Section 98-1.7 - Limitations of a certificate of authority

98-1.7 Limitations of a certificate of authority.

(a) A certificate of authority pursuant to this Subpart shall be limited to the proposed article 44 service area described in the application upon which the certificate is issued.

(b) A certified operating MCO which seeks to extend its approved article 44 service area, and has defined a new potential enrolled population therein, shall submit an application, and shall not extend the service area until an amended certificate of authority is issued. An application for extension of the service area shall include:

(1) identification of the new service area for which approval is sought, and the projected enrollment on a monthly basis for three years;

(2) copies of all proposed contracts with providers of services for the proposed new service area; these contracts shall include the provisions in section 98-1.5(b)(6)(i-v);

(3) a list of providers and facilities with whom contracts have been or will be executed, including the location and specialty area of each provider; and

(4) except for PCPCPs, such other information, including financial projections, as the commissioner, in consultation with the superintendent, as appropriate, shall deem necessary to determine the ability of the applicant to make services available and accessible to the identified potential enrollment population, and to otherwise approve the service area expansion application.

Effective Date: 
Wednesday, June 29, 2005
Doc Status: 
Complete