Texas Administrative Code

The applicant shall have the right to proceed with activities covered by the application immediately upon submitting the certificates, bond (or other substitute collateral), approved application fee required in § 11.95 of this title (relating to Surface Mining Bonding, Insurance,…

(a) This section applies only to an MPO serving an urbanized area with a population over 200,000 and the award of TA Set-Aside funds suballocated for such an urbanized area. (b) The MPO, in consultation with the department, shall develop a competitive process to allow project spo…

(a) During a program call administered by the department, TA Set-Aside funds may be awarded for any of the following activities: (1) construction of on-road and off-road trail facilities for pedestrians, bicyclists, and other non-motorized forms of transportation, including sidew…

(a) Access purchase request. A request to purchase a new access connection to a highway across an access denial line will be considered under this section. The request must include an engineering study acceptable to the department. (b) Determination. The commission will make the …

Transportation corridors in urban areas strive to meet the aesthetic needs of local citizens just as they strive to meet the transportation needs of all Texans. To that end, the Texas Department of Transportation will coordinate the resources of the state, of local governments, a…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Commission--Texas Transportation Commission. (2) Department--Texas Department of Transportation. (3) Executive director--The executi…

(a) The state is required to suballocate, in accordance with 23 U.S.C. § 133(h) , a part of its TA Set-Aside apportionment to urbanized areas with populations over 200,000. (b) Each MPO serving an urbanized area with a population over 200,000 shall implement the TA Set-Aside Prog…

(a) Except as otherwise provided, words and terms defined in Insurance Code Chapters 823 (concerning Insurance Holding Company Systems), 843 (concerning Health Maintenance Organizations), 1271 (concerning Benefits Provided by Health Maintenance Evidence of Coverage; Charges), 127…

An HMO is subject to the requirements of Insurance Code Chapter 823 (concerning Insurance Holding Company Systems); Insurance Code Chapter 824 (concerning Merger and Consolidation of Stock Insurance Corporations); and Chapter 7, Subchapter B, of this title (relating to Insurance …

The commissioner may require additional information as needed to make any determination required by Insurance Code Chapter 843 (concerning Health Maintenance Organizations) and Insurance Code Chapter 1271 (concerning Benefits Provided by Health Maintenance Evidence of Coverage; C…

(a) HMOs must include the following notice in information provided to new subscribers: Attached Graphic (b) The entire notice must be in at least 10-point type. If the newsletter or other mailing is in larger than 10-point type, the notice must be in the same type as the rest of …

(a) An HMO may not require any pharmacy or pharmacist participating or applying to participate as a contracted provider in an HMO delivery network to: (1) provide financial statements to the HMO; or (2) deposit with the HMO any monies or other form of consideration, except for re…

An HMO may not require an enrollee in a group health plan to pay a premium or contribution that is different from the premium or contribution for a similarly situated enrollee based on a health status-related factor. For purposes of this section, the term "similarly situated" has…

(a) Whenever requested by the department, an MCO participating in Medicaid must file with the department a complete set of financial exhibits pertaining to the state Medicaid program, in the format of the Managed Care Financial Statistical Report, as may be modified or amended by…

(a) Basic, single service, and limited service HMOs must develop and maintain an ongoing QI program designed to objectively and systematically monitor and evaluate the quality and appropriateness of care and services and to pursue opportunities for improvement. Unless the HMO has…

The QI program for basic, single service, and limited service HMOs must be continuous and comprehensive, addressing both the quality of clinical care and the quality of services. The HMO must dedicate adequate resources, such as personnel and information systems, to the QI progra…

A filing fee required by Insurance Code § 843.154 (concerning Fees), as determined by § 7.1301 of this title (relating to Regulatory Fees), must accompany an application for a certificate of authority, unless the filing is made electronically through the NAIC's System for Electro…

(a) Revisions during the review of an application for a certificate of authority must be addressed to: Company Licensing and Registration Office, Mail Code 103-CL, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104, or submitted electronically as instructed …

The application for a certificate of authority must contain the following, in this order: (1) a completed name application form along with any certificate of reservation of corporate name issued by the secretary of state; (2) a completed certificate of authority application form;…

(a) The following documents must be made available for review at the applicant's office in Texas or another location within Texas agreed to by the department and on request during the application process: (1) administrative: policy and procedure manuals; (2) health information sy…

Each limited service HMO evidence of coverage providing long-term care services and benefits must comply with Insurance Code Chapter 1651 (concerning Long-Term Care Benefit Plans) and Chapter 3, Subchapter Y, of this title (relating to Standards for Long-Term Care Insurance, Non-…

The following words and terms, when used in this subchapter, have the meaning indicated below unless the context indicates otherwise: (1) Coinsurance--An amount in addition to the premium and copayments due from an enrollee who accesses out-of-plan covered benefits, for which the…

(a) Financial requirements. An HMO that issues a point-of-service rider is subject to the requirements of Insurance Code § 843.403 (concerning Minimum Net Worth) and § 7.402 of this title (relating to Risk-Based Capital and Surplus Requirements for Insurers and HMOs). (b) Termina…

(a) A delegating HMO must: (1) identify all responsibilities relating to the function being delegated; (2) create an agreement that enables the HMO and department to monitor both the delegated entity's financial solvency and performance or subsequent delegation of all delegated f…

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Delegated entity--An entity, other than an HMO authorized to do business under Insurance Code Chapter 843 (concerning Health Maintenance O…

(a) Any delegation of any function under Insurance Code Chapter 843 (concerning Health Maintenance Organizations) and Chapter 1272 (concerning Delegation of Certain Functions by Health Maintenance Organization), and other applicable insurance laws and regulations of this state by…

(a) An HMO that delegates any function required by Insurance Code Chapter 843 (concerning Health Maintenance Organizations) and Chapter 1272 (concerning Delegation of Certain Functions by Health Maintenance Organization), and other applicable insurance laws and regulations of thi…

Individual and group agreements must contain the following additional mandatory provisions as applicable: (1) Certificate. Group agreements must include provisions that the contract holder must be provided with subscriber certificates to be delivered to each subscriber, the certi…

Evidences of coverage may contain optional provisions, including, but not limited to, the following: (1) Coordination of benefits. Plans may contain a provision that the value of any benefits or services provided by the HMO may be coordinated with any other type of insurance plan…

An HMO may provide health services to its enrollees in addition to the services required in § 11.508 of this title (relating to Basic Health Care Services and Mandatory Benefit Standards: Group, Individual and Conversion Agreements). An HMO may limit these optional health service…

HMOs must comply with Insurance Code Chapters 541 (concerning Unfair Methods of Competition and Unfair or Deceptive Acts or Practices), 542 (concerning Processing and Settlement of Claims), and 547 (concerning False Advertising by Unauthorized Insurers) and related rules, to the …

Any HMO licensed to do business in Texas that offers coverage to Medicare beneficiaries under the provisions of Subchapter XVIII of 42 United States Code, Health Insurance for the Aged and Disabled, must file with the department a copy of each advertisement related to the coverag…

(a) The following items must be incorporated into a guarantee from a sponsoring organization for the HMO to report expenses and liabilities as covered: (1) the guarantee must be approved by a board resolution of the sponsoring organization; (2) the sponsoring organization must ha…

(a) In addition to any other actions available under the Insurance Code, the commissioner may take action against an HMO under §843.157 (concerning Rehabilitation, Liquidation, Supervision, or Conservation of Health Maintenance Organizations) and Insurance Code § 843.461 (concern…

(a) An HMO must allow an enrollee with chronic, disabling, or life threatening illnesses to apply to the HMO's medical director to use a nonprimary care physician specialist as a primary care physician, provided that: (1) the enrollee makes a request for special consideration tha…

(a) An HMO may not: (1) require a physician to use a hospitalist for a hospitalized patient by contract under Insurance Code § 843.320 , concerning Use of Hospitalist; (2) refuse to contract with a nurse first assistant to be part of a provider network or refuse to reimburse a nu…

(a) An HMO may not, as a condition of a contract with a physician or provider, or in any other manner, prohibit, attempt to prohibit, or discourage a physician or provider from discussing with or communicating to a current, prospective, or former patient, or a party designated by…

(a) The commission adopts by reference the rules of the Texas Comptroller of Public Accounts, Statewide Procurement and Support Services in 34 TAC § 20.207 and § 20.208(relating to Competitive Sealed Bidding and Competitive Sealed Proposals). (b) The adoption of this rule is requ…

(a) Pursuant to Texas Government Code, § 2261.253 , the commission shall assess each contract to determine appropriate contract and performance monitoring requirements. (b) The executive director or his designee shall ensure that risk assessment factors are used to determine when…

The contract monitoring roles and responsibilities of agency internal audit staff and other inspection, investigative, or audit staff are as follows. (1) A unit within the agency will perform internal audit activities which will include providing assistance and consulting regardi…

This subchapter applies only to contracts for goods or services which have been procured by one of the procurement methods described in Texas Government Code, § 2261.001 as being subject to the requirements of Texas Government Code, Chapter 2261. Notes 30 Tex. Admin. Code § 11.20…

(a) Any actual or prospective bidder, offeror, proposer, or contractor who is aggrieved in connection with the solicitation, evaluation, or award of a contract may formally protest to the Procurements and Contracts Manager of the commission or his designee (hereafter Manager). Su…

(a) A contractor may request a contested case hearing before the State Office of Administrative Hearings (SOAH) of any unsettled portion of the claim. (b) A contractor must file the request for hearing with the chief clerk in writing on a form to be determined by the commission. …

The purpose of this chapter is to prescribe rules and regulations for the Texas State Technical College System in the general operation of its campuses, extension facilities, and programs. Notes 19 Tex. Admin. Code § 11.1 The provisions of this §11.1 adopted to be effective Augus…

(a) Covered produce. Covered produce includes produce listed in 21 CFR § 112.1 . (b) Produce that is not covered. (1) The following produce is "not covered" by the Produce Safety Rule under 21 CFR § 112.2(a) : (A) produce that is produced by an individual for personal consumption…

(a) Texas Education Code, Section 135.01 , creates the Texas State Technical College System and provides that it shall be a coeducational two-year institution of higher education offering courses of study in technical-vocational education for which there is demand within the Stat…

(a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise. (1) Regulation--A rule. (2) Rule-- (A) a state agency statement of general applicability that: (i) implements, interprets, or prescribe…