5504.1 Each QO shall submit the following information to the Department, at the time of application for a contract:

1. (a) A copy of the basic organizational documents of the QO, such as articles of incorporation, and each amendment;
2. (b) A copy of the by-laws or similar documents regulating conduct of the internal affairs of the QO;
3. (c) A description of the organization's ownership and a list of major owners (stockholders having five percent (5%) or more of outstanding shares);
4. (d) A list of board members and their affiliations;
5. (e) A roster of key personnel and their qualifications;
6. (f) A list of subcontracts and a copy of each type of subcontract;
7. (g) The number of clinical, administrative and marketing employees;
8. (h) The form of evidence of coverage to be issued to enrollees;
9. (i) For on-going organizations, financial statements showing the organizations assets, liabilities and sources of financial support, including the most recent audited financial statement;
10. (j) For start-up organizations, pro forma operating statements and balance sheets and a statement as to sources of working capital and other sources of funding;
11. (k) A description of the proposed method of marketing;
12. (l) A description of the enrollee grievance process;
13. (m) A description of the procedures and programs to assure the availability and accessibility of high quality services;
14. (n) A description of the enrollment process;
15. (o) A statement of policies and procedures governing claim payments to providers and distribution of revenues to owners;

(p) A written description of the medical record, and statistical reporting systems;

(q) A statement on the organization's background and experience in serving low income, diversified population groups in the District; and

(r) A statement of the proposed methods of handling out-of-plan emergency and out-of-area coverage.

5504.2 The QO shall notify the Department's Office of Health Care Financing in writing within thirty (30) days of any material modifications cited under §5504.1 on file.

SOURCE: Final Rulemaking published at 34 DCR 1550, 1555 (March 6, 1987).