N.J. Admin. Code § 11:24-2.13

Current through Register Vol. 56, No. 19, October 7, 2024

Section 11:24-2.13 - Violations

(a) A violation may be cited by the Commissioner or his or her designee upon determination that the HMO does not comply with the rules in this chapter and 26:2J-1 et seq.

(b) At the conclusion of an examination, or within 30 business days thereafter, the Department shall provide the HMO with a written summary of violations of this chapter and any factual findings used as a basis to determine that a violation has occurred.

(c) The Department may require that the HMO submit a written plan of correction specifying how each violation that has been cited will be corrected along with the time frames for completion of each corrective action. A single plan of correction may address all events associated with a given violation. The plan of correction, where required, shall be submitted by the HMO within 20 business days of receipt of the notice of violations, or sooner, if the Commissioner determines that the violations jeopardize the safety of enrollees. The plan of correction shall be reviewed by the Department and shall be approved where the plan demonstrates to the satisfaction of the Department that compliance will be achieved within a reasonable time period. If the plan is not approved, the Department may request that an amended plan of correction be submitted within five business days.

(d) The summary of violations and the written plan of correction shall not be released as public information until such time that the Department has received the plan of correction or, in the event no plan of correction is submitted, 20 business days of receipt of the summary of violations by the HMO, whichever is sooner. Unless otherwise documented, the Department will presume receipt of the summary of violations by the HMO by the third business day if sent by regular mail.

N.J. Admin. Code § 11:24-2.13