Current through Register Vol. 56, No. 24, December 18, 2024
(a) The
Department may suspend or revoke the certification of a CODS upon a finding
that:
1. The ODS is operating in
contravention of its basic organizational documents;
2. The ODS is unable to fulfill its
obligations to the carriers with which it has contracted;
3. The continued operation of the ODS would
be detrimental to the carriers with which it has contracted to provide
services, or hazardous to the health and welfare of the covered persons of the
carriers with which the ODS has contracted to provide services;
4. The ODS is unable to maintain the
standards applicable to it in this chapter;
5. The ODS has failed to comply with the
applicable provisions of
N.J.S.A. 26:2S-1 et seq., and rules
promulgated pursuant thereto;
6.
The ODS has failed to provide the services for which it was certified and has
provided services in contravention of the contract or contracts filed with the
Department, or the ODS has provided services pursuant to management agreements
or provider agreements for which the ODS has not been approved;
7. The ODS has failed to comply with the Act,
or with other applicable law not otherwise enumerated in (a)1 through 6 above;
or
8. There are other grounds that
the Department believes reasonably warrant suspension or revocation of the
certification.
(b) When
the Department orders a suspension or revocation of a certification, it shall
do so in writing setting forth the grounds for the suspension or revocation,
and setting forth a time for a hearing to be conducted in accordance with the
Administrative Procedure Act,
N.J.S.A. 52:14B-1 et seq., and the Uniform
Administrative Procedure Rules, N.J.A.C. 1:1.
1. The suspension or revocation shall be
effective no later than 10 days following the date of the written notice, but
the effective date may be stayed until a final decision is issued following a
hearing upon the written request of the ODS, unless the Department determines
in writing that a stay of the suspension or revocation would be hazardous to
the carrier(s) with which the ODS does business, or the covered persons of such
carrier(s).
2. The ODS may waive
its right to a hearing by providing affirmative notice of such a waiver to the
agency issuing the notice of the suspension or revocation.
3. Unless the ODS waives its right to a
hearing, the ODS shall submit with its request for the hearing, a written
response to the notice of suspension or revocation either accepting or denying
the findings set forth in the notice of suspension or revocation, and with
respect to denials of the findings, specifying the factual and legal bases on
which the ODS relies for denial of the findings.
(c) If an ODS' certification is revoked, the
ODS shall submit to the Department within 15 days of the date of notice of the
revocation, a plan for the winding-up of the ODS' affairs, and the ODS shall
conduct no further business subject to the Act regardless of whether the
revocation is stayed pending a hearing.
1.
The ODS shall not engage in any business subject to the Act that is in addition
to the business in which it was engaged on the date of the order of revocation,
except that, if the Department stays the revocation pending the outcome of a
hearing, the ODS may provide services to new covered persons of the carrier(s)
with which it is contracted on the date of the order of revocation, unless the
order specifies otherwise.
2. The
ODS' plan to wind-up its business subject to the Act shall specify the means by
which the ODS shall assure continuity of care for a carrier's covered persons,
unless the order of revocation finds that the provision of continuity of care
by the ODS would be hazardous to the carrier or the carrier's covered
persons.
3. The ODS may request in
writing that the Department approve the ODS to continue engaging in activities
with carriers, which activities are not otherwise essential to the winding up
of the ODS' business subject to the Act and the Department may grant such a
request in its discretion.
4. The
Department may permit or require an ODS to continue to engage in activities
that are essential to the winding-up of an ODS' business subject to the Act, or
additional activities, if the Department determines in writing that the
performance of such activities are in the best interests of the covered persons
of one or more carriers with which the ODS has a contract.
(d) The Department shall provide written
notice to carriers contracted with an ODS of the suspension or revocation of
the ODS' certification, and the proceedings therefor, except that the
Department shall be obligated to notify only those carriers of which the
Department has specific notice of a contract with the ODS.
1. The Department shall not be obligated to
notify any other party doing business with the ODS of the suspension or
revocation of the certification of the ODS.
