Section 5: Threat of financial insolvency due to risk-bearing provider organization's alternative payment contracts with downside risk; notice; suspension or cancellation of risk certificate; hearing
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/ma/part-i/title-xxii/chapter-176t/5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 5.
(a)If upon examination or at any other time the commissioner determines that the risk-bearing provider organization's existing or proposed alternative payment contracts with downside risk are likely to threaten the financial solvency of the risk-bearing provider organization, the commissioner shall provide notice to the risk-bearing provider organization.
(b)The commissioner may suspend, cancel, non-renew or refuse to issue a risk-bearing provider organization's risk certificate upon a determination that the risk-bearing provider organization has not cured a threat to financial solvency, that the risk-bearing provider organization's application for a risk certificate is incomplete or contains or is based on fraudulent information, or that the risk-bearing provider organization has otherwise failed to comply with the requirements of this chapter. The commissioner shall notify the risk-bearing provider organization and advise, in writing, of the reason for any refusal to issue or non-renew a risk certificate under this chapter. A copy of the notice shall be forwarded to the commission and center. The applicant or certified risk-bearing provider organization may make written demand upon the commissioner within 30 days of receipt of such notification for a hearing before the commissioner to determine the reasonableness of the commissioner's action. The hearing shall be held pursuant to chapter 30A.
(c)The commissioner shall not suspend or cancel a risk certificate unless the commissioner has first afforded the risk-bearing provider organization an opportunity for a hearing pursuant to chapter 30A.
(d)Upon a ruling by the commissioner to suspend or cancel a risk-I bearing provider organization's certification, a written notice shall be forwarded to the commission and the center.