NAC695C.1284. Provider-sponsored organization: Grounds for suspension or revocation of certificate; effect of revocation.

     1. The Commissioner may suspend or revoke any certificate of authority issued to a provider-sponsored organization pursuant to the provisions of this chapter if he or she finds that any of the following conditions exist:

     (a) The provider-sponsored organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted pursuant to NAC 695C.111, 695C.115 or 695C.350, unless any amendments to those submissions have been filed with and approved by the Commissioner;

     (b) The provider-sponsored organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

     (c) The continued operation of the provider-sponsored organization would be hazardous to its enrollees; or

     (d) The provider-sponsored organization has otherwise failed to comply substantially with the provisions of this chapter.

     2. A certificate of authority must be suspended or revoked only after compliance with the requirements of NAC 695C.1286.

     3. If the certificate of authority of a provider-sponsored organization is revoked, the provider-sponsored organization shall proceed to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the provider-sponsored organization. The Commissioner may by written order permit such further operation of the provider-sponsored organization as he or she may find to be in the best interest of enrollees to the end that enrollees are afforded the greatest practical opportunity to obtain continuing coverage for health care.

     (Added to NAC by Comm’r of Insurance by R148-99, eff. 1-27-2000)