{"data":{"id":"us-ky/krs-304.38-130","jurisdiction":"us-ky","citation":"KRS 304.38-130","heading":"Revocation or suspension of certificate of authority.","body":"(1) The commissioner may suspend or revoke any certificate of authority issued to a\nhealth maintenance organization under this subtitle if the commissioner finds that\nany of the conditions exist for which the commissioner could suspend or revoke a\ncertificate of authority as provided in Subtitles 2 and 3 of this chapter or if the\ncommissioner finds that any of the following conditions exist:\n(a) The health maintenance organization is operating significantly in\ncontravention of its basic organizational document or in a manner contrary to\nthat described in and reasonably inferred from any other information\nsubmitted under KRS 304.38 -040, unless amendments to such submissions\nhave been filed with and approved by the commissioner;\n(b) The health maintenance organiza tion issues evidence of coverage or uses a\nschedule of charges for health care services which do not comply with the\nrequirements of KRS 304.38-050 or Subtitle 17A of this chapter;\n(c) The health maintenance organization does not provide or arrange for hea lth\ncare services as approved by the commissioner in KRS 304.38-050(1)(a);\n(d) The certificate of need and licensure board certifies to the commissioner that\nthe health maintenance organization fails to meet the requirements of the\nboard or that the health  maintenance organization is unable to fulfill its\nobligations to furnish health care services;\n(e) The health maintenance organization is no longer financially responsible and\nmay reasonably be expected to be unable to meet its obligations to enrollees or\nprospective enrollees;\n(f) The health maintenance organization, or any person on its behalf, has\nadvertised or merchandised its services in an untrue, misrepresentative,\nmisleading, deceptive, or unfair manner;\n(g) The continued operation of the health ma intenance organization would be\nhazardous to its enrollees;\n(h) The health maintenance organization has otherwise failed to substantially\ncomply with this subtitle; or\n(i) The health maintenance organization has contracted with the Department for\nMedicaid Services to act as a managed care organization providing Medicaid\nbenefits pursuant to KRS Chapter 205 and has exhibited willful or frequent\nand repeated failure to comply with KRS 304.17A -700 to 304.17A -730,\n205.593, and 304.14 -135 and KRS 205.522, 205.53 2 to 205.536, and\n304.17A-515.\n(2) If the certificate of authority of a health maintenance organization is suspended, the\nhealth maintenance organization shall not, during the period of the suspension,\nenroll any additional enrollees except newborn childre n or other newly acquired\ndependents of existing enrollees, and shall not engage in any advertising or\nsolicitation whatsoever.\n(3) If the certificate of authority of a health maintenance organization is revoked, the\norganization shall proceed, immediately following the effective date of the order of\nrevocation, to wind up its affairs, and shall conduct no further business except as\nmay be essential to the orderly conclusion of the affairs of the organization. It shall\nengage in no further advertising or so licitation whatsoever. The commissioner may,\nby written order, permit the further operation of the organization as the\ncommissioner may find to be in the best interest of enrollees, to the end that\nenrollees will be afforded the greatest practical opportun ity to obtain continuing\nhealth care coverage. If the commissioner permits such further operation the health\nmaintenance organization will continue to collect the periodic prepayments required\nof enrollees.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=47797","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:56Z","sha256":"b79d5c66bf23219964e6ddd4460c666f75b010799d5c9cbdfe04f001c1ed96c2","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.38-120","next":"us-ky/krs-304.38-140"},"notice":"GroundRules: Original legal text. Not legal advice."}