reglab/housing_qa huggingface dataset:
TX Ins Code § 848.005 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter A. General Provisions|Section 848.005. Certain Information Confidential

Sec. 848.005.  CERTAIN INFORMATION CONFIDENTIAL.  (a)  Except as provided by Subsection (b), an application, filing, or report required under this chapter is public information subject to disclosure under Chapter 552, Government Code.(b)  The following information is confidential and is not subject to disclosure under Chapter 552, Government Code:(1)  a contract, agreement, or document that establishes another arrangement:(A)  between a health care collaborative and a governmental or private entity for all or part of health care services provided or arranged for by the health care collaborative; or(B)  between a health care collaborative and participating physicians and health care providers;(2)  a written description of a contract, agreement, or other arrangement described by Subdivision (1);(3)  information relating to bidding, pricing, or other trade secrets submitted to:(A)  the department under Sections 848.057(a)(5) and (6); or(B)  the attorney general under Section 848.059;(4)  information relating to the diagnosis, treatment, or health of a patient who receives health care services from a health care collaborative under a contract for services; and(5)  information relating to quality improvement or peer review activities of a health care collaborative.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.006 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter A. General Provisions|Section 848.006. Coverage by Health Care Collaborative Not Required

Sec. 848.006.  COVERAGE BY HEALTH CARE COLLABORATIVE NOT REQUIRED.  (a)  Except as provided by Subsection (b) and subject to Chapter 843 and Section 1301.0625, an individual may not be required to obtain or maintain coverage under:(1)  an individual health insurance policy written through a health care collaborative; or(2)  any plan or program for health care services provided on an individual basis through a health care collaborative.(b)  This chapter does not require an individual to obtain or maintain health insurance coverage.(c)  Subsection (a) does not apply to an individual:(1)  who is required to obtain or maintain health benefit plan coverage:(A)  written by an institution of higher education at which the individual is or will be enrolled as a student; or(B)  under an order requiring medical support or dental support for a child; or(2)  who voluntarily applies for benefits under a state administered program under Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.), or Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.).(d)  Except as provided by Subsection (e), a fine or penalty may not be imposed on an individual if the individual chooses not to obtain or maintain coverage described by Subsection (a).(e)  Subsection (d) does not apply to a fine or penalty imposed on an individual described in Subsection (c) for the individual's failure to obtain or maintain health benefit plan coverage.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 55, eff. September 1, 2018.|
TX Ins Code § 848.051 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.051. Operation of Health Care Collaborative

Sec. 848.051.  OPERATION OF HEALTH CARE COLLABORATIVE.  A health care collaborative that is certified by the department under this chapter may provide or arrange to provide health care services under contract with a governmental or private entity.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.053 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.053. Compensation Advisory Committee; Sharing of Certain Data

Sec. 848.053.  COMPENSATION ADVISORY COMMITTEE; SHARING OF CERTAIN DATA.  (a)  The board of directors of a health care collaborative shall establish a compensation advisory committee to develop and make recommendations to the board regarding charges, fees, payments, distributions, or other compensation assessed for health care services provided by physicians or health care providers who participate in the health care collaborative.  The committee must include:(1)  two members of the board of directors, of which one member is the hospital-based physician member, if the health care collaborative includes hospital-based physicians; and(2)  if the health care collaborative consists of physicians and other health care providers:(A)  a physician who is not a participant in the health care collaborative, selected by the physicians who are participants in the collaborative; and(B)  a member selected by the other health care providers who participate in the collaborative.(b)  A health care collaborative shall establish and enforce policies to prevent the sharing of charge, fee, and payment data among nonparticipating physicians and health care providers.(c)  The compensation advisory committee shall make recommendations to the board of directors regarding all charges, fees, payments, distributions, or other compensation assessed for health care services provided by a physician or health care provider who participates in the health care collaborative.(d)  Except as provided by Subsections (e) and (f), the board of directors and the compensation advisory committee may not use or consider a government payor's payment rates in setting the charges or fees for health care services provided by a physician or health care provider who participates in the health care collaborative.(e)  The board of directors or the compensation advisory committee may use or consider a government payor's payment rates when setting the charges or fees for health care services paid by a government payor.(f)  This section does not prohibit a reference to a government payor's payment rates in agreements with health maintenance organizations, insurers, or other payors.(g)  After the compensation advisory committee submits a recommendation to the board of directors, the board shall formally approve or refuse the recommendation.(h)  For purposes of this section, "government payor" includes:(1)  Medicare;(2)  Medicaid;(3)  the state child health plan program; and(4)  the TRICARE Military Health System.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.054 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.054. Certificate of Authority and Determination of Approval Required

Sec. 848.054.  CERTIFICATE OF AUTHORITY AND DETERMINATION OF APPROVAL REQUIRED.  (a)  An organization may not organize or operate a health care collaborative in this state unless the organization holds a certificate of authority issued under this chapter.(b)  The commissioner shall adopt rules governing the application for a certificate of authority under this subchapter.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.055 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.055. Exceptions

Sec. 848.055.  EXCEPTIONS.  (a)  An organization is not required to obtain a certificate of authority under this chapter if the organization holds an appropriate certificate of authority issued under another chapter of this code.(b)  A person is not required to obtain a certificate of authority under this chapter to the extent that the person is:(1)  a physician engaged in the delivery of medical care; or(2)  a health care provider engaged in the delivery of health care services other than medical care as part of a health maintenance organization delivery network.(c)  A medical school, medical and dental unit, or health science center as described by Section 61.003, 61.501, or 74.601, Education Code, is not required to obtain a certificate of authority under this chapter to the extent that the medical school, medical and dental unit, or health science center contracts to deliver medical care services within a health care collaborative.  This chapter is otherwise applicable to a medical school, medical and dental unit, or health science center.(d)  An entity licensed under the Health and Safety Code that employs a physician under a specific statutory authority is not required to obtain a certificate of authority under this chapter to the extent that the entity contracts to deliver medical care services and health care services within a health care collaborative.  This chapter is otherwise applicable to the entity.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.056 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.056. Application for Certificate of Authority

Sec. 848.056.  APPLICATION FOR CERTIFICATE OF AUTHORITY.  (a)  An organization may apply to the commissioner for and obtain a certificate of authority to organize and operate a health care collaborative.(b)  An application for a certificate of authority must:(1)  comply with all rules adopted by the commissioner;(2)  be verified under oath by the applicant or an officer or other authorized representative of the applicant;(3)  be reviewed by the division within the office of attorney general that is primarily responsible for enforcing the antitrust laws of this state and of the United States under Section 848.059;(4)  demonstrate that the health care collaborative contracts with a sufficient number of primary care physicians in the health care collaborative's service area;(5)  state that enrollees may obtain care from any physician or health care provider in the health care collaborative; and(6)  identify a service area within which medical services are available and accessible to enrollees.(c)  Not later than the 190th day after the date an applicant submits an application to the commissioner under this section, the commissioner shall approve or deny the application.(d)  The commissioner by rule may:(1)  extend the date by which an application is due under this section; and(2)  require the disclosure of any additional information necessary to implement and administer this chapter, including information necessary to antitrust review and oversight.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.057 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.057. Requirements for Approval of Application

Sec. 848.057.  REQUIREMENTS FOR APPROVAL OF APPLICATION.  (a)  The commissioner shall issue a certificate of authority on payment of the application fee prescribed by Section 848.152 if the commissioner is satisfied that:(1)  the applicant meets the requirements of Section 848.056;(2)  with respect to health care services to be provided, the applicant:(A)  has demonstrated the willingness and potential ability to ensure that the health care services will be provided in a manner that:(i)  increases collaboration among health care providers and integrates health care services;(ii)  promotes improvement in quality-based health care outcomes, patient safety, patient engagement, and coordination of services; and(iii)  reduces the occurrence of potentially preventable events;(B)  has processes that contain health care costs without jeopardizing the quality of patient care;(C)  has processes to develop, compile, evaluate, and report statistics on performance measures relating to the quality and cost of health care services, the pattern of utilization of services, and the availability and accessibility of services; and(D)  has processes to address complaints made by patients receiving services provided through the organization;(3)  the applicant is in compliance with all rules adopted by the commissioner under Section 848.151;(4)  the applicant has working capital and reserves sufficient to operate and maintain the health care collaborative and to arrange for services and expenses incurred by the health care collaborative;(5)  the applicant's proposed health care collaborative is not likely to reduce competition in any market for physician, hospital, or ancillary health care services due to:(A)  the size of the health care collaborative; or(B)  the composition of the collaborative, including the distribution of physicians by specialty within the collaborative in relation to the number of competing health care providers in the health care collaborative's geographic market; and(6)  the pro-competitive benefits of the applicant's proposed health care collaborative are likely to substantially outweigh the anticompetitive effects of any increase in market power.(b)  A certificate of authority is effective for a period of one year, subject to Section 848.060(d).|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.058 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.058. Denial of Certificate of Authority

Sec. 848.058.  DENIAL OF CERTIFICATE OF AUTHORITY.  (a)  The commissioner may not issue a certificate of authority if the commissioner determines that the applicant's proposed plan of operation does not meet the requirements of Section 848.057.(b)  If the commissioner denies an application for a certificate of authority under Subsection (a), the commissioner shall notify the applicant that the plan is deficient and specify the deficiencies.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.059 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.059. Concurrence of Attorney General

Sec. 848.059.  CONCURRENCE OF ATTORNEY GENERAL.  (a)  If the commissioner determines that an application for a certificate of authority filed under Section 848.056 complies with the requirements of Section 848.057, the commissioner shall forward the application, and all data, documents, and analysis considered by the commissioner in making the determination, to the attorney general.  The attorney general shall review the application and the data, documents, and analysis and, if the attorney general concurs with the commissioner's determination under Sections 848.057(a)(5) and (6), the attorney general shall notify the commissioner.(b)  If the attorney general does not concur with the commissioner's determination under Sections 848.057(a)(5) and (6), the attorney general shall notify the commissioner.(c)  A determination under this section shall be made not later than the 60th day after the date the attorney general receives the application and the data, documents, and analysis from the commissioner.(d)  If the attorney general lacks sufficient information to make a determination under Sections 848.057(a)(5) and (6), within 60 days of the attorney general's receipt of the application and the data, documents, and analysis the attorney general shall inform the commissioner that the attorney general lacks sufficient information as well as what information the attorney general requires.  The commissioner shall then either provide the additional information to the attorney general or request the additional information from the applicant.  The commissioner shall promptly deliver any such additional information to the attorney general.  The attorney general shall then have 30 days from receipt of the additional information to make a determination under Subsection (a) or (b).(e)  If the attorney general notifies the commissioner that the attorney general does not concur with the commissioner's determination under Sections 848.057(a)(5) and (6), then, notwithstanding any other provision of this subchapter, the commissioner shall deny the application.(f)  In reviewing the commissioner's determination, the attorney general shall consider the findings, conclusions, or analyses contained in any other governmental entity's evaluation of the health care collaborative.(g)  The attorney general at any time may request from the commissioner additional time to consider an application under this section.  The commissioner shall grant the request and notify the applicant of the request.  A request by the attorney general or an order by the commissioner granting a request under this section is not subject to administrative or judicial review.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.060 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter B. Authority to Engage in Business|Section 848.060. Renewal of Certificate of Authority and Determination of Approval

Sec. 848.060.  RENEWAL OF CERTIFICATE OF AUTHORITY AND DETERMINATION OF APPROVAL.  (a)  Not later than the 180th day before the one-year anniversary of the date on which a health care collaborative's certificate of authority was issued or most recently renewed, the health care collaborative shall file with the commissioner an application to renew the certificate.(b)  An application for renewal must:(1)  be verified by at least two principal officers of the health care collaborative; and(2)  include:(A)  a financial statement of the health care collaborative, including a balance sheet and receipts and disbursements for the preceding calendar year, certified by an independent certified public accountant;(B)  a description of the service area of the health care collaborative;(C)  a description of the number and types of physicians and health care providers participating in the health care collaborative;(D)  an evaluation of the quality and cost of health care services provided by the health care collaborative;(E)  an evaluation of the health care collaborative's processes to promote evidence-based medicine, patient engagement, and coordination of health care services provided by the health care collaborative;(F)  the number, nature, and disposition of any complaints filed with the health care collaborative under Section 848.107; and(G)  any other information required by the commissioner.(c)  If a completed application for renewal is filed under this section:(1)  the commissioner shall conduct a review under Section 848.057 as if the application for renewal were a new application, and, on approval by the commissioner, the attorney general shall review the application under Section 848.059 as if the application for renewal were a new application; and(2)  the commissioner shall renew or deny the renewal of a certificate of authority at least 20 days before the one-year anniversary of the date on which a health care collaborative's certificate of authority was issued.(d)  If the commissioner does not act on a renewal application before the one-year anniversary of the date on which a health care collaborative's certificate of authority was issued or renewed, the health care collaborative's certificate of authority expires on the 90th day after the date of the one-year anniversary unless the renewal of the certificate of authority or determination of approval, as applicable, is approved before that date.(e)  A health care collaborative shall report to the department a material change in the size or composition of the collaborative.  On receipt of a report under this subsection, the department may require the collaborative to file an application for renewal before the date required by Subsection (a).|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.101 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter C. General Powers and Duties of Health Care Collaborative|Section 848.101. Providing or Arranging for Services

Sec. 848.101.  PROVIDING OR ARRANGING FOR SERVICES.  (a)  A health care collaborative may provide or arrange for health care services through contracts with physicians and health care providers or with entities contracting on behalf of participating physicians and health care providers.(b)  A health care collaborative may not prohibit a physician or other health care provider, as a condition of participating in the health care collaborative, from participating in another health care collaborative.(c)  A health care collaborative may not use a covenant not to compete to prohibit a physician from providing medical services or participating in another health care collaborative in the same service area.(d)  Except as provided by Subsection (f), on written consent of a patient who was treated by a physician participating in a health care collaborative, the health care collaborative shall provide the physician with the medical records of the patient, regardless of whether the physician is participating in the health care collaborative at the time the request for the records is made.(e)  Records provided under Subsection (d) shall be made available to the physician in the format in which the records are maintained by the health care collaborative.  The health care collaborative may charge the physician a fee for copies of the records, as established by the Texas Medical Board.(f)  If a physician requests a patient's records from a health care collaborative under Subsection (d) for the purpose of providing emergency treatment to the patient:(1)  the health care collaborative may not charge a fee to the physician under Subsection (e); and(2)  the health care collaborative shall provide the records to the physician regardless of whether the patient has provided written consent.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|