reglab/housing_qa huggingface dataset:
TN Code § 56-32-117 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-117. Rehabilitation, Liquidation, Conservation or Supervision of Hmos

  Any rehabilitation, liquidation, conservation or supervision of an HMO shall be deemed to be the rehabilitation, liquidation, conservation or supervision of an insurance company and shall be conducted under the supervision of the commissioner pursuant to chapter 9 of this title. The commissioner may apply for an order directing the commissioner to rehabilitate, liquidate, conserve or supervise an HMO upon any one (1) or more grounds set out in chapter 9 of this title, or when in the commissioner's opinion the continued operation of the HMO would be hazardous either to the enrollees or to the people of this state. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.   A claim by a health care provider for an uncovered expenditure has the same priority as an enrollee; provided, that the provider of services agrees not to assert the claim against any enrollee of the HMO.    For the purposes of supervision, rehabilitation, or liquidation of HMOs that participate in the TennCare program under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, and in addition to the powers and duties set forth in this chapter, the department or the chancery court shall have the power to examine and investigate the affairs of every person, entity, HMO, an affiliate of the parent of the HMO, or an affiliate of the HMO, in order to determine whether the person, entity, HMO, an affiliate of the parent of the HMO, or an affiliate of the HMO, is operating in accordance with this chapter and title 71, chapter 5. For purposes of this subdivision (c)(1), “affiliate” means any entity that exercises control over or is controlled by the HMO, directly or indirectly through:  Equity ownership of voting securities;   Common managerial control; or   Collusive participation by the management of the HMO and affiliate in the management of the HMO or the affiliate.     For purposes of subdivision (c)(1), “person” includes an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity.
TN Code § 56-32-118 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-118. Rules and Regulations — Notice of Hearing for Denial, Revocation or Suspension of Certificates — Administrative Procedure

  The commissioner of commerce and insurance and the commissioner of health may, after notice and hearing, promulgate reasonable rules and regulations, as are necessary or proper to carry out this chapter.   When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall notify the HMO in writing specifically stating the grounds for denial, suspension or revocation and fixing a time of at least thirty (30) days thereafter for a hearing on the matter.   The Uniform Administrative Procedures Act, compiled in title 4, chapter 5, shall apply to proceedings under this section.
TN Code § 56-32-119 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-119. Fees

 Every HMO subject to this chapter shall pay to the commissioner the following fees for:   Filing an application for certificate of authority, one thousand three hundred dollars ($1,300);   Filing an amendment to the organization documents that require approval, sixty dollars ($60.00);   Filing each annual report, one hundred ninety-five dollars ($195); and   Renewal of the certificate of authority each year, four hundred forty-five dollars ($445).
TN Code § 56-32-120 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-120. Administrative Penalty — Cease and Desist Orders — Injunctions

  The commissioner may, in lieu of suspension or revocation of a certificate of authority under § 56-32-118, levy an administrative penalty in an amount not less than one thousand dollars ($1,000) nor more than ten thousand dollars ($10,000), if reasonable notice in writing is given of the intent to levy the penalty and the HMO has a reasonable time within which to remedy the defect in its operations that gave rise to the penalty citation. The commissioner may augment this penalty by an amount equal to the sum that the commissioner calculates to be the damages suffered by enrollees or other members of the public.    The commissioner may issue an order directing an HMO or a representative of an HMO to cease and desist from engaging in any act or practice in violation of this chapter.   Within fifteen (15) days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. The hearings shall be conducted pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.     In the case of any violation of this chapter, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (b), the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in the chancery court of Davidson County.
TN Code § 56-32-121 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-121. Applicability of Other Laws — Construction

  Except as otherwise provided in this chapter, the insurance laws and the hospital or medical service corporation laws are not applicable to any HMO granted a certificate of authority under this chapter. This subsection (a) does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state, except with respect to its HMO activities authorized and regulated pursuant to this chapter.   Solicitation of enrollees by an HMO granted a certificate of authority, or its representatives, shall not be construed to violate any law relating to solicitation or advertising by health professions.   Any HMO authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from title 63, chapter 6, relating to the practice of medicine.   The Insurance Holding Company System Act of 1986, compiled in chapter 11 of this title, shall be applicable to HMOs to the extent provided in that act, and to the extent provided in § 56-32-122.   HMOs providing utilization review services for mental health and chemical dependency care for their own enrollees shall be subject to chapter 6, part 7 of this title, regarding the provision of utilization review services for mental health or chemical dependency care. This subsection (e) shall not apply to utilization review services provided to TennCare enrollees.
TN Code § 56-32-122 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-122. Acquisition of Control of or Merger of an Hmo

 No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of an HMO or enter into any other agreement if, after the consummation of the agreement, that person would, directly or indirectly, or by conversion or by exercise of any right to acquire, be in control of the HMO, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of an HMO, unless, at the time any offer, request or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the HMO, information required by § 56-11-103(b)(1)-(5) and (13), and the offer, request, invitation, agreement or acquisition has been approved by the commissioner. Approval by the commissioner shall be governed by § 56-11-103(d)(1) and (2).
TN Code § 56-32-123 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-123. Bidding

  Each employer, public or private, except any public entity that has a metropolitan form of government and a population of not less than four hundred thousand (400,000), according to the 1980 federal census or any subsequent federal census, in this state that offers its employees a health benefit plan and employs not less than twenty-five (25) employees, shall afford at least two (2) qualified HMOs the opportunity to bid or to provide health care services. This dual offering is contingent upon written requests being received from the HMOs for inclusion in the employer's health benefit plan, and provided the HMOs are different types or models, such as medical group or staff and individual practice association. Where there is a prevailing collective bargaining agreement, the selection of the HMO or organizations to be made available to the employees shall be made under the agreement.   No employer in this state shall be required to pay more for health benefits as a result of the application of this section than would otherwise be required by any prevailing collective bargaining agreement or other contract for the provision of health benefits to its employees; provided, that the employer or benefits fund shall pay to the HMO chosen by each employee or member an amount equal to the lesser of:  The amount paid on behalf of its other employees or members for health benefits; or   The HMO's charge for coverage approved by the commissioner pursuant to § 56-32-107.
TN Code § 56-32-124 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-124. Taxation

  All HMOs doing business in this state shall pay tax on the gross amount of all dollars collected from an enrollee or on an enrollee's behalf in the amount of six percent (6%).   The taxes provided for in this section shall be due and payable in an electronic format approved by the commissioner on a quarterly basis with payments being due and payable on June 1, August 20, December 1 and March 1. Any company failing or refusing to render tax statement information or to pay taxes as specified in this section shall be subject to  § 56-4-216.   The amount of taxes collected under this section shall be a single credit against the sum total of the taxes imposed by the Franchise Tax Law, compiled in title 67, chapter 4, part 21, and by the Excise Tax Law, compiled in title 67, chapter 4, part 20.
TN Code § 56-32-125 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-125. Confidentiality of Information

  Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from the person or from any provider by any HMO shall be held in confidence by the HMO and shall not be disclosed by the HMO to any person, except upon any one (1) of the following circumstances:  To the extent that it may be necessary to carry out the purposes of this chapter;   Upon the express consent of the enrollee or applicant;   In the event of a claim or litigation between an enrollee or applicant and the HMO wherein the data or information is pertinent;   To implement the purposes of title 71, chapter 5; or   When the data or information is required to be disclosed by the authority of another statute.     Nothing in this section shall be construed to amend § 63-1-150 regarding confidentiality of records and statements relating to quality improvement committees of the HMO that shall remain privileged and not subject to subpoena or discovery.
TN Code § 56-32-129 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-129. Prohibited Discrimination

  The managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services or indemnification as to any provider within a class of providers who is acting within the scope of the provider's license or certification under state law, solely on the basis of the license or certification. In selecting among providers of health services for membership in a provider network, the managed health insurance issuer or other network shall not discriminate against a class of providers who provide services that are covered by the plan by prohibiting the class of providers from membership in the provider network. This section shall not be construed as prohibiting managed health insurance issuers from including providers or classes of providers only to the extent necessary to meet the needs of the managed health insurance issuer's plan and its enrollees, or from limiting referrals or establishing any other measure designed to maintain quality and control costs consistent with the responsibilities of the plan. This chapter shall not be construed as creating coverage for any service that is not otherwise covered under the terms of the managed health insurance issuer's plan.   As used in this section, “class of providers” means optometrists, ophthalmologists, podiatrists, pharmacists, and chiropractors.
TN Code § 56-32-131 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-131. Verification of Health Benefit Delivery — Annual Review — Survey of Persons Disenrolled by the Tenncare Program

  It is the intent of this section to establish a procedure to verify that the HMOs and behavioral health organizations participating by contract in the TennCare program are delivering the health benefits required under their TennCare contracts with the state. This procedure shall also assure that each of these entities have adequate provider networks to ensure the effective and efficient delivery of health care services to TennCare enrollees.   The commissioner, with the advice and consent of the office of the comptroller of the treasury, shall contract with an entity independent of the state of Tennessee to conduct annual reviews of organizations contracting with the state in the TennCare program. The contract shall be entered into in accordance with appropriate state procedures. The purpose of this contract shall be to verify, on an annual basis, that each HMO and behavioral health organization contracting with the state of Tennessee in the TennCare program is delivering health care services in conformity with the TennCare contract and applicable statutory authority. This annual review shall include verifying that each of these organizations maintains an adequate network. The standards for network adequacy are defined by the TennCare contract and applicable statutes and regulations. Nothing in this subsection (b) precludes the expansion of the state's current contract with its External Quality Review Organization (EQRO) to include having the EQRO conduct this review. The contractor shall submit all findings for each organization in writing to the commissioner, the comptroller of the treasury and the director of the TennCare bureau.   The department of commerce and insurance is authorized to conduct a survey of persons disenrolled by the TennCare program to determine if the persons were able to procure health insurance in the private market, or otherwise had access to healthcare benefits. The survey will not commence until a survey form is developed with the assistance of the TennCare bureau of the department of finance and administration, adopted by the commissioner of commerce and insurance, and approved by the state comptroller of the treasury. The survey will be conducted of persons who were disenrolled during the period from January 1, 2002, to December 31, 2002.
TN Code § 56-32-132 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-132. Investigatory Powers of the Department of Commerce and Insurance

 For the purposes of regulation and oversight of HMOs that participate in the TennCare program under Title XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, and in addition to the powers and duties set forth in this title, the department of commerce and insurance has the power to examine and investigate the affairs of every person, entity, HMO, an affiliate of the parent of the HMO, or an affiliate of the HMO, in order to determine whether the person, entity, HMO, an affiliate of the parent of the HMO, or an affiliate of the HMO, is operating in accordance with this chapter and title 71, chapter 5.
TN Code § 56-32-134 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-134. Required Information for Verification and Audit Purposes

  As used in this section, “affiliate” has the same meaning as defined in § 56-32-102.    For verification and audit purposes, each managed care organization that participates in the TennCare program shall provide to the department of commerce and insurance the following information for its organization:  The names and addresses of all persons required to file a disclosure with the commissioner of health under § 71-5-137(a) and (b);   An explanation of the interest in or connection with the managed care organization, or an affiliate of the organization, in accordance with § 71-5-137(a), of each person required to file a disclosure under subdivision (b)(1)(A); and   A listing of all compensation of any form paid to each person required to file a disclosure under subdivision (b)(1)(A) related to the person's interest in or connection with the managed care organization, or an affiliate of the organization, in accordance with § 71-5-137(a).     The information shall be provided on or before January 15 of each year for the preceding calendar year.
TN Code § 56-32-135 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-135. Confidentiality

 Any information and documentation obtained by the department pursuant to § 56-32-117(c) or § 56-32-132, shall be considered confidential, unless the commissioner in the commissioner's sole discretion determines to disclose the information or documentation.
TN Code § 56-32-136 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-136. Violation and Penalty

 A violation of this chapter shall subject the violator to the penalty contained in § 56-1-801.
TN Code § 56-32-137 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-137. Discrimination Prohibited — Coverage Not Created

 A managed health insurance issuer shall not discriminate with respect to participation, referral, reimbursement of covered services, or indemnification as to any provider who is acting within the scope of the provider's license or certification under state law, solely on the basis of the license or certification. In selecting among providers of health services for membership in a provider network, a managed health insurance issuer or other network shall not discriminate against a class of providers who provide services that are covered by the plan by prohibiting the class of providers from membership in the provider network. As used in this section, “class of providers” means licensed physician assistants as defined in § 63-19-102, certified nurse midwives as described in § 56-7-2407, and nurses in advanced practice as defined in § 56-7-2408. This section shall not be construed as prohibiting managed health insurance issuers from including providers or classes of providers only to the extent necessary to meet the needs of the managed health insurance issuer's plan and its enrollees or from limiting referrals or establishing any other measure designed to maintain quality and control costs consistent with the responsibilities of the plan. This section shall not be construed as creating coverage for any service that is not otherwise covered under the terms of the managed health insurance issuer's plan.
TN Code § 56-32-138 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 32 - Health Maintenance Organization Act of 1986|§ 56-32-138. Payment of Authorized Pharmacy Claims — Corrections by Pharmacy

   If authorization is given and a pharmacy claim is adjudicated by an HMO or its agent to any pharmacy services provider for care to be delivered to a covered beneficiary under any evidence of coverage issued by the HMO, including those organizations participating in the TennCare program, collectively referred to as “organization,” then the organization acting directly or by delegation through an agent acting on behalf of the organization shall not subsequently rescind or modify that authorization or deny the authorized payment to the pharmacy services provider for the authorized service after the provider renders the authorized service in good faith and pursuant to the authorization, except for payments made as a result of the provider's misrepresentation or fraud.   If the bureau of TennCare provides notice to the HMO or its agent that a person is eligible to participate in the TennCare program, and, if based on good faith reliance on the information, the HMO makes a payment to a pharmacy provider for providing pharmacy services to the person enrolled in the TennCare program, and if the bureau of TennCare later rescinds the eligibility for the person, then the bureau of TennCare shall remain liable to the HMO for any amount the HMO paid to the provider for the pharmacy services. The bureau of TennCare shall not be liable when the eligibility is rescinded in the case of fraud or death as defined in the contract. The bureau of TennCare shall not be liable due to an error or delay on the part of the managed care organization or its agents in processing eligibility information received from the bureau of TennCare.     Notwithstanding subsection (a), any organization may request the pharmacy to adjust or correct an adjudicated claim to correct incorrect data elements, including incorrect billing units, incorrect national drug code (NDC) numbers and incorrect prescriber identification numbers submitted in error and in good faith by the pharmacy. An organization shall provide the pharmacy an opportunity to correct claims submitted by the pharmacy in good faith. If the pharmacy does not correct the adjudicated claim requested within thirty (30) days of receipt of the request, then the organization may rescind, modify or recoup the funds paid on the requested claim and shall not be in violation of this section.
TN Code § 56-36-101 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 36 - Standard Nonforfeiture Law for Individual Deferred Annuities|§ 56-36-101. Short Title

 This chapter shall be known and may be cited as the “Standard Nonforfeiture Law for Individual Deferred Annuities.”