3 Colo. Code Regs. § 702-3-1-14-6

Current through Register Vol. 47, No. 24, December 25, 2024

Section 3 CCR 702-3-1-14-6 - Appropriate Management Expertise and Infrastructure

A. A Carrier shall ascertain that a Risk Bearing Entity has the management expertise and infrastructure needed to successfully enter into and perform in accordance with the risk contract.

1. Prior to entering into a contract the Carrier shall review the health care experience of senior management; the composition of the Board and its committees; bylaws; ownership of the Risk Bearing Entity; available financial resources; ownership interests of participating providers; adequacy of transaction systems, utilization management, quality assurance, claims, credentialing, and member services; and copies of provider contracts.

2. Annually, the Carrier shall review changes in senior management; ownership; ownership interests of participating providers; adequacy of transaction systems, utilization management, quality assurance, claims, credentialing and member services.

3. The Carrier shall ascertain that the Risk Bearing Entity has a plan to distribute its annual report to all contracted providers and that the report is archived in a manner to which the parties agree.

B. The Risk Bearing Entity shall notify the Carrier of 1) all material modifications to its plan of operations; 2) changes in ownership structure and 3) material financial or operational concerns regarding the financial viability of the Risk Bearing Entity or of the Carrier's contract which has been brought to the attention of the Risk Bearing Entity's board of directors.

3 CCR 702-3-1-14-6

37 CR 20, October 25,2014, effective 11/15/2014

37 CR 20, October 25,2014, effective 1/1/2015

37 CR 23, December 10, 2014, effective 1/1/2015

38 CR 17, September 10, 2015, effective 10/1/2015

39 CR 05, March 10, 2016, effective 4/1/2016

39 CR 14, July 25, 2016, effective 8/15/2016

39 CR 23, December 10, 2016, effective 1/1/2017

40 CR 03, February 10, 2017, effective 3/15/2017

40 CR 05, March 10, 2017, effective 4/1/2017

40 CR 13, July 10, 2017, effective 8/1/2017

40 CR 17, September 10, 2017, effective 11/1/2017

43 CR 06, March 25, 2020, effective 4/15/2020

44 CR 03, February 10, 2021, effective 3/15/2021

44 CR 23, December 10, 2021, effective 1/1/2022

46 CR 03, February 10, 2023, effective 3/2/2023