LICENSED BY THE STATE AS A RISK-BEARING ENTITY

What is LICENSED BY THE STATE AS A RISK-BEARING ENTITY?

LICENSED BY THE STATE AS A RISK-BEARING ENTITY meaning An entity that is licensed or otherwise authorized by the State to assume risk for offering health insurance or health benefits coverage. The entity is authorized to accept prepaid capitation for providing, arranging, or paying for comprehensive health services under an M+C contract. Designation that an M+C organization has been reviewed and determined “fully accredited” by a CMS-approved accrediting organization for those standards within the deeming categories that the accrediting organization has the authority to deem.

 

reference: Centers for Medicare & Medicaid Services

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