Licensed by the state as a risk-bearing entity

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 a Medicare+Choice (M+C) contract. Designation that an M+C organization has been reviewed and determined “fully accredited” by a Centers for Medicare and Medicaid Services (CMS)-approved accrediting organization for those standards within the deeming categories that the accrediting organization has the authority to deem.

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