28 CA ADC § 1300.89
28 CCR s 1300.89
Cal. Admin. Code tit. 28, s 1300.89
CALIFORNIA CODE OF REGULATIONS
TITLE 28. MANAGED HEALTH CARE
DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
CHAPTER 2. HEALTH CARE SERVICE PLANS
ARTICLE 14. MISCELLANEOUS PROVISIONS
This database is current through 06/09/06, Register 2006, No. 23.
s 1300.89. Petition for Restoration.
(a) The fee for the filing of a petition for restoration shall be $100 for
a solicitor, $250 for a solicitor firm, and $500 for a plan.
(b) A petition for restoration shall be made upon the following form:
(Official Use Only) DEPARTMENT OF MANAGED CARE
File No.
(Insert file number of
previous filings before the
Fee Paid $ Department, if any.)
FILING FEE: Solicitor: $100
Receipt No. Solicitor firm: $250
Plan: $500
Not refundable except pursuant to
Section 250.15, Title 10, California
Code of Regulations.
EXECUTION PAGE DEPARTMENT OF MANAGED HEALTH CARE STATE OF CALIFORNIA
PETITION
FOR RESTORATION UNDER THE KNOX-KEENE HEALTH CARE SERVICE PLAN ACT OF 1975
INDICATE TYPE OF FILING BY CHECKING ONE OF THE FOLLOWING:
[ ] ORIGINAL PETITION FOR SOLICITOR
[ ] ORIGINAL PETITION FOR SOLICITOR FIRM
[ ] ORIGINAL PETITION FOR PLAN
[ ] AMENDMENT TO PETITION FOR SOLICITOR
[ ] AMENDMENT TO PETITION FOR SOLICITOR FIRM
[ ] AMENDMENT TO PETITION FOR PLANV SUBSEQUENT PETITION
Date first petitioned for restoration __________ __________ Date of any
subsequent petitions __________ __________
TABULAR OR GRAPHIC MATERIAL SET FORTH AT THIS POINT IS NOT DISPLAYABLE
1. Name of petitioner (Complete name as appearing on articles of
incorporation, partnership agreement, etc.) __________
2. Address of principle office of petitioner. (Number and Street) (City)
(State) (Zip Code) __________
3. Address of principle office of petitioner in the State of California.
(Number and Street) (City) (State) (Zip Code) __________
4. Name and address of person to whom communications should be addressed
concerning this petition. __________
5. Within 20 days of a request from the Director, the petitioner shall
furnish additional information as the Director may require pursuant to
subsection (c) of this section. __________
EXECUTION
The undersigned, duly authorized by the petitioner, has signed this
petition on the petitioner's behalf.
__________________________ By:_______
(Petitioner) Title:____
I certify under penalty of perjury that I have read this petition and the
exhibits and attachments and know the contents, and that the statements
are true.
Executed at_____________________________________on_____________,___
(City) (State)
_____________________________________
(Signature of Declarant)
(If executed other than in a state which permits verifications under
penalty of perjury, attach a verification executed and sworn to before a
Notary Public.) __________
6. Name and address of officer or partner of petitioner who is to receive
compliance and informational communications from the Department and who is
responsible for disseminating the same within the petitioner's
organization.
7. Set forth the grounds upon which the license, employment, or activity
was suspended, revoked, or barred. Attach a copy of the decision,
administrative record, and order suspending, revoking or barring
petitioner.
8. Set forth the basis upon which petitioner believes that restoration is
warranted.
9. Set forth the steps which petitioner has taken to prevent a recurrence
of the grounds referred to in item 7, above, and any other information
which petitioner believes to be relevant.
10. If the petitioner is a plan, is its application on file with the
Department current without the need for any amendment?VYesVNo If "no,"
state the day on which petitioner will comply with subsection (c) of this
section.
11. If the petitioner is a plan, attach as exhibits all current reports,
information, and statements which are required to be filed under the Act
or rules but which have not been filed to date.
12. If the petitioner is a solicitor firm, describe the organization of
petitioner, identify its principle persons, and describe the manner in
which it proposes to act as a solicitor firm.
13. If the petitioner is a solicitor firm, attach financial statements as
required:
A. If petitioner is subject to the tangible net worth requirement of
Section 1300.76.2, Title 28, Calif. Code of Regulations, attach a copy of
petitioner's financial statement consisting of at least a balance sheet
and statement reporting the results of operations for the petitioner,
prepared as of a date within 30 days of the filing of this petition. Such
financial statement need not be certified, but if not certified, also
attach as an exhibit certified financial statements of the petitioner as
of the close of its last fiscal year.
B. If petitioner is exempted from Section 1300.76.2, attach a statement to
that effect and attach a copy of petitioner's financial statement, which
need not be certified, consisting of at least a balance sheet and
statement reporting the results of operations for the petitioner, prepared
as of a date within 30 days of the filing of this petition.
C. If petitioner accepts no funds, in the form of checks or otherwise, of
plans, subscribers or other persons contracting with plans (exclusive of
petitioner's compensation for its solicitation activities), attach a
statement to that effect, and do not include financial statements of the
petitioner as an exhibit to the petition.
14. If petitioner has applied for restoration previously and been denied,
attach copies of all prior petitions, administrative records, and
decisions on those petitions.
(c) If the petition provided in subsection (b) is filed by a plan, the
plan shall file an amendment to its application on file with the
Department which will bring that application current, or, if its
application is current without the need for any amendment, it shall so
allege.
(d) The Director may require additional information and/or undertakings as
a condition of granting a petition for restoration. This requested
material will be used to determine whether the petitioner, if restored,
would engage in business in full compliance with the objectives and
provisions of the Act and the applicable regulations. The Director, in
evaluating the rehabilitation of the petitioner and his or her eligibility
for a license or status as a solicitor, shall consider the following
criteria:
(1) The nature and severity of the act(s) or offense(s).
(2) The administrative record applicable to the disciplinary proceedings.
(3) The time that has elapsed since commission of the act(s) or
offense(s).
(4) Whether the petitioner has complied with any terms of parole,
probation, restitution or any other sanctions imposed against him or her.
(5) If applicable, evidence of expungement proceedings pursuant to Section
1203.4 of the Penal Code.
(6) Evidence, if any, of rehabilitation submitted by the petitioner.
(7) Any other information or material that the Director deems to be
appropriate and relevant.
Note: Authority cited; Section 1344, Health and Safety Code. Reference:
Section 1389, Health and Safety Code.
HISTORY
1. New section filed 1-12-83; effective thirtieth day thereafter (Register
83,
No. 3).
2. Change without regulatory effect amending section filed 7-18-2000
pursuant
to section 100, title 1, California Code of Regulations (Register 2000,
No. 29).
3. Change without regulatory effect updating title reference on sample
execution page filed 12-22-2000 pursuant to
section 100, title 1, CaliforniaCode of Regulations (Register 2000, No.
51).
4. Change without regulatory effect amending subsection (b) filed
11-21-2002
pursuant to section 100, title 1, California Code of Regulations (Register
2002, No. 47).
5. Amendment filed 12-16-2002; operative 1-15-2003 (Register 2002, No.
51).
28 CA ADC s 1300.89
END OF DOCUMENT
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