Florida Regulations 69O-191.030: Governing Body
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(1) Each HMO shall have a governing body that sets policy and has overall responsibility for the organization, including the following:
(a) Adopting organizational bylaws, rules and regulations, or similar form of document which provides a clear concise statement of the mission, goals, and objectives of the organization.
(b) Adopting a quality assurance program, as required by Florida Statutes Chapter 641, Part IV, that monitors the key areas of the health care delivery system, to identify problems and ensure early recognition of opportunities to improve the delivery of quality health care services.
(c) Maintaining ultimate responsibility for ongoing licensing and credentialing programs.
(2) Nothing in this rule shall prohibit the designation of qualified management personnel to implement the provisions of subsection (1), and to manage the operation of the HMO in the geographic area or areas serviced. The relationship between management personnel and the governing body shall be set forth in writing, including each person’s authority, responsibilities and functions.
(3) Biographical statements and character reports are required to be submitted to the Office and shall be included in the application for a Certificate of Authority (COA) on the following persons:
(a) Persons who own or control in excess of five percent of the outstanding stock of the HMO;
(b) Members of the Board of Directors of the HMO;
(c) All officers who are identified by the Office based on a review of the structure of the HMO and the decision making process of the HMO as policy decision making officers and any other individuals who have policy decision making authority;
(d) All officers and directors of any parent corporation or corporations of the HMO, if applicable; and,
(e) All officers and directors of any external management company contracted with the HMO, if applicable, pursuant to paragraph (c), above.
(f) This requirement also applies to individuals who, subsequent to the date of application for a COA, become associated with an HMO and meet any of the qualifications listed in paragraphs (a) through (e), above.
(4) Abbreviated biographical statements will be required to be submitted to the Office every two years for the individuals included in paragraphs (a), (b), (c) and (e), above.
(5) Each HMO or applicant shall notify the Office of any legal proceeding, excluding minor infractions, involving related parties as defined in subsection 69O-191.024(20), F.A.C., including any and all criminal, civil and administrative actions entered by any state or federal entity and to include pending but yet unresolved actions.
Rulemaking Authority 641.36 FS. Law Implemented 120.60(2), 641.21, 641.22 FS. History-New 2-22-88, Formerly 4-31.030, Amended 5-28-92, 8-15-94, Formerly 4-191.030.
Terms Used In Florida Regulations 69O-191.030
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
(b) Adopting a quality assurance program, as required by Florida Statutes Chapter 641, Part IV, that monitors the key areas of the health care delivery system, to identify problems and ensure early recognition of opportunities to improve the delivery of quality health care services.
(c) Maintaining ultimate responsibility for ongoing licensing and credentialing programs.
(2) Nothing in this rule shall prohibit the designation of qualified management personnel to implement the provisions of subsection (1), and to manage the operation of the HMO in the geographic area or areas serviced. The relationship between management personnel and the governing body shall be set forth in writing, including each person’s authority, responsibilities and functions.
(3) Biographical statements and character reports are required to be submitted to the Office and shall be included in the application for a Certificate of Authority (COA) on the following persons:
(a) Persons who own or control in excess of five percent of the outstanding stock of the HMO;
(b) Members of the Board of Directors of the HMO;
(c) All officers who are identified by the Office based on a review of the structure of the HMO and the decision making process of the HMO as policy decision making officers and any other individuals who have policy decision making authority;
(d) All officers and directors of any parent corporation or corporations of the HMO, if applicable; and,
(e) All officers and directors of any external management company contracted with the HMO, if applicable, pursuant to paragraph (c), above.
(f) This requirement also applies to individuals who, subsequent to the date of application for a COA, become associated with an HMO and meet any of the qualifications listed in paragraphs (a) through (e), above.
(4) Abbreviated biographical statements will be required to be submitted to the Office every two years for the individuals included in paragraphs (a), (b), (c) and (e), above.
(5) Each HMO or applicant shall notify the Office of any legal proceeding, excluding minor infractions, involving related parties as defined in subsection 69O-191.024(20), F.A.C., including any and all criminal, civil and administrative actions entered by any state or federal entity and to include pending but yet unresolved actions.
Rulemaking Authority 641.36 FS. Law Implemented 120.60(2), 641.21, 641.22 FS. History-New 2-22-88, Formerly 4-31.030, Amended 5-28-92, 8-15-94, Formerly 4-191.030.