Texas Administrative Code

(a) All HCC filings for original or renewal application as required by this subchapter must be made to Company Licensing & Registration, Mail Code 305-2C, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104, and copies of all HCC forms are available through t…

(a) While planning or developing an HCC, an organization may use the terms "health care collaborative" or "HCC" as a part of the proposed HCC's name provided the developmental status of the proposed HCC is clearly communicated in all dealings with employers, individuals, prospect…

(a) The application filing fee required by Insurance Code § 848.152 must accompany the application required to be filed by Insurance Code § 848.056 or § 848.060 . (b) The fee for filing the original application for certificate of authority is $10,000 and is nonrefundable. (c) The…

(a) Revisions during the review of the application must be addressed to: Company Licensing & Registration, Mail Code 305-2C, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. (b) Each revision to the basic organizational document, bylaws, or officers' and …

(a) Order of contents. The application must include the items in the order listed in this section. (b) Original and copies. An applicant filing a nonelectronic application must submit two additional copies of the application along with the original application. (c) General conten…

(a) This section specifies circumstances under which an applicant is not required to provide the information specified in § 13.413 (i) of this title (relating to Contents of the Application) in filing an original or renewal application for certificate of authority. (b) An applica…

(a) The following documents must be provided to the department on request and available for review at the HCC's office located within Texas: (1) administrative: policy and procedure manuals, including procedures relating to confidentiality; patient materials; organizational chart…

(a) An HCC must comply with Insurance Code § 848.053 , including requirements relating to committee membership, charges, fees, distributions, or other compensation assessed for services provided by HCC participants, and to the sharing of the data among nonparticipating physicians…

(a) An HCC must establish and administer procedures and internal controls to safeguard and ensure against the sharing of any confidential information with or among participants. (b) The requirements of this section include establishing and enforcing collection, custodial, retriev…

HCCs must comply with Insurance Code Chapters 541 and 542, and rules promulgated by the department pursuant to Insurance Code Chapters 541 and 542, as applicable, in the same manner as insurance companies or HMOs. Notes 28 Tex. Admin. Code § 13.429 The provisions of this §13.429 …

(a) An HMO's delegation of functions to an HCC is subject to the requirements of Insurance Code Chapter 1272 and Chapter 11, Subchapter AA of this title (relating to Delegated Entities). (b) An insurer's delegation of functions to an HCC is subject to the requirements of Insuranc…

(a) An HCC must develop and maintain an ongoing quality improvement (QI) program designed to objectively and systematically monitor and evaluate the quality and appropriateness of health care services that it arranges for or offers, and to pursue opportunities for improvement. Un…

(a) An HCC must establish, implement, and administer a continuous quality assurance and quality improvement program that includes defined policies and processes to: (1) promote evidence-based medicine and best practices; (2) secure patient engagement; (3) promote coordination of …

An HCC must implement a documented process for selection and retention of contracted participants. The credentialing process must comply with the standards promulgated by the National Committee for Quality Assurance, URAC, the Joint Commission on Accreditation of Hospital Organiz…

(a) Each HCC must implement and maintain a complaint system that complies with Insurance Code § 848.107 and this division that provides reasonable procedures for resolving an oral or written complaint initiated by a complainant concerning the HCC or health care services arranged …

(a) Management of approved PEO. An approved PEO must be managed by competent and trustworthy individuals. An individual responsible for risk management, financial reporting, underwriting, claims, or investment functions of the plan and trust must be eligible for licensure based o…

An approved PEO must contract for stop-loss insurance in the name of and on behalf of the plan and trust that complies with § 13.567 of this title (relating to Stop-Loss Insurance), until the trustees have contracted for stop-loss insurance as provided in § 13.555 of this subchap…

An approved PEO must maintain a fidelity bond or a zero-deductible crime policy that complies with the requirements of § 13.568 of this title (relating to Standards for Fidelity Coverage). The fidelity bond or zero-deductible crime policy must cover each person responsible for ha…

(a) Assessed contributions. Contributions assessed by the approved PEO from clients for coverage for their participants must be sufficient to fund at least 100 percent of the plan and trust's aggregate stop-loss retention, as provided in Division 6 of this subchapter, plus all ot…

(a) Marketing material. An approved PEO's marketing material discussing the plan and trust must be fair and accurate, and must not represent the plan or a prospective client's projected contributions to be assessed for coverage under the plan in a way that is materially inaccurat…

(a) Initial deposit or letter of credit. Before receiving a certificate of approval, a PEO applying for a certificate of approval must establish a deposit of at least 25 percent of the attachment point of the aggregate limit included in the plan's stop-loss insurance agreement or…

A deposit must consist of funds in the form of: (1) money of the United States including certificates of deposit issued by a qualified financial institution, but the amount of total deposits by the approved PEO in the qualified financial institution may not exceed the greater of:…

(a) Annual recalculation. An approved PEO must recalculate its deposit required every year, not later than 60 days after negotiating the plan's stop-loss insurance agreement for the current plan year, using the formula stated in § 13.562 (b) of this title (relating to Deposit or …

(a) Requirements. Instead of a deposit, an approved PEO may maintain a letter of credit. A letter of credit must comply with the following requirements: (1) the letter of credit cannot be supported or collateralized by a guaranty; (2) the letter of credit and all amendments to th…

(a) Annual recalculation. An approved PEO must recalculate the required amount of its letter of credit every year, not later than 60 days after negotiating the plan's stop-loss insurance agreement for the current plan year, using the formula stated in § 13.562 (b) of this title (…

(a) Hazardous conditions. An approved PEO's plan and trust are considered to be in hazardous condition if any of the following conditions exist with respect to the plan and trust: (1) assets to liability ratio less than 1:1; (2) negative financial position; (3) negative net incom…

(a) Withdrawal plan. An approved PEO that undertakes of its own initiative or is required by § 13.581 or § 13.582 of this title (relating to Limitation, Suspension, or Cancellation of Certificate of Approval in Response to TDLR Action and Limitation, Suspension, or Cancellation o…

(a) Notice of TDLR action against approved PEO's license. The commissioner will limit, suspend, or cancel an approved PEO's certificate of approval in response to an action by TDLR against the approved PEO's license. (b) Notice of TDLR's contemplated action. An approved PEO must …

(a) Commissioner's authority. Nothing in this section limits the commissioner's authority under Insurance Code Chapters 404, Financial Condition; 406, Special Deposits Required Under Potentially Hazardous Conditions; 441, Supervision and Conservatorship; or 443, the Insurer Recei…

(a) Plan termination. If the commissioner determines that an approved PEO's certificate of approval should be canceled, the approved PEO must terminate its health benefit plan in compliance with § 13.580 of this title (relating to Withdrawal from Market). The approved PEO must fi…

There is no present rule on this subject. Licensees should refer to statutory law. Notes 28 Tex. Admin. Code § 13.6 The provisions of this §13.6 adopted to be effective May 3, 1983, 8 TexReg 1294.

In addition to the definitions set out in Texas Agriculture Code, Chapters 101, and 103 and Chapter 1, Subchapter A of this title (relating to the General Rules of Practice), the following words and terms, when used in this chapter, shall have the following meanings, unless the c…

(a) What claims can be filed. Only claims against a licensee or a person required to be licensed for loss or damages due to a violation of the terms or conditions of a contract for the sale of perishable commodities grown in Texas may be filed. The following claims may not be acc…

(a) Once a claim is filed in accordance with § 14.10 of this title (relating to Claims Against the Fund), the department shall investigate the claim and may conduct a hearing to determine the amount due the aggrieved party. All hearings shall be conducted by a department hearing …

(a) A person who disputes the recommendation of the department's hearing officer or the department's final determination on a claim shall file a Notice of Protest with the department. The notice shall be sent to the attention of the Hearings Clerk, General Counsel Division, Texas…

(a) The following payments of claims shall apply for a claim based on a violation occurring prior to September 1, 2009. (1) Claims of $2000 or less may be paid in full. (2) Claims of more than $2000 may be paid in the following manner: (A) If the claim was filed on or after Septe…

(a) If the department pays a claim against a licensee, or a person required to be licensed, from the Fund:(1) Upon issuance of a final determination from the department or the Board, the licensee shall reimburse the total amount paid by the Fund or agree in writing to reimburse t…

A licensee or a packer, processor, warehouseman or transporter may not receive or handle citrus fruit without requiring the person from whom the citrus fruit is purchased or received to furnish proof of ownership on a form approved by the department; except for citrus fruit being…

The purpose of these sections is to provide operating procedures for the Produce Recovery Fund Board (the Board), and to provide procedures for the conduct and determination of Board decisions, so that hearings and other proceedings before the Board may be conducted in a uniform …

(a) A prospective licensee may apply to AFS for one or more licenses specified in subsection (b)(1) - (8) of this section. A prospective container manufacturer may apply to AFS for a container manufacturer registration specified in subsection (d) of this section. Fees required to…

(a) This section applies to military service members, military veterans, or military spouses, as those terms are defined in Texas Occupations Code, Chapter 55. (b) The Commission shall waive license and examination fees for: (1) a military service member or military veteran whose…

(a) Requirements and application for a new certificate. (1) In addition to NFPA 52 §§4.1 and 4.2 and 59A §14.9, no person shall perform work, directly supervise LNG activities, or be employed in any capacity requiring contact with LNG unless that individual: (A) is a certificate …

(a) The Board shall: (1) advise the department on all matters relating to the Fund, including the Fund's budget and revenues necessary to accomplish the purposes of the Fund; (2) advise the department on the adoption of rules relating to the payment of claims from the Fund and to…

(a) Location, conduct and time of meetings. The Board shall meet in Austin, or other places designated by the Board, on dates to be determined by the department with the advice of the Board, for the purpose of conducting hearings on matters appealed to the Board and/or for the pu…

(a) Representation. Parties to proceedings before the Board shall have a right to appear and may be represented by counsel, or any other designated person, and shall have a right to have witnesses appear to testify on their behalf. (b) Review of Department Record and Presentation…

(a) All final determinations of the Board shall be in writing and shall set forth findings of fact and conclusions of law as required by the Administrative Procedure Act. (b) Unless otherwise prohibited by statute or by this chapter, all final Board determinations may be signed b…

A motion for rehearing shall be governed by the Administrative Procedure Act, §§2001.145-2001.146. Communications regarding any such motion shall be directed to the Board, and filed with the Hearings Clerk, General Counsel Division, Texas Department of Agriculture. A copy of the …