Louisiana Revised Statutes 22:248 – Issuance of certificate of authority
Terms Used In Louisiana Revised Statutes 22:248
- Basic health care services: means emergency care, inpatient hospital and physician care, outpatient medical and chiropractic services, and laboratory and x-ray services. See Louisiana Revised Statutes 22:242
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:242
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Enrollee: means an individual who is enrolled in a health maintenance organization. See Louisiana Revised Statutes 22:242
- Health care services: means any services rendered by providers which include but are not limited to medical and surgical care; psychological, optometric, optic, chiropractic, podiatric, nursing, and pharmaceutical services; health education, rehabilitative, and home health services; physical therapy; inpatient and outpatient hospital services; dietary and nutritional services; laboratory and ambulance services; and any other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability. See Louisiana Revised Statutes 22:242
- Health maintenance organization: means any corporation organized as either a business corporation or a nonprofit corporation and domiciled in this state which undertakes to provide or arrange for the provision of basic health care services to enrollees in return for a prepaid charge. See Louisiana Revised Statutes 22:242
- Provider: means any physician, hospital, or other person, organization, institution, or group of persons licensed or otherwise authorized in this state to furnish health care services. See Louisiana Revised Statutes 22:242
- Secretary: means the secretary of the Louisiana Department of Health. See Louisiana Revised Statutes 22:242
A. Within ninety days of receipt of a completed application, the commissioner shall issue a certificate of authority to do business in the state to a corporation filing an application and paying the prescribed fees, if the commissioner determines 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 applicant will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for co-payments.
(3) The applicant is financially responsible and may 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 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 hospital or medical service corporation, a government, or any other organization for insuring the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the health maintenance organization.
(d) Any agreement between a health maintenance organization and providers for the provision of health care or other related services which holds the enrollee harmless from liability of any kind to the provider or any other third party for services rendered to the enrollee.
(e) Any deposit of cash or securities submitted in accordance with La. Rev. Stat. 22:254.
B. A copy of each certificate of authority shall be filed by the commissioner with the secretary.
C. Every certificate of authority issued under this Subpart shall remain in effect until revoked or suspended by the commissioner.
Acts 1986, No. 1065, §1; Redesignated from La. Rev. Stat. 22:2005 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
NOTE: Former La. Rev. Stat. 22:248 redesignated as La. Rev. Stat. 22:2246 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.