20-1052.01. Establishment of provider sponsored health care services organizations; rules; limitations

A. No person shall establish or operate a provider sponsored health care services organization in this state, or sell or offer to sell, or solicit offers to purchase, or receive advance or periodic consideration in conjunction with a health care plan without obtaining and maintaining a certificate of authority pursuant to this article.

B. To operate as a provider sponsored health care services organization in this state, the firm or corporation shall:

1. Be a provider sponsored organization as defined in this article.

2. To the extent that the requirements are not preempted by federal law, meet the requirements prescribed in this article that apply to health care services organizations.

C. In addition to the general rule making authority vested in the director pursuant to chapter 1, article 2 of this title, the director may also adopt rules that:

1. Are necessary to implement the provider sponsored health care services organization provisions of this article.

2. Impose solvency requirements of a provider sponsored health care services organization that are the same as the requirements pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859) and any rules adopted under the medicare-plus-choice program.

D. A certificate of authority issued to a provider sponsored health care services organization pursuant to this article is a limited certificate of authority that authorizes the provider sponsored health care services organization to provide coverage for health care services only to medicare beneficiaries pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859).

E. The solvency standards adopted by rule pursuant to this section apply only to a provider sponsored health care services organization that provides coverage for health care services only to medicare beneficiaries pursuant to the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code sections 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859).

F. Nothing in this section applies to an insurer, health care services organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation or hospital, medical, dental and optometric service corporation or any other person licensed under this title other than a provider sponsored organization that is licensed as a provider sponsored health care services organization.