Chapter 176T

Section 1. As used in this chapter the following words shall, unless the context clearly requires otherwise, have the following meanings:— ''Alternative payment contract'', any contract between a provider or provider organization and a health care payer payer which utilizes alter…

Section 2. Except as hereinafter provided, a risk-bearing provider organization shall not be subject to chapters 175, 176A, 176B, 176C, 176E, 176F, 176G and 176J; provided, however, that a risk-bearing provider organization that enters into a contract with employers or individual…

Section 3. (a) Each registered provider organization that enters into or renews an alternative payment contract with a carrier or public health care payer in which the provider organization accepts downside risk shall file an application for a risk certificate with the division; …

Section 4. (a) The commissioner may make an examination of the affairs of a risk-bearing provider organization regarding its alternate payment arrangements with downside risk when the commissioner deems prudent but, not less frequently than once every 3 years. The focus of the ex…

Section 5. (a) If upon examination or at any other time the commissioner determines that the risk-bearing provider organization's existing or proposed alternative payment contracts with downside risk are likely to threaten the financial solvency of the risk-bearing provider organ…

Section 6. (a) For purposes of this section, ''health care provider'' shall mean any physician, hospital or other person or entity furnishing health services that has contracted to provide services according to its agreements with a risk-bearing provider organization. (b) A healt…

Section 7. All information provided by risk-bearing provider organizations to the division under this chapter shall be made available to the center and the commission.

Section 8. Nothing in this chapter shall exempt any person from any applicable provisions of chapter 111, 112 or 176T including, but not limited to, provisions relating to determination of need, licensure and regulation of hospitals and clinics and registration of health professi…

Section 9. The commissioner shall promulgate rules and regulations as are necessary to carry out the provisions of this chapter. In developing the rules and regulations, including risk-bearing standards, certification and reporting requirements, the commissioner shall consider ot…