North Dakota Administrative Code
Title 45 - Insurance, Commissioner of
Article 45-06 - Accident and Health Insurance
Chapter 45-06-13 - Provider-Sponsored Organizations
Section 45-06-13-01 - Definitions

1. "Commissioner" means the insurance commissioner of North Dakota.

2. "Department" means the North Dakota insurance department.

3. "Health care services" means the following medically necessary services: preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory, and diagnostic and therapeutic radiological services.

4. "Medicare+choice program" means the criteria developed by the Balanced Budget Act of 1997 [ Pub. L. 105-33; 111 Stat. 312; 42 U.S.C. 1345 et seq.], whereby risk-bearing organizations are permitted to offer health insurance or health benefits coverage to medicare-eligible enrollees through a medicare+choice plan.

5. "Provider" means any physician, hospital, or other person licensed or otherwise authorized to furnish health care services.

6. "Provider-sponsored organization" means a public or private entity that:

a. Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;

b. Provides a substantial proportion of the health care items and services under the medicare+choice program 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.

General Authority: NDCC 26.1-01-07.6

Law Implemented: NDCC 26.1-01-07.6