02-031 C.M.R. ch. 870, § 5 - Application for Certification

Applicants for an exemption must file a signed affidavit that describes in detail how the applicant has made the determination that each of the requirements have been met. The affidavit should be accompanied by documents that support the affirmations made in the affidavit. Examples of supporting documentation include but are not limited to the following:

A. Documents from the facility that describe investment terms.

B. Marketing materials which demonstrate that investment opportunities are offered equally to health care practitioners and other potential investors.

C. Copies of any loan arrangement between the practitioner and the facility.

D. Copies of any forms or a written description of how the health care practitioner discloses his or her investment interest to patients being referred to the facility. To the extent that alternative facilities are reasonably available, the health care practitioner must demonstrate how patients are informed of the alternative facilities.

E. A description of the internal utilization review program, including a copy of the goals and the bylaws or rules of operation of the program, and a list of the names and licensure and specialty certification status of the persons who will be conducting the review.

F. Documents demonstrating that the investor's attempts to secure financing from alternative sources for this venture have failed.

The Superintendent may request any additional documents necessary to make the finding whether each of the requirements of this Rule has been met. Such documents must be made available within thirty days after a written request by the Superintendent, or the application will be denied. The applicant with good cause may request an extension of time, which shall not be unduly denied by the Superintendent.

Notes

02-031 C.M.R. ch. 870, § 5