Page:United States Statutes at Large Volume 111 Part 1.djvu/340

 Ill STAT. 316 PUBLIC LAW 105-33—AUG. 5, 1997 " (2) CERTIFICATION PROCESS FOR SOLVENCY STANDARDS FOR PSOS. —The Secretary shall establish a process for the receipt and approval of applications of a provider-sponsored organization described in paragraph (1) for certification (and periodic recertification) of the organization as meeting such solvency standards. Under such process, the Secretary shall act upon such a certification application not later than 60 days after the date the application has been received. " (d) PROVIDER-SPONSORED ORGANIZATION DEFINED. — "(1) IN GENERAL.—In this part, the term 'provider-sponsored organization' means a public or private entity— "(A) that is established or organized, and operated, by a health care provider, or group of affiliated health care providers, "(B) that provides a substantial proportion (as defined by the Secretary in accordance with paragraph (2)) of the health care items and services under the contract \inder this part directly through the provider or affiliated group of providers, and "(C) 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. "(2) SUBSTANTIAL PROPORTION.—In defining what is a 'substantial proportion' for purposes of paragraph (1)(B), the Secretary— "(A) shall take into account the need for such an organization to assume responsibility for providing— "(i) significantly more than the majority of the items and services under the contract under this section through its own affiliated providers; and "(ii) most of the remainder of the items and services under the contract through providers with which the organization has an agreement to provide such items and services, in order to assure financial stability and to address the practical considerations involved in integrating the delivery of a wide range of service providers; "(B) shall take into account the need for such an organization to provide a limited proportion of the items and services under the contract through providers that are neither affiliated with nor have an agreement with the organization; and "(C) may allow for variation in the definition of substantial proportion among such organizations based on relevant differences among the organizations, such as their location in an urban or rural area. "(3) AFFILIATION. —For purposes of this subsection, a provider is 'affiliated' with another provider if, through contract, ownership, or otherwise— "(A) one provider, directly or indirectly, controls, is controlled by, or is under common control vvith the other, "(B) both providers are part of a controlled group of corporations under section 1563 of the Internal Revenue Code of 1986,

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