§4219. Administrative procedures
1. When the superintendent has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, the superintendent shall notify the health maintenance organization and the Commissioner of Health and Human Services in writing specifically stating the grounds for suspension or revocation. The Commissioner of Health and Human Services, or the commissioner's designated representative, shall participate in any disciplinary proceedings. In the process of determining whether grounds for suspension or revocation exist the findings of the commissioner with respect to matters relating to the quality of health care services provided are conclusive and binding upon the Superintendent of Insurance. The duration of and conditions attached to any suspension are determined by the superintendent after a hearing held in accordance with Title 5, chapter 375, subchapter IV.
[PL 1997, c. 592, §72 (AMD); PL 2003, c. 689, Pt. B, §7 (REV).]
2. The Superintendent of Insurance, acting in concert with the Commissioner of Health and Human Services, has the authority to amend, modify or refuse to renew any certificate of authority for cause, pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV.
[PL 1977, c. 694, §436 (RPR); PL 2003, c. 689, Pt. B, §7 (REV).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1977, c. 694, §436 (RPR). PL 1997, c. 592, §72 (AMD). PL 2003, c. 689, §B7 (REV).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS
24-A §4202. Definitions (REPEALED)
24-A §4203. Establishment of health maintenance organizations
24-A §4204. Issuance of certificate of authority
24-A §4204-A. Surplus requirements
24-A §4205. Powers of health maintenance organizations
24-A §4205-A. Continuity of licensure; business combinations
24-A §4207. Evidence of coverage and charges for health care services
24-A §4207-A. Point-of-service products
24-A §4208. Annual and interim reports
24-A §4209. Information to enrollees
24-A §4210-A. Continuity of health insurance coverage (REPEALED)
24-A §4212. Prohibited practices
24-A §4213. Regulation of agents
24-A §4214. Powers of insurers and nonprofit hospital or medical service corporations
24-A §4216. Suspension or revocation of certificate of authority
24-A §4217. Rehabilitation, liquidation or conservation of health maintenance organizations
24-A §4218-A. Compliance with the Affordable Care Act
24-A §4219. Administrative procedures
24-A §4221. Penalties and enforcement
24-A §4222. Statutory construction and relationship to other laws
24-A §4223. Filings and reports as public documents
24-A §4224. Confidentiality; liability; access to records
24-A §4224-A. Loss information (REPEALED)
24-A §4225. Commissioner of Health and Human Services' authority to contract
24-A §4226. Federal legislation
24-A §4227. Choice of alternative coverage
24-A §4228. Utilization review data
24-A §4229. Acquired Immune Deficiency Syndrome
24-A §4230. Trade practices and frauds (REPEALED)
24-A §4231. Insolvency or withdrawal; alternative coverage
24-A §4232. Replacement coverage
24-A §4233. Registration, regulation and supervision of holding company systems
24-A §4233-A. Extension of coverage for dependent children
24-A §4233-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
24-A §4233-C. Mandatory offer of coverage for certain adults with disabilities
24-A §4234-A. Mental health services coverage
24-A §4234-B. Maternity and routine newborn care
24-A §4234-C. Newborn children coverage
24-A §4234-D. Off-label use of prescription drugs for cancer
24-A §4234-E. Off-label use of prescription drugs for HIV or AIDS
24-A §4234-F. Maternity and postpartum care
24-A §4235. Standardized claim forms
24-A §4236. Chiropractors in health maintenance organizations
24-A §4237. Coverage for breast cancer treatment
24-A §4237-A. Screening mammograms
24-A §4238. Medical food coverage for inborn error of metabolism
24-A §4239. Medical child support
24-A §4240. Coverage for diabetes supplies
24-A §4241. Gynecological and obstetrical services
24-A §4242. Coverage for Pap tests (REALLOCATED FROM TITLE 24-A, SECTION 4240)
24-A §4243. Limits on priority liens; subrogation
24-A §4244. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 4243)
24-A §4245. NCQA accreditation survey report
24-A §4246. Coverage for services provided by registered nurse first assistants
24-A §4247. Coverage for contraceptives (REALLOCATED FROM TITLE 24-A, SECTION 4245)
24-A §4249. Mandated offer of domestic partner benefits
24-A §4250. Coverage for hospice care services (REALLOCATED FROM TITLE 24-A, SECTION 4249)
24-A §4252. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
24-A §4253. Enrollment for individuals or families establishing eligibility for MaineCare
24-A §4254. Coverage for colorectal cancer screening
24-A §4255. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 4253)
24-A §4257. Coverage for services provided by independent practice dental hygienist
24-A §4258. Coverage for children's early intervention services