Minn. R. agency 144, ch. 4685, DEFINITIONS, pt. 4685.0300

Current through Register Vol. 49, No. 20, November 12, 2024

Part 4685.0300 - APPLICATION

Subpart 1.Forms.

Application for certificates of authority shall be submitted on forms provided by the commissioner of health which shall include, but not be limited to the matters covered in this part.

Subp. 2.Disclosure in applications.

Each application for a certificate of authority shall include disclosure of the following:

A. Any contractual or financial arrangements between members of the board of directors/principal officers and the health maintenance organization including: a description of any obligations, specified by contract or otherwise, to be met by each party in accordance with any such arrangement; and a listing of the dollar amounts of any consideration to be paid each party in accordance with any such arrangements.

B. Any financial arrangements between members of the board of directors/principal officers and any provider or other person, which provider or other person also has a financial relationship with the health maintenance organization. This disclosure shall include:

(1) a description of the obligations to be met by each party in accordance with any such arrangements;

(2) a listing of the dollar amounts of the consideration to be paid each party in accordance with any such arrangements; and

(3) a listing and description of any circumstances under which a director/principal officer is employed by or engages in a substantial commercial or professional relationship with any provider/other person.

Subp. 3.Insurance.

Each application for a certificate of authority shall attach pertinent documents, including copies of insurance contracts, in verification of compliance with Minnesota Statutes, sections 62D.04, subdivision 1, clause (f), 62D.05, 62D.12, subdivisions 4 and 9, and 62D.13 with respect to assumption of risks and insurance against risks.

Subp. 4.Financial responsibility.

Each application shall state which option for demonstrating financial responsibility has been elected pursuant to Minnesota Statutes, section 62D.04, subdivision 1, clause (e) and any pertinent documents which demonstrate financial responsibility shall be attached to the application.

Subp. 5.Statistics.

The application shall detail procedures established to develop, compile, evaluate, and report statistics which shall include the collection and maintenance of at least the following data:

A. operational statistics sufficient to meet the requirements of Minnesota Statutes, section 62D.08, subdivision 3, clause (a), relating to annual financial reports;

B. gross utilization aggregates, including hospital discharges, surgical hospital discharges, hospital bed days, outpatient visits, laboratory tests and x-rays;

C. demographic characteristics, including the age and sex of enrollees;

D. disease-specific and age-specific mortality rates; and

E. enrollment statistics compiled in accordance with Minnesota Statutes, section 62D.08, subdivision 3, clause (b).

Subp. 6.Provider agreements.

The application shall include copies of all types of agreements with providers by virtue of which enrollees will receive health care from the providers, and a description of any other relationships with providers who might attend enrollees together with a statement describing the manner in which these other relationships assure availability and accessibility of health care.

Subp. 7.Other requirements.

Each application must also include documentation or evidence of compliance with all of the requirements of the act and parts 4685.0100 to 4685.3400, and the commissioner of health may require such other information in applications for certificates of authority as the commissioner feels is necessary to make a determination on the application.

Minn. R. agency 144, ch. 4685, DEFINITIONS, pt. 4685.0300

23 SR 1238

Statutory Authority: MS s 62D.20