Colorado § 10-16-416 - Examination.

§ 10-16-416. Examination.

(1) The commissioner may make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements pursuant to its health-care plan as often as the commissioner deems it necessary for the protection of the interests of the people of this state but not less frequently than once every five years.

(2) Repealed.

(3) Every health maintenance organization and provider shall submit its books and records relating to the health-care plan to the examination required by subsection (1) of this section and shall in every way facilitate the examination. Medical records of individuals and records of physicians providing service under a contract to the health maintenance organization are not subject to the examination, although they may be subject to subpoena upon a showing of good cause. For the purpose of the examination, the commissioner may administer oaths to, and examine, the officers and agents of the health maintenance organization and the principals of its providers concerning their business.

(4) The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the commissioner.

(5) In lieu of an examination, the commissioner may accept the report of an examination made by the commissioner or the head of the health department of another state.

(6) To supplement the examination powers of the commissioner, as provided in this section, the commissioner may request or require any foreign company, entity, or new applicant, or any domestic company may make a request to the commissioner, to be examined by independent examiners certified by the society of financial examiners, actuaries who are members of the American academy of actuaries, or other qualified loss reserve specialists, independent risk managers, independent certified public accountants, or other qualified examiners of insurance companies deemed competent by the commissioner, or any combination of such qualified persons. The commissioner may also accept, as part of the commissioner's examination, reports made by any qualified person pursuant to this subsection (6). Neither such persons nor members of their immediate families shall be officers of, connected with, or financially interested in the entity, company, or applicant being examined other than as policyholders, nor shall they be financially interested in any other corporation or person affected by the examination, investigation, or hearing. The commissioner shall establish guidelines for assuring the neutrality of those persons to be authorized to supplement the examination procedures authorized in this section. The reasonable expenses and charges of such persons so retained or designated shall be paid directly by any foreign company, entity, or new applicant or domestic company to any such outside authorized examiner.

Source: L. 92: Entire article R&RE, p. 1706, § 1, effective July 1. L. 97: (1) amended, p. 530, § 3, effective April 24. L. 2017: (2) repealed and (3), (4), and (5) amended, (SB 17-249), ch. 283, p. 1546, § 9, effective June 1.

Editor's note: This section is similar to former § 10-17-118 as it existed prior to 1992.