806 KAR 38:040.
Financial projections; area overlapping.
RELATES TO: KRS
304.38-040
STATUTORY AUTHORITY:
KRS 304.38-150
NECESSITY, FUNCTION,
AND CONFORMITY: KRS 304.38-040 provides that a health maintenance organization
supply the executive director information upon
application for certificate of authority. This administrative regulation
explains the authenticity of the health maintenance organization's financial
projections and possibility of overlapping health maintenance organizations
within a particular geographic area.
Section 1. The three
(3) year projections for the financial program of the applicant health
maintenance organization shall be prepared by an individual who has satisfied
the executive director by virtue of his
training, education and experience that he is qualified to make such
projections.
Section 2. The
existence or proposed operation of health maintenance organizations in the same
geographic area that could affect the number of prospective enrollees of the
applicant health maintenance organization shall be disclosed to the executive
director in the description of the initial geographic area to be
served.
Section 3. In noting
the sources of working capital and funding, the proposed health maintenance
organization shall inform the executive director
whether there are grants, loans or loan guarantees from the federal government;
if so, the amounts thereof, rates of interest, if any, the schedule of
repayment, if any, of the principal and interest. If the working capital and
funding is derived from other than through the federal government, indicate
such source, giving details of such program, including any schedule of
repayments of principal and interest on loans which may have been made. (1
Ky.R. 1090; eff. 7-2-75; TAm eff. 8-9-2007.)