solvency requirements
(2) Special exception for provider-sponsored organizations (A) In general In the case of a provider-sponsored organization that seeks to offer a Medicare+Choice plan in a State, the Secretary shall waive the requirement of paragraph (1) that the organization be licensed in that State if— (i) the organization files an application for such waiver with the Secretary by not later than November 1, 2002 , and (ii) the Secretary determines, based on the application and other evidence presented to the Secretary, that any of the grounds for approval of the application described in subparagraph (B), (C), or (D) has been met. (B) Failure to act on licensure application on a timely basis The ground for approval of such a waiver application described in this subparagraph is that the State has failed to complete action on a licensing application of the organization within 90 days of the date of the State’s receipt of a substantially complete application. No period before August 5, 1997 , shall be included in determining such 90-day period. (C) Denial of application based on discriminatory treatment The ground for approval of such a waiver application described in this subparagraph is that the State has denied such a licensing application and— (i) the standards or review process imposed by the State as a condition of approval of the license imposes any material requirements, procedures, or standards (other than solvency requirements) to such organizations that are not generally applicable to other entities engaged in a substantially similar business, or (ii) the State requires the organization, as a condition of licensure, to offer any product or plan other than a Medicare+ÐChoice plan. (D) Denial of application based on application of solvency requirements With respect to waiver applications filed on or after the date of publication of solvency standards under section 1395w–26(a) of this title , the ground for approval of such a waiver application described in this subparagraph is that the State has denied such a licensing application based (in whole or in part) on the organization’s failure to meet applicable solvency requirements and— (i) such requirements are not the same as the solvency standards established under section 1395w–26(a) of this title ; or (ii) the State has imposed as a condition of approval of the license documentation or information requirements relating to solvency or other material requirements, procedures, or standards relating to solvency that are different from the requirements, procedures, and standards applied by the Secretary under subsection (d)(2). For purposes of this paragraph, the term “solvency requirements” means requirements relating to solvency and other matters covered under the standards established under section 1395w–26(a) of this title . (E) Treatment of waiver In the case of a waiver granted under this paragraph for a provider-sponsored organization with respect to a State— (i) Limitation to State The waiver shall be effective only with respect to that State and does not apply to any other State. (ii) Limitation to 36-month period The waiver shall be effective only for a 36-month period and may not be renewed. (iii) Conditioned on compliance with consumer protection and quality standards The continuation of the waiver is conditioned upon the organization’s compliance with the requirements described in subparagraph (G). (iv) Preemption of State law Any provisions of law of that State which relate to the licensing of the organization and which prohibit the organization from providing coverage pursuant to a contract under this part shall be superseded. (F) Prompt action on application The Secretary shall grant or deny such a waiver application within 60 days after the date the Secretary determines that a substantially complete waiver application has been filed. Nothing in this section shall be construed as preventing an organization which has had such a waiver application denied from submitting a subsequent waiver application. (G) Application and enforcement of State consumer protection and quality standards (i) In general A waiver granted under this paragraph to an organization with respect to licensing under State law is conditioned upon the organization’s compliance with all consumer protection and quality standards insofar as such standards— (I) would apply in the State to the organization if it were licensed under State law; (II) are generally applicable to other Medicare+Choice organizations and plans in the State; and (III) are consistent with the standards established under this part. Such standards shall not include any standard preempted under section 1395w–26(b)(3)(B) of this title . (ii) Incorporation into contract In the case of such a waiver granted to an organization with respect to a State, the Secretary shall incorporate the requirement that the organization (and Medicare+Choice plans it offers) comply with standards under clause (i) as part of the contract between the Secretary and the organization under section 1395w–27 of this title . (iii) Enforcement In the case of such a waiver granted to an organization with respect to a State, the Secretary may enter into an agreement with the State under which the State agrees to provide for monitoring and enforcement activities with respect to compliance of such an organization and its Medicare+Choice plans with such standards. Such monitoring and enforcement shall be conducted by the State in the same manner as the State enforces such standards with respect to other Medicare+Choice organizations and plans, without discrimination based on the type of organization to which the standards apply. Such an agreement shall specify or establish mechanisms by which compliance activities are undertaken, while not lengthening the time required to review and process applications for waivers under this paragraph. (H) Report By not later than December 31, 2001 , the Secretary shall submit to the Committee on Ways and Means and the Committee on Commerce of the House of Representatives and the Committee on Finance of the Senate a report regarding whether the waiver process under this paragraph should be continued after December 31, 2002 . In making such recommendation, the Secretary shall consider, among other factors, the impact of such process on beneficiaries and on the long-term solvency of the program under this subchapter.