§1395w–26 Establishment of standards

Summary

The Secretary of Health and Human Services must quickly create rules that say how financially strong provider‑sponsored organizations must be to qualify under this part. The rules must cover financial strength and capital adequacy. In making them, the Secretary must talk with interested groups and consider the organization’s own care‑delivery assets and ability to serve enrollees directly, other ways to protect against insolvency (like reinsurance, surplus, letters of credit, guarantees, insurance, partnerships, or value from direct delivery), and any National Association of Insurance Commissioners standards. The rules must also stop enrollees from being made responsible for the organization’s debts. The Secretary must publish a notice within 45 days after August 5, 1997, set April 1, 1998 as the target publication date, shorten one comment period from 30 days to 15 days, appoint a negotiated rulemaking committee within 30 days after that comment period ends and name a facilitator within 10 days, have the committee report by January 1, 1998 and, if it continues, submit a proposed rule at least one month before April 1, 1998. If consensus fails, the Secretary can end the process and use another way to publish a rule. The Secretary must publish the rule by April 1, 1998; it takes effect right away as an interim rule, must allow at least 60 days for public comment, and must be reconsidered and republished within one year after April 1, 1998. The Secretary must also write other Medicare+Choice rules not covered above and publish them by June 1, 1998. Those rules can take effect on an interim basis while comments are gathered and should be based on similar standards in section 1395mm. These federal standards override state laws or rules for MA plans, except for state licensing laws and state laws about plan solvency. The Secretary cannot put in new, significant regulatory requirements on a Medicare+Choice organization or plan except at the start of a calendar year.