§ 301.43. Review by the Department.
(a) Before the Department issues a certificate of authority, a thorough review will be made to determine whether the proposed HMO, the plan under which it proposes to operate and the services which it proposes to provide are consistent with the act and this chapter.
(b) Within 10 business days of receiving an application for a certificate of authority, the Department will determine whether the application contains the items listed in § 301.42 (relating to content of application for certificate of authority). If the Department determines that the application is not complete, it will send a written request to the applicant corporation stating specifically what additional information is needed.
(c) The application for a certificate of authority will not be considered complete until the additional information is received by the Department.
(d) Upon receipt of a completed application for a certificate of authority, the Department will publish a notification of receipt of the filing in the Pennsylvania Bulletin in order to provide an opportunity for public comment.
(e) Within 90 days of receipt of a completed application for a certificate of authority, the Secretary and Commissioner will jointly do either of the following:
(1) Approve the application and issue a certificate of authority.
(2) Disapprove the application specifying in writing the reasons for the disapproval. Disapproval of an application may be appealed under 2 Pa.C.S. (relating to administrative agency law and procedure).
(f) The Department may conduct an examination of the books and papers of the proposed HMO to determine its financial ability to carry out its required functions.
(g) The Department may inspect the site or proposed site of the HMO’s facilities to determine its ability to carry out its required functions.
(h) The Department may hold a public hearing to obtain additional information about a proposed HMO. The Department, whenever possible and appropriate, will attempt to hold joint hearings with the Department of Health.
(1) If the Department decides to hold a public hearing, notification in writing will be provided to the applicant corporation by certified mail at least 10 days prior to the hearing.
(2) Notice of the hearing will also be published in the Pennsylvania Bulletin at least 10 days prior to the hearing.
(3) The hearing will be conducted as soon as possible, but no earlier than 10 business days after written notice has been provided to the applicant corporation.
(i) The Department will confer with and coordinate its investigation with the Secretary.
Source The provisions of this § 301.43 adopted February 20, 1987, effective February 21, 1987, 17 Pa.B. 807.
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