§1395w–26 Establishment of Standards

Summary

The Secretary must quickly write clear financial rules that provider‑sponsored organizations must meet to be allowed to operate. In making those rules, the Secretary must work with groups like the National Association of Insurance Commissioners, the American Academy of Actuaries, beneficiary groups, and others. The rules must look at the organization’s delivery assets and ability to provide care directly, other ways to guard against going broke (for example reinsurance, surplus funds, letters of credit, guarantees, insurance, partnerships, or valuing direct care capacity), and any NAIC standards for risk‑based health care groups. The rules must protect enrollees so they are not responsible for the organization’s debts if the organization becomes insolvent. The Secretary must publish a notice by not later than 45 days after August 5, 1997, and set April 1, 1998 as the target date to publish the rule. The public comment time is shortened to 15 days. A negotiated rulemaking committee must be named within 30 days after that comment period ends, and a facilitator nominated within 10 days after the committee is chosen. The committee must report on progress by January 1, 1998 and, if it stays, submit a proposed rule by one month before the target date. The rule must be published by the target date, take effect immediately on an interim basis, allow at least 60 days for public comment, and be republished with changes within one year. The Secretary must also put other related rules in place by June 1, 1998; federal standards override state laws except for state licensing and state solvency laws, and major new rules can only start at the beginning of a calendar year.