West Virginia Code 33-40A-7 – Hearings
Upon the occurrence of any of the following events the health organization has the right to a confidential departmental hearing, on a record, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five days after the notification by the commissioner under subsection (a), (b), (c) or (d) of this section. Upon receipt of the health organization’s request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten nor more than thirty days after the date of the health organization’s request. The events include:
Terms Used In West Virginia Code 33-40A-7
- Corrective order: means an order issued by the commissioner specifying corrective actions which the commissioner has determined are required. See West Virginia Code 33-40A-1
- Health organization: means a health maintenance organization licensed under article twenty-five-a of this chapter, limited health service organization licensed under article twenty-five-d of this chapter, provider-sponsored network licensed under article twenty-five-g of this chapter, hospital, medical and dental indemnity or service corporation licensed under article twenty-four of this chapter or other managed care organization licensed under article twenty-five of this chapter. See West Virginia Code 33-40A-1
- RBC plan: means a comprehensive financial plan containing the elements specified in subsection (b), section three of this article. See West Virginia Code 33-40A-1
- RBC report: means the report required in section two of this article. See West Virginia Code 33-40A-1
(a) Notification to a health organization by the commissioner of an adjusted RBC report;
(b) Notification to a health organization by the commissioner that:
(1) The health organization’s RBC plan or revised RBC plan is unsatisfactory; and
(2) Notification constitutes a regulatory action level event with respect to the health organization;
(c) Notification to a health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the company action level event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or
(d) Notification to a health organization by the commissioner of a corrective order with respect to the health organization.