Sec. 845.053. REQUIREMENTS APPLICABLE TO CERTAIN PLANS. (a) Except as provided by Subsection (b), if the system seeks to sponsor, arrange for the provision of, or provide health care services to enrollees in exchange for a predetermined payment per enrollee on a prepaid basis, the system must comply with:
(1) all requirements under this code imposed on health plans, including health maintenance organizations; and
(2) any additional requirements the commissioner determines are necessary to ensure enrollee access to health care providers and health care services.
(b) The system is not required to comply with requirements described by Subdivision (a)(1) that relate to mileage, distance, network adequacy, and scope of coverage that the commissioner determines are not applicable to the system.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.214(a), eff. Sept. 1, 2003.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 845 - Statewide Rural Health Care System
Section 845.051. Statewide Rural Health Care System
Section 845.052. Organization Requirements
Section 845.053. Requirements Applicable to Certain Plans
Section 845.054. Local Government
Section 845.055. Provision of Administrative and Health Care Services
Section 845.056. Gifts and Grants
Section 845.057. Limitation on Authority of Participating Hospital Providers