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: (A) Provides testing, diagnosis or treatment of a human disease or dysfunction; or(B) 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: (A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;(B) ider-sponsored organization' or 'PSO' means a public or private entity that: (A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;(B) 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(C)(i) 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;(ii) As used in subdivision (6)(C)(i), a provider is 'affiliated' with another provider if, through contract, ownership or otherwise:(a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other;(b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563;(c) 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(d) The Code of 1986, § 1563;(c) 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(d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.Acts 1998, ch. 896, § 3.
Tennessee Legal Code