New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter 2 - ESTABLISHMENT OF HEALTH MAINTENANCE ORGANIZATIONS
Section 11:24-2.7 - Notice of changes in HMO operations
Universal Citation: NJ Admin Code 11:24-2.7
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Following issuance of a certificate of authority, the HMO shall notify the Department, in writing, of any substantial change to items identified at 11:24-2.2(c)1 through 24, at least 30 days prior to the date when such change is expected to occur. The Department shall deem such change approved within 30 days from the date of receipt of notice of the change unless the Department notifies the HMO otherwise. Substantial changes include, but are not limited to:
1. Any change or reduction in the provider
network that adversely impacts network adequacy requirements identified at
N.J.A.C. 11:24-6;
2. The
subcontracting of any major functions not specified at
11:24-2.6(a) to
another entity;
3. The nonrenewal
of a hospital provider's contract which shall be reported in accord with
11:24-3.5(b);
and
4. The establishment of a new
group health center in a county or service area that has previously received
certificate of authority approval for initiation of group health center
services in that area.
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