Before an entity may operate under the Medicare+Choice program, the entity must obtain a license from the commissioner or be a PSO that obtains a waiver of the requirement for state licensure from HHS in accordance with United States Public Law 105-33, the Balanced Budget Act of 1997. Any entity that obtains such a waiver is not required to obtain a license from the commissioner to operate as a PSO offering a Medicare+Choice plan in this state.