2006 Minnesota Statutes

62N.27 DEFINITIONS.
    Subdivision 1. Applicability. For purposes of sections 62N.27 to 62N.32, the terms defined
in this section have the meanings given. Other terms used in those sections have the meanings
given in sections 62D.041, 62D.042, and 62D.044.
    Subd. 2. Net worth. "Net worth" means admitted assets as defined in subdivision 3, minus
liabilities. Liabilities do not include those obligations that are subordinated in the same manner
as preferred ownership claims under section 60B.44, subdivision 10. For purposes of this
subdivision, preferred ownership claims under section 60B.44, subdivision 10, include promissory
notes subordinated to all other liabilities of the community integrated service network.
    Subd. 3. Admitted assets. "Admitted assets" means admitted assets as defined in section
62D.044, except that real estate investments allowed by section 62D.045 are not admitted assets.
Admitted assets include the deposit required under section 62N.32.
    Subd. 4. Accredited capitated provider. "Accredited capitated provider" means a health
care providing entity that:
(1) receives capitated payments from a community network under a contract to provide
health services to the network's enrollees. For purposes of this section, a health care providing
entity is "capitated" when its compensation arrangement with a network involves the provider's
acceptance of material financial risk for the delivery of a predetermined set of services for
a specified period of time;
(2) is licensed to provide and provides the contracted services, either directly or through
an affiliate. For purposes of this section, an "affiliate" is any person that directly or indirectly
controls, is controlled by, or is under common control with the health care providing entity, and
"control" exists when any person, directly or indirectly, owns, controls, or holds the power to
vote or holds proxies representing no less than 80 percent of the voting securities or governance
rights of any other person;
(3) agrees to serve as an accredited capitated provider of a community network or for the
purpose of reducing the network's net worth and deposit requirements under section 62N.28; and
(4) is approved by the commissioner as an accredited capitated provider for a community
network in accordance with section 62N.31.
    Subd. 5. Percentage of risk ceded. "Percentage of risk ceded" means the ratio, expressed as
a percentage, between capitated payments made or, in the case of a new entity, expected to be
made by a community network to all accredited capitated providers during any contract year and
the total premium revenue, adjusted to eliminate expected administrative costs, received for the
same time period by the community network.
    Subd. 6. Provider amount at risk. "Provider amount at risk" means a dollar amount certified
by a qualified actuary to represent the expected direct costs to an accredited capitated provider
for providing the contracted, covered health care services to the enrollees of the network to
which it is accredited for a period of 120 days.
History: 1994 c 625 art 1 s 8; 2004 c 285 art 3 s 8