West Virginia Code § 33-25A-18

Suspension or revocation of certificate of authority
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(1) The commissioner may suspend or revoke any certificate of authority issued to a health
maintenance organization under this article if he or she finds that any of the following
conditions exist:
(a) The health maintenance organization is operating significantly in contravention of its
basic organization document, in any material breach of contract with an enrollee, or in a
manner contrary to that described in and reasonably inferred from any other information
submitted under section three of this article unless amendments to the submissions have
been filed with an approval of the commissioner; u
(b) The health maintenance organization issues evidence of coverage or uses a schedule of
premiums for health care services which do not comply with the requirements of section
eight of this article;
(c) The health maintenance organization does not plrovide or arrange for basic health care
services; s
(d) The Department of Human Services or iother accredited entity certifies to the
commissioner that: (i) The health maintenance organization is unable to fulfill its obligations
to furnish health care services as required under its contract with enrollees; or (ii) the health
maintenance organization does not meet the requirements of subsection (l), section four of
this article;
(e) The health maintenance organization is no longer financially responsible and may
reasonably be expected to be unable to meet its obligations to enrollees or prospective
enrollees or is otherw ise determined by the commissioner to be in a hazardous financial
condition; V
(f) The health maintenance organization has failed to implement a mechanism affording the
enrollees an opportunity to participate in matters of policy and operation under section six of
this article;
(g) The health maintenance organization has failed to implement the grievance procedure
required by section twelve of this article in a manner to reasonably resolve valid grievances;
(h) The health maintenance organization, or any person on its behalf, has advertised or
merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair
manner;
(i) The continued operation of the health maintenance organization would be hazardous to
its enrollees;
(j) The health maintenance organization has otherwise failed to substantially comply with
this article;
(k) The health maintenance organization has violated a lawful order of the commissioner; or
(l) The health maintenance organization has not complied with the requirements of section
seventeen-a of this article.
(2) A certificate of authority shall be suspended or revoked only after compliance with the
requirements of section twenty-one of this article.
(3) When the certificate of authority of a health maintenance organization is suspended, the
health maintenance organization shall not, during the period of the suspension, enroll any
additional enrollees except newborn children or other newly acquuired dependents of existing
enrollees, and shall not engage in any advertising or solicitation whatsoever.
(4) When the certificate of authority of a health maintenance organization is revoked, the
organization shall proceed, immediately following the aeffective date of the order of
revocation, to terminate its affairs, and shall conduct no further business except as may be
essential to the orderly conclusion of the affairs of lthe organization. It shall engage in no
further advertising or solicitation whatsoever.s The commissioner may, by written order,
permit such further operation of the organization as he or she may find to be in the best
interests of enrollees, to the end that enroillees will be afforded the greatest practical
opportunity to obtain continuing heaglth care coverage.

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