(a) Within 10 days after receipt of an application for a certificate of authority, the director shall forward a copy of the application to the commissioner of health. Within 60 days after the commissioner of health receives the copy of the application, the commissioner shall make a recommendation regarding the granting of the certificate of authority.
(b) The director shall either issue or deny a certificate of authority within 30 days after receipt of the commissioner of health's recommendation. However, the director may extend the time for issuance or denial of a certificate of authority if additional information is needed in order to make a decision, and notice of the extension is provided to the applicant by the 90th day after the director received the application. A certificate of authority shall be issued if the director determines that the following conditions are met:
(1) the persons responsible for the conduct of the affairs of the applicant are competent and trustworthy;
(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 copayments;
(3) the applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees; in determining if this condition is met, the director may consider
(A) the financial soundness of the arrangements for health care services and the schedule of charges used in connection with those services;
(B) the adequacy of working capital;
(C) an agreement with an insurer, a hospital or medical service corporation, a government, or other organization for ensuring the payment of the cost of health care services or providing for automatic applicability of an alternative coverage if the health maintenance organization is discontinued;
(D) an agreement with providers for the provision of health care services; and
(E) a deposit of cash or securities submitted under AS 21.86.140;
(4) the enrollees will be afforded an opportunity to participate in matters of policy and operation as provided in AS 21.86.040;
(5) nothing in the proposed method of operation, as shown by the information submitted under AS 21.86.010 or by independent investigation, is contrary to the public interest;
(6) the information submitted under AS 21.86.010(b)(12) indicates that the applicant will be able to comply with state and federal statutes and regulations regarding the quality of health care.
(c) If a certificate of authority is denied under this section, the applicant may request a hearing under AS 21.86.200.
Structure Alaska Statutes
Chapter 86. Health Maintenance Organizations
Sec. 21.86.010. Establishment of health maintenance organizations.
Sec. 21.86.020. Issuance of certificate of authority; approval of changes.
Sec. 21.86.030. Powers of a health maintenance organization.
Sec. 21.86.040. Governing body; enrollee participation.
Sec. 21.86.045. Biographical affidavits.
Sec. 21.86.050. Fiduciary responsibility.
Sec. 21.86.060. Provision of services.
Sec. 21.86.070. Evidence of coverage; charges for health care services.
Sec. 21.86.075. Chiropractic health care services.
Sec. 21.86.078. Choice of health care provider.
Sec. 21.86.080. Annual statement; additional reports.
Sec. 21.86.090. Information to enrollees.
Sec. 21.86.100. Complaint system; report.
Sec. 21.86.110. Recovery of health care costs.
Sec. 21.86.120. Return of agreement.
Sec. 21.86.140. Protection against insolvency.
Sec. 21.86.150. Prohibited practices.
Sec. 21.86.160. Regulation of agents.
Sec. 21.86.170. Powers of insurers and of hospital or medical service corporations.
Sec. 21.86.190. Suspension or revocation of certificate of authority.
Sec. 21.86.200. Administrative procedures.
Sec. 21.86.210. Rehabilitation, liquidation, or conservation.
Sec. 21.86.250. Penalties and enforcement.
Sec. 21.86.260. Statutory construction and relationship to other law.
Sec. 21.86.270. Filings and reports as public documents.
Sec. 21.86.290. Contract authority for commissioner of health.
Sec. 21.86.300. Acquisition of control or merger of a health maintenance organization.