42 USC 300e-17 - Financial disclosure

U.S Code last checked for updates: May 03, 2024

§ 300e–17.

Financial disclosure

(a)

Financial information reported to Secretary

Each health maintenance organization shall, in accordance with regulations of the Secretary, report to the Secretary financial information which shall include the following:

(1)

Such information as the Secretary may require demonstrating that the health maintenance organization has a fiscally sound operation.

(2)

A copy of the report, if any, filed with the Centers for Medicare & Medicaid Services containing the information required to be reported under section 1320a–3 of this title by disclosing entities and the information required to be supplied under section 1396a(a)(38) of this title.

(3)

A description of transactions, as specified by the Secretary, between the health maintenance organization and a party in interest. Such transactions shall include—

(A)

any sale or exchange, or leasing of any property between the health maintenance organization and a party in interest;

(B)

any furnishing for consideration of goods, services (including management services), or facilities between the health maintenance organization and a party in interest, but not including salaries paid to employees for services provided in the normal course of their employment and health services provided to members by hospitals and other providers and by staff, medical group (or groups), individual practice association (or associations), or any combination thereof; and

(C)

any lending of money or other extension of credit between a health maintenance organization and a party in interest.

The Secretary may require that information reported respecting a health maintenance organization which controls, is controlled by, or is under common control with, another entity be in the form of a consolidated financial statement for the organization and such entity.

(b)

“Party in interest” defined

For the purposes of this section the term “party in interest” means:

(1)

any director, officer, partner, or employee responsible for management or administration of a health maintenance organization, any person who is directly or indirectly the beneficial owner of more than 5 per centum of the equity of the organization, any person who is the beneficial owner of a mortgage, deed of trust, note, or other interest secured by, and valuing more than 5 per centum of the health maintenance organization, and, in the case of a health maintenance organization organized as a nonprofit corporation, an incorporator or member of such corporation under applicable State corporation law;

(2)

any entity in which a person described in paragraph (1)—

(A)

is an officer or director;

(B)

is a partner (if such entity is organized as a partnership);

(C)

has directly or indirectly a beneficial interest of more than 5 per centum of the equity; or

(D)

has a mortgage, deed of trust, note, on other interest valuing more than 5 per centum of the assets of such entity;

(3)

any person directly or indirectly controlling, controlled by, or under common control with a health maintenance organization; and

(4)

any spouse, child, or parent of an individual described in paragraph (1).

(c)

Information availability

(d)

Evaluation of transactions

(e)

Repealed. Pub. L. 99–660, title VIII, § 810, Nov. 14, 1986, 100 Stat. 3801

(f)

Rates

(g)

Annual financial statement

(h)

Penalties

(July 1, 1944, ch. 373, title XIII, § 1318, as added Pub. L. 95–559, § 9(a), Nov. 1, 1978, 92 Stat. 2135; amended Pub. L. 97–35, title IX, § 948, Aug. 13, 1981, 95 Stat. 577; Pub. L. 99–660, title VIII, § 810, Nov. 14, 1986, 100 Stat. 3801; Pub. L. 108–173, title IX, § 900(e)(2)(E), Dec. 8, 2003, 117 Stat. 2372.)

cite as: 42 USC 300e-17