Page:United States Statutes at Large Volume 124.djvu/216

124 STAT. 190 PUBLIC LAW 111–148—MAR. 23, 2010 (A) the governance of the organization is subject to a majority vote of its members; (B) its governing documents incorporate ethics and conflict of interest standards protecting against insurance industry involvement and interference; and (C) as provided in regulations promulgated by the Sec- retary, the organization is required to operate with a strong consumer focus, including timeliness, responsiveness, and accountability to members. (4) PROFITS INURE TO BENEFIT OF MEMBERS.—An organiza- tion shall not be treated as a qualified nonprofit health insur- ance issuer unless any profits made by the organization are required to be used to lower premiums, to improve benefits, or for other programs intended to improve the quality of health care delivered to its members. (5) COMPLIANCE WITH STATE INSURANCE LAWS.—An organization shall not be treated as a qualified nonprofit health insurance issuer unless the organization meets all the require- ments that other issuers of qualified health plans are required to meet in any State where the issuer offers a qualified health plan, including solvency and licensure requirements, rules on payments to providers, and compliance with network adequacy rules, rate and form filing rules, any applicable State premium assessments and any other State law described in section 1324(b). (6) COORDINATION WITH STATE INSURANCE REFORMS.—An organization shall not be treated as a qualified nonprofit health insurance issuer unless the organization does not offer a health plan in a State until that State has in effect (or the Secretary has implemented for the State) the market reforms required by part A of title XXVII of the Public Health Service Act (as amended by subtitles A and C of this Act). (d) ESTABLISHMENT OF PRIVATE PURCHASING COUNCIL.— (1) IN GENERAL.—Qualified nonprofit health insurance issuers participating in the CO–OP program under this section may establish a private purchasing council to enter into collec- tive purchasing arrangements for items and services that increase administrative and other cost efficiencies, including claims administration, administrative services, health informa- tion technology, and actuarial services. (2) COUNCIL MAY NOT SET PAYMENT RATES.—The private purchasing council established under paragraph (1) shall not set payment rates for health care facilities or providers partici- pating in health insurance coverage provided by qualified non- profit health insurance issuers. (3) CONTINUED APPLICATION OF ANTITRUST LAWS.— (A) IN GENERAL.—Nothing in this section shall be con- strued to limit the application of the antitrust laws to any private purchasing council (whether or not established under this subsection) or to any qualified nonprofit health insurance issuer participating in such a council. (B) ANTITRUST LAWS.—For purposes of this subpara- graph, the term ‘‘antitrust laws’’ has the meaning given the term in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). Such term also includes section 5 of the Federal Trade Commission Act (15 U.S.C. 45) to