NAC695F.320. List of providers: Submission; changes; excessive reduction.

     1. An applicant for a certificate of authority to operate an organization shall:

     (a) Submit a list of the providers in its limited health service plan and a description of the type of providers based upon a projected number of enrollees;

     (b) Sufficiently describe its list of providers to demonstrate the accessibility and availability of a limited health service to its enrollees; and

     (c) Describe a plan for increasing the number of providers based upon increased enrollment.

     2. An organization shall notify the Commissioner in writing at the end of each quarter of each calendar year of any changes in its list of providers.

     3. Based upon the current list of providers of an organization, an overall reduction in the number of providers in a geographic area of service to a number which reduces the ratio of providers to members below the ratio approved by the Commissioner shall be deemed by the Commissioner to jeopardize the ability of the organization to meet its obligations to its enrollees, unless the organization rebuts this presumption by providing appropriate written information to the Commissioner.

     4. The provisions of subsection 3 do not apply if the organization:

     (a) Notifies the Commissioner in writing;

     (b) Submits information concerning the number of persons enrolled in the organization and the reasons for any reductions; and

     (c) Obtains the approval of the Commissioner for the reduction.

     (Added to NAC by Comm’r of Insurance, eff. 2-3-97)