§1395w–26 Establishment of Standards

Summary

The Secretary must quickly create rules that say how provider‑sponsored organizations must prove they have enough money and capital to operate. The Secretary will use a negotiated rulemaking process and must talk with interested groups. When making the solvency rules, the Secretary must consider the organization’s delivery‑system assets and its ability to provide care directly, other ways to protect against insolvency (for example, reinsurance, unrestricted surplus, letters of credit, guarantees, insurance, partnerships, or value from delivering care directly), and any NAIC standards for risk‑based health care groups. The rules must stop enrollees from being held responsible for the organization’s debts if the organization becomes insolvent. The Secretary must publish the notice required under section 564(a) no later than 45 days after August 5, 1997, with a target publication date of April 1, 1998. For the rulemaking timetable, 15 days is substituted for 30 days in section 564(c). A negotiated rulemaking committee must be appointed within 30 days after the shortened comment period ends and a facilitator named within 10 days after that. The committee must report by January 1, 1998 on progress; if it cannot reach consensus, the Secretary may end the process and publish a rule by other means. If not ended, the committee must submit a proposed rule by one month before the target date, and the Secretary must publish the rule by the target date as an immediate interim rule with at least 60 days for public comment and republish within one year after the target date. The Secretary must also issue other Medicare+Choice rules by June 1, 1998 (they may be interim), base them on section 1395mm standards, let these federal standards override state laws except for state licensing and solvency laws, and not start new major rules mid‑year (only at the start of a calendar year).