Section 602 – Enforcement by department — Rulemaking.
Effective 7/17/2016 31A-44-602. Enforcement by department — Rulemaking. (1) Subject to the requirements of Title 63G, Chapter 4, Administrative Procedures Act, the department may: (a) receive and act on a complaint from a resident about a provider or a facility; (b) take action designed to obtain voluntary compliance by the provider with this chapter for […]
Section 603 – Examinations.
Effective 5/9/2017 31A-44-603. Examinations. (1) The department may conduct periodic on-site examinations of a provider. (2) In conducting an examination, the department or the department’s staff: (a) shall have full and free access to all the provider’s records; and (b) may summon and qualify as a witness, under oath, and examine, any director, officer, member, […]
Section 604 – Criminal and civil penalties.
Effective 5/10/2016 31A-44-604. Criminal and civil penalties. (1) A person who knowingly violates this chapter or files materially false information with a registration application or renewal under this chapter is: (a) guilty of a class B misdemeanor; and (b) subject to revocation of the person’s registration under this chapter. (2) Subject to Title 63G, Chapter […]
Section 605 – Civil liability.
Effective 7/17/2016 31A-44-605. Civil liability. (1) A provider who enters into a continuing care contract with an individual without complying with the disclosure statement requirement described in this chapter, or who makes a continuing care contract with an individual who relies on a disclosure statement that misstates or omits a material fact, is liable to […]
Section 103 – Managed care contract standards.
Effective 1/1/2018 31A-45-103. Managed care contract standards. The commissioner shall adopt rules relating to standards for the manner and content of policy provisions, and disclosures to be made in connection with the sale of policies covered by this chapter, dealing with at least the following matters: (1) terms of renewability; (2) initial and subsequent conditions […]
Section 201 – Applicability to other provisions of law — Commissioner discretion.
Effective 1/1/2018 31A-45-201. Applicability to other provisions of law — Commissioner discretion. (1) Except for exemptions specifically granted under this title, a managed care organization is subject to regulation under all of the provisions of this title. (2) The commissioner may by rule waive other specific provisions of this title that the commissioner considers inapplicable […]
Section 301 – Written contracts — Limited liability of enrollee — Provider claim disputes — Leased networks.
Effective 1/1/2018 31A-45-301. Written contracts — Limited liability of enrollee — Provider claim disputes — Leased networks. (1) A managed care organization may not contract with a health care provider for treatment of illness or injury unless the health care provider is licensed to perform that treatment. Every contract between a managed care organization and […]
Section 302 – Provider payment information — Notice of admissions.
Effective 1/1/2018 31A-45-302. Provider payment information — Notice of admissions. (1) (a) A managed care organization shall provide the managed care organization’s network providers access to current information necessary for the network provider to determine: (i) the effect of procedure codes on payment or compensation before a claim is submitted for a procedure; (ii) the […]
Section 403 – Resident advisory committee.
Effective 5/10/2016 31A-44-403. Resident advisory committee. (1) A provider shall maintain, beginning no later than two years after the day on which a facility is operational, a resident advisory committee for the facility that meets the requirements of this section. (2) A resident advisory committee shall: (a) consist of no fewer than the lesser of […]
Section 404 – Nondisturbance of residents.
Effective 7/17/2016 31A-44-404. Nondisturbance of residents. (1) A person may not directly or indirectly disturb the rights of a resident or third party beneficiary under a continuing care contract and this chapter if the resident has substantially performed the resident’s obligations under the continuing care contract. (2) If the person to whom a resident owes […]