Tennessee § 56-48-102 - Chapter definitions.

§ 56-48-102. Chapter definitions.

As used in this chapter, unless the context otherwise requires: “Commissioner” means the commissioner of commerce and insurance; “Health care services” means a health or medical care procedure or service rendered by a health care provider that: Provides testing, diagnosis or treatment of a human disease or dysfunction; or Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction; “HHS” means the United States department of health and human services; “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; “Provider” means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services; and “Provider-sponsored organization” or “PSO” means a public or private entity that: Is established or organized, and operated, by a health care provider, or group of affiliated health care providers; 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 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; As used in subdivision (6)(C)(i), a provider is “affiliated” with another provider if, through contract, ownership or otherwise: One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other; The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563; 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 The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414. Acts 1998, ch. 896, § 3. Compiler's Notes. Public Law 105-33, referred to in this section, is codified throughout the United States Code. Provisions concerning the “Medicare + Choice” program appear as 42 U.S.C. § 1395 w-21 et seq. Sections 414 and 1563 of the Internal Revenue Code of 1986, referred to in this section, are codified as 26 U.S.C. §§ 414 and 1563, respectively.