As used in this chapter, unless the context otherwise requires:

(1) “Commissioner” means the commissioner of commerce and insurance;

Terms Used In Tennessee Code 56-48-102

  • Balanced budget: A budget in which receipts equal outlays.
  • Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-48-102
  • Contract: A legal written agreement that becomes binding when signed.
  • Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
  • 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. See Tennessee Code 56-48-102
  • HHS: means the United States department of health and human services. See Tennessee Code 56-48-102
  • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
  • Provider: means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services. See Tennessee Code 56-48-102
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
(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) 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 providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
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