Section 20A. If the commissioner is satisfied, upon examination or other evidence submitted to him, that (1) any health maintenance organization is insolvent or is in an unsound financial condition, (2) its business policies or methods are unsound or improper, (3) its condition or management is such as to render its further transaction of business hazardous to the public or its members or creditors, (4) it is transacting business fraudulently, (5) the health maintenance organization or its officers or agents have refused to submit to an examination under section 10 or to perform any legal obligation relative thereto, (6) the amount of its funds, net cash or contingent assets is deficient, (7) the health maintenance organization has attempted or is attempting to compromise with its creditors on the ground that it is financially unable to pay its claims in full, or (8) the health maintenance organization has inadequately reserved for unearned premiums, he may seek administrative supervision, rehabilitation or liquidation pursuant to section 20 or revoke or suspend the license issued to the health maintenance organization under section 14 for a period not exceeding the unexpired terms thereof.
In the case of revocation or suspension, the commissioner shall give written notice to the company specifying the date on which such revocation or suspension shall be effective, the term of any such suspension and the ground for such revocation or suspension; provided, that if the ground for revocation or suspension is that the health maintenance organization has violated any provision of law or has failed to comply with its charter, the effective date of such revocation or suspension shall be not less than 10 days from the date of issue of the notice, and the particulars of such violation or failure to comply with its charter shall be specified in said notice. Such notice may be served by registered mail, sent postage prepaid, addressed to the health maintenance organization at its last home office address or to the last known address of the resident agent. An affidavit of the commissioner, in such form as he may prescribe, or of anyone authorized by him to give such notice, appended to a copy thereof, that such notice has been mailed as aforesaid shall be prima facie evidence that such notice has been duly given. He shall also cause notice of such revocation or suspension to be published in such manner as he may deem necessary for the protection of the public. A health maintenance organization aggrieved by a revocation or suspension of its license under this section, may within 10 days from the effective date of such revocation or suspension file a petition in the supreme judicial court for the county of Suffolk for a review of such action of the commissioner. The court shall summarily hear and determine the question whether the ground for revocation or suspension specified in the notice of the commissioner exists and may make any appropriate order or decree. If the order or decree is adverse to the petitioning health maintenance organization it may within 10 days therefrom appeal to the full court and in case of such an appeal the revocation or suspension of the license of the health maintenance organization shall continue in full force until the final determination of the question by the full court, unless vacated by the commissioner during the pendency of such appeal.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176g - Health Maintenance Organizations
Section 2 - Application of Laws
Section 3 - Organization; Accounting; Contracts
Section 4 - Required Coverage for Certain Conditions and Groups
Section 4a - Employees Terminated Due to Plant Closings; Coverage
Section 4b - Confidentiality of Information; Mental or Nervous Condition; Exceptions
Section 4c - Home Care Benefits
Section 4d - Nonprescription Enteral Formulas for Home Use
Section 4e - Off-Label Drug Use; Cancer Treatment
Section 4f - Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants
Section 4g - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment
Section 4h - Items Medically Necessary for Diagnosis and Treatment of Diabetes
Section 4i - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care
Section 4j - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment
Section 4k - Newborn Hearing Screening Tests
Section 4l - Coverage for Hospice Services
Section 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS
Section 4p - Patient Care Services Provided Pursuant to Qualified Clinical Trials
Section 4q - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing
Section 4s - Coverage for Prosthetic Devices and Repairs
Section 4t - Coverage for Eligible Dependents Under 26 Years of Age
Section 4u - Coverage for Medically Necessary Hypodermic Syringes or Needles
Section 4v - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder
Section 4w - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate
Section 4x - Coverage for Orally Administered Anticancer Medications
Section 4y - Coverage for Abuse Deterrent Opioid Drug Products
Section 4z - Preauthorization for Substance Abuse Treatment Not to Be Required
Section 4aa - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services
Section 4bb - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease
Section 4ee - Pain Management Access Plans
Section 4ff - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products
Section 4hh - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs
Section 4ii - Coverage for Prescription Eye Drops
Section 5 - Emergency Services Provided to Members for Emergency Medical Conditions
Section 5a - Divorced or Separated Spouses; Coverage
Section 6a - Group Health Maintenance Contracts; Contribution Percentages
Section 6b - Retroactive Claims Denials for Behavioral Health Services
Section 8 - Public Dissemination of Deceptive or Misleading Materials
Section 9 - Trade Regulation Practices; Application of Law
Section 10 - Reports; Audits, Examinations or Inspections; Confidentiality and Privilege
Section 11 - Contracts With Group Insurance Commission or Local Governments
Section 11a - Alternative Dental Coverage Option
Section 12 - Health Regulations Not Limited
Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner
Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner
Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles
Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults
Section 17 - Rules and Regulations; Standardized Claim Form
Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination
Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract
Section 23 - Insolvency of Health Maintenance Organization; Replacement Coverage
Section 25 - Net Worth of Health Maintenance Organization
Section 26 - Deposit Maintained With Trustee Acceptable to Commissioner
Section 27 - Merger or Acquisition of Control
Section 28 - Registration With Commissioner
Section 30 - Statement for Individuals Provided With Creditable Coverage; Reporting
Section 31 - Attribution of Members to a Primary Care Provider