of acorporation, and the partners or members in the case of a partnership orassociation;

(5)        A copy of any contract form made or to be made between anyclass of providers and the PSO and a copy of any contract form made or to bemade between third‑party administrators, marketing consultants, orpersons listed in subdivision (3) of this subsection and the PSO;

(6)        A statement generally describing the provider sponsoredorganization, its sponsoring providers, its health care plan or plans,facilities, and personnel and certifying that its medical director or otherperson charged with determining and overseeing the PSO's medical policies is amedical doctor holding an unrestricted license to practice medicine underArticle 1 of Chapter 90 of the General Statutes;

(7)        A copy of the hospital license of each sponsoring providerthat is a hospital, a copy of the license to practice medicine of eachsponsoring provider or owner of a sponsoring provider that is a licensedphysician, and a copy of the health care service or facility license held byany other licensed sponsoring provider;

(8)        Financial statements showing the applicant's assets,liabilities, sources of financial support, and the financial statements of eachsponsoring provider that holds greater than a five percent (5%) interest in thePSO showing the sponsoring provider's assets, liabilities, and sources ofsupport. If the applicant's or any such sponsoring provider's financial affairsare audited by independent certified public accountants, a copy of theapplicant's or sponsoring provider's most recent regular certified financialstatement shall be considered to satisfy this requirement unless the Divisiondirects that additional or more recent financial information is required forthe proper administration of this Article;

(9)        If the applicant's obligations under G.S. 131E‑282,131E‑283, 131E‑297, 131E‑298, and 131E‑299 areguaranteed by one or more guarantors:

a.         Documentation that each guarantor meets the followingrequirements:

1.                     Theguarantor is a legal entity authorized to conduct business in North Carolina.

2.                     Theguarantor is not under federal bankruptcy or State receivership orrehabilitation proceedings.

3.                     Theguarantor has a net worth, not including other guarantees, intangibles, andrestricted reserves, equal to three times the amount of the PSO's guarantee.

b.         Financial statements showing each guarantor's assets,liabilities, and source of financial support.

c.         If a guarantor's financial affairs are audited byindependent certified public accountants, a copy of the guarantor's most recentregular audited financial statement shall be considered to satisfy thisrequirement unless the Division directs that additional or more recentfinancial information is required for the proper administration of thisArticle.

d.         The guarantee document, including a statement of thefinancial obligation covered by the guarantee, an agreement to unconditionallyfulfill the financial obligations covered by the guarantee, an agreement not tosubordinate the guarantee to any other claim on the resources of the guarantorand a declaration that the guarantor must act on a timely basis to satisfy thefinancial obligations covered by the guarantee.

(10)      A financial plan, satisfactory to the Division, covering thefirst 12 months of operation under the PSO's Medicare contract and which meetsthe requirements of G.S. 131E‑283. If the financial plan projects losses,the financial plan must cover the period through 12 months beyond the projectedbreakeven;

(11)      A statement reasonably describing the geographic area orareas to be served;

(12)      A description of the procedures to be implemented to meet theprotection against insolvency requirements of G.S. 131E‑298; and

(13)      Any other information the Division may require to make thedeterminations required in G.S. 131E‑282. (1998‑227, s. 1.)