Arizona Laws 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.
Terms Used In Arizona Laws 20-1052.01
- Balanced budget: A budget in which receipts equal outlays.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Health care plan: means any contractual arrangement whereby any health care services organization undertakes to provide directly or to arrange for all or a portion of contractually covered health care services and to pay or make reimbursement for any remaining portion of the health care services on a prepaid basis through insurance or otherwise. See Arizona Laws 20-1051
- Health care services: means services for the purpose of diagnosing, preventing, alleviating, curing or healing human illness or injury. See Arizona Laws 20-1051
- Health care services organization: means any person that undertakes to conduct one or more health care plans. See Arizona Laws 20-1051
- Person: means any natural or artificial person including individuals, partnerships, associations, providers of health care, trusts, insurers, hospital or medical service corporations or other corporations, prepaid group practice plans, foundations for medical care and health maintenance organizations. See Arizona Laws 20-1051
- Provider: means any physician, hospital or other person that is licensed or otherwise authorized to furnish health care services in this state. See Arizona Laws 20-1051
- Provider sponsored health care services organization: means a provider sponsored organization that provides at least one health care plan only to medicare beneficiaries under the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code §§ 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859). See Arizona Laws 20-1051
- Provider sponsored organization: means an entity that:
(a) Is a legal aggregation of providers that operate collectively to provide health care services to medicare beneficiaries under the medicare-plus-choice program established under the balanced budget act of 1997 (42 United States Code §§ 1395w-21 through 1395w-28 and title XVIII, part C of the social security act, sections 1851 through 1859). See Arizona Laws 20-1051
- United States: includes the District of Columbia and the territories. See Arizona Laws 1-215
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 §§ 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 §§ 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 §§ 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.