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Tennessee Code Title 56. Insurance § 56-48-102

Current as of January 02, 2024 | Updated by Findlaw Staff

As used in this chapter, unless the context otherwise requires:

(1) “Commissioner” means the commissioner of commerce and insurance;

(2) “Health care services” means a health or medical care procedure or service rendered by a health care provider that:

(A) Provides testing, diagnosis or treatment of a human disease or dysfunction; or

(B) Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction;

(3) “HHS” means the United States department of health and human services;

(4) “Medicare+Choice program” means the criteria developed by United States Public Law 105-33, The Balanced Budget Act of 1997 (BBA), whereby risk-bearing organizations are permitted to offer health insurance or health benefits coverage to Medicare-eligible enrollees through a Medicare+Choice plan;

(5) “Provider” means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services; and

(6) “Provider-sponsored organization” or “PSO” means a public or private entity that:

(A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;

(B) Provides a substantial proportion, as defined by rule or regulation promulgated by HHS, of the health care items and services under the Medicare+Choice program directly through the provider or affiliated group of providers; and

(C)(i) With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity;

(ii) As used in subdivision (6)(C)(i), a provider is “affiliated” with another provider if, through contract, ownership or otherwise:

(a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other;

(b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563;

(c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or

(d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.

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Cite this article: FindLaw.com - Tennessee Code Title 56. Insurance § 56-48-102 - last updated January 02, 2024 | https://codes.findlaw.com/tn/title-56-insurance/tn-code-sect-56-48-102/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

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