NAC695C.1225. Provider-sponsored organization: Transmittal of information to State Board of Health; conditions for issuance of certificate.

Upon the receipt of an application for a certificate of authority, the Commissioner will transmit a copy of the application and any accompanying documents to the State Board of Health for informational purposes. The Commissioner will issue or deny a certificate of authority to any person filing an application pursuant to NAC 695C.111 within 90 days after the date that the Commissioner receives the application for a certificate of authority to operate as a provider-sponsored organization. A certificate of authority must be issued upon payment of the fees prescribed in NAC 695C.365 if the Commissioner is satisfied that the following conditions are met:

     1. The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy and possess good reputations.

     2. The provider-sponsored organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. In making this determination, the Commissioner may consider:

     (a) The financial soundness of the arrangements of the health care plan for health care services and the schedule of charges used in connection therewith;

     (b) The adequacy of working capital;

     (c) Any agreement with an insurer, a government or any other organization for insuring the payment of the cost of health care services;

     (d) Any agreement with providers for the provision of health care services; and

     (e) Any surety bond or deposit of cash or securities to guarantee that the obligations will be duly performed.

     3. Nothing in the proposed method of operation, as shown by the information submitted pursuant to NAC 695C.111, 695C.115 and 695C.350 or by independent investigation, is contrary to the public interest.

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