42 USC 1395w-26 - Establishment of standards

U.S Code last checked for updates: Apr 28, 2024

§ 1395w–26.

Establishment of standards

(a)

Establishment of solvency standards for provider-sponsored organizations

(1)

Establishment

(A)

In general

(B)

Factors to consider for solvency standards

In establishing solvency standards under subparagraph (A) for provider-sponsored organizations, the Secretary shall consult with interested parties and shall take into account—

(i)

the delivery system assets of such an organization and ability of such an organization to provide services directly to enrollees through affiliated providers,

(ii)

alternative means of protecting against insolvency, including reinsurance, unrestricted surplus, letters of credit, guarantees, organizational insurance coverage, partnerships with other licensed entities, and valuation attributable to the ability of such an organization to meet its service obligations through direct delivery of care, and

(iii)

any standards developed by the National Association of Insurance Commissioners specifically for risk-based health care delivery organizations.

(C)

Enrollee protection against insolvency

(2)

Publication of notice

(3)

Target date for publication of rule

(4)

Abbreviated period for submission of comments

(5)

Appointment of negotiated rulemaking committee and facilitator

The Secretary shall provide for—

(A)

the appointment of a negotiated rulemaking committee under section 565(a) of such title by not later than 30 days after the end of the comment period provided for under section 564(c) of such title (as shortened under paragraph (4)), and

(B)

the nomination of a facilitator under section 566(c) of such title by not later than 10 days after the date of appointment of the committee.

(6)

Preliminary committee report

(7)

Final committee report

(8)

Interim, final effect

(9)

Publication of rule after public comment

(b)

Establishment of other standards

(1)

In general

(2)

Use of current standards

(3)

Relation to State laws

(4)

Prohibition of midyear implementation of significant new regulatory requirements

(Aug. 14, 1935, ch. 531, title XVIII, § 1856, as added Pub. L. 105–33, title IV, § 4001, Aug. 5, 1997, 111 Stat. 317; amended Pub. L. 106–554, § 1(a)(6) [title VI, §§ 612(a), 614(a)], Dec. 21, 2000, 114 Stat. 2763, 2763A–560; Pub. L. 108–173, title II, § 232(a), Dec. 8, 2003, 117 Stat. 2208.)

cite as: 42 USC 1395w-26