Chapter Definitions

1. Law
2. Tennessee Code
3. Insurance
4. Provider-Sponsored Organization Act of 1998
5. Chapter Definitions

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:
   1. Provides testing, diagnosis or treatment of a human disease or dysfunction; or
   2. 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:
   1. Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;
   2. 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
   3. 1. 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;
      2. As used in subdivision (6)(C)(i), a provider is “affiliated” with another provider if, through contract, ownership or otherwise:

1. One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other;
2. The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563;
3. 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
4. The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.

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