Section 1300.84.3 - Monthly Financial Reports (California Code of Regulations)

§ 1300.84.3. Monthly Financial Reports

(a) Each plan shall maintain internal procedures which provide one or more of its principal officers on at least a monthly basis with the information necessary for the report required pursuant to this section.

(b) Each plan shall report to the Director the increase during any calendar quarter of the amount owed by the plan to providers for health care services, if the amount of such increase exceeds 10 percent of the amount owed at the close of the previous quarter. In the event the amount owed to a provider is disputed, the amount claimed as due by the provider shall control for the purposes of this section. This report shall be filed within 30 days after the close of the quarter for which the report is made.

(c) Each plan shall promptly advise the Director of any extraordinary loss, or of any claim whether or not admitted by the plan or a contingent claim, which

(1) renders the plan unable to meet its obligations as they become due, or

(2) reduces (or would reduce) the tangible net equity of the plan below the amount required by section 1300.76 of these rules.

(d) Each plan shall, upon the occurrence of any of the events specified below, file a report with the Director within 30 days of the close of the month for which such condition is noted, and each month thereafter until notified by the Director to discontinue such reports. Each such report shall consist of a balance sheet and statement of operations of the plan, which need not be certified, a calculation of tangible net equity in accordance with section 1300.76 of these rules, and the verification required by subsection (e) of this rule. Such financial statements must be prepared on a basis consistent with the financial statements furnished by the plan pursuant to section 1300.84.2 of these rules. The events the occurrence of which shall require reporting under this section are the following:

(1) The tangible net equity of the plan, individually or on a combined basis with affiliates (Rule 1300.84(c)), is less than 130% of the minimum tangible net equity required by section 1300.76(a) or (b), as specified.

(2) The statement of operations of the plan, individually or on a combined basis with affiliates (Rule 1300.84(c)), reflects a loss during any month the amount of which exceeds the difference between the tangible net equity of the plan (or the combined entity) as of the end of such month and the minimum net equity required by Section 1300.76 of these rules.

(3) The plan has not been licensed for twelve (12) months.

(e) Each report required to be furnished by a plan pursuant to subsection (d) of this rule shall be verified by a principal officer of the plan as follows:

I certify (or declare) under penalty of perjury under the laws of the State of California that I have read this report and know the contents thereof, and that the statements therein are true and correct.

Executed at ____________________________________, on ____________________
   (Place)    (Date)
(1. Amendment of subsection (d) filed 6-2-78; effective thirtieth day thereafter (Register 78, No. 22). 2. Amendment of subsection (d) filed 7-3-84; effective thirtieth day thereafter (Register 84, No. 27). 3. Amendment filed 7-21-86; effective thirtieth day thereafter (Register 86, No. 30). 4. Change without regulatory effect of subsection (d) (Register 86, No. 38). 5. Amendment of subsection (d) filed 12-14-90; operative 12-31-90 (Register 91, No. 6). 6. Change without regulatory effect amending subsection (e) filed 4-4-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 14). 7. Change without regulatory effect amending subsections (b), (c) and (d) filed 7-18-2000 pursuant to section 100, title 1, California Code of Regulations (Register 2000, No. 29). 8. Amendment of subsection (d)(1) and repealer of subsections (d)(1)(A)-(G) filed 12-9-2015; operative 4-1-2016 (Register 2015, No. 50).)

Note: Authority cited: Sections 1344 and 1384, Health and Safety Code. Reference: Section 1384, Health and Safety Code.

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