reglab/housing_qa huggingface dataset:
TX Ins Code § 843.082 (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 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.082. Requirements for Approval of Application

Sec. 843.082.  REQUIREMENTS FOR APPROVAL OF APPLICATION.  The commissioner shall issue a certificate of authority on payment of the application fee prescribed by Section 843.154(c) if the commissioner is satisfied that:(1)  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 to:(i)  ensure both availability and accessibility of adequate personnel and facilities;  and(ii)  enhance availability, accessibility, quality of care, and continuity of services;(B)  has arrangements, established in accordance with rules adopted by the commissioner, for a continuing quality of health care assurance program concerning health care processes and outcomes;  and(C)  has a procedure, that is in accordance with rules adopted by the commissioner, to develop, compile, evaluate, and report statistics relating to the cost of operation, the pattern of utilization of services, and availability and accessibility of services;(2)  the person responsible for the conduct of the affairs of the applicant is competent, is trustworthy, and has a good reputation;(3)  the health care plan, limited health care service plan, or single health care service plan is an appropriate mechanism through which the health maintenance organization will effectively provide or arrange for the provision of basic health care services, limited health care services, or a single health care service on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments;(4)  the health maintenance organization is fully responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees, after considering:(A)  the financial soundness of the health care plan's arrangement for health care services and the schedule of charges used in connection with the arrangement;(B)  the adequacy of working capital;(C)  any agreement with an insurer, a group hospital service corporation, a political subdivision of government, or any other organization for insuring the payment of the cost of health care services or providing for automatic applicability of an alternative coverage in the event the plan is discontinued;(D)  any agreement that provides for the provision of health care services;  and(E)  any deposit of cash or securities submitted in accordance with Section 843.405 as a guarantee that the obligations will be performed;  and(5)  the proposed plan of operation, as shown by the information submitted under Section 843.078 and, if applicable, Section 843.079, or by independent investigation, does not violate state law.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.083 (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 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.083. Denial of Certificate of Authority

Sec. 843.083.  DENIAL OF CERTIFICATE OF AUTHORITY.  (a)  If the commissioner certifies that the health maintenance organization's proposed plan of operation does not meet the requirements of Section 843.082, the commissioner may not issue a certificate of authority.(b)  The commissioner shall notify the applicant that the plan is deficient and specify the deficiencies.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.084 (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 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.084. Duration of Certificate of Authority

Sec. 843.084.  DURATION OF CERTIFICATE OF AUTHORITY.  A certificate of authority continues in effect:(1)  while the certificate holder meets the requirements of this chapter and:(A)  Section 1367.053;(B)  Subchapter A, Chapter 1452;(C)  Subchapter B, Chapter 1507;(D)  Chapters 222, 251, and 258, as applicable to a health maintenance organization; and(E)  Chapters 1271 and 1272; or(2)  until the commissioner suspends or revokes the certificate or the commissioner terminates the certificate at the request of the certificate holder.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.037, eff. April 1, 2009.|
TX Ins Code § 843.085 (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 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.085. Change in Control: Commissioner Approval

Sec. 843.085.  CHANGE IN CONTROL:  COMMISSIONER APPROVAL.  Any change in control, as defined by Chapter 823, of a health maintenance organization is subject to the approval of the commissioner.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.102 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.102. Health Maintenance Organization Quality Assurance

Sec. 843.102.  HEALTH MAINTENANCE ORGANIZATION QUALITY ASSURANCE.  (a)  A health maintenance organization shall establish procedures to ensure that health care services are provided to enrollees under reasonable standards of quality of care that are consistent with prevailing professionally recognized standards of medical practice.  The procedures must include mechanisms to ensure availability, accessibility, quality, and continuity of care.(b)  A health maintenance organization shall operate a continuing internal quality assurance program to monitor and evaluate its health care services, including primary and specialist physician services and ancillary and preventive health care services, in all institutional and noninstitutional settings.(c)  The commissioner by rule may establish minimum standards and requirements for the quality assurance programs, including standards for ensuring availability, accessibility, quality, and continuity of care.(d)  A health maintenance organization shall record formal proceedings of quality assurance program activities and maintain documentation in a confidential manner.  The health maintenance organization shall make the quality assurance program minutes available to the commissioner.(e)  A health maintenance organization shall establish and maintain a physician review panel to assist in:(1)  reviewing medical guidelines or criteria;  and(2)  determining prescription drugs to be covered by the health maintenance organization, if the health maintenance organization offers a prescription drug benefit.(f)  A health maintenance organization shall ensure the use and maintenance of an adequate patient record system to facilitate documentation and retrieval of clinical information for the health maintenance organization's evaluation of continuity and coordination of patient care and assessment of the quality of health and medical care provided to enrollees.(g)  The clinical records of enrollees shall be available to the commissioner for examination and review to determine compliance.  The records are confidential and privileged and are not subject to the public information law, Chapter 552, Government Code, or to subpoena, except to the extent necessary to enable the commissioner to enforce this section.(h)  A health maintenance organization shall establish a mechanism for the periodic reporting of quality assurance program activities to its governing body, providers, and appropriate health maintenance organization staff.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.103 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.103. Acquisition and Operation of Facilities; Certain Loans; Commissioner Approval of Affiliate Transactions

Sec. 843.103.  ACQUISITION AND OPERATION OF FACILITIES;  CERTAIN LOANS;  COMMISSIONER APPROVAL OF AFFILIATE TRANSACTIONS.  (a)  A health maintenance organization may:(1)  purchase, lease, construct, renovate, operate, or maintain hospitals or medical facilities and ancillary equipment and other property reasonably required for the principal office of the health maintenance organization or for another purpose necessary in engaging in the business of the health maintenance organization;  and(2)  make loans to a medical group, under an independent contract with the group to further its program, or corporations under its control, to acquire or construct medical facilities and hospitals, or to further a program providing health care services to enrollees.(b)  If the exercise of a power granted under Subsection (a) involves an affiliate, as described by Section 823.003, the health maintenance organization before exercising that power shall file notice and adequate supporting information with the commissioner for approval.(c)  The commissioner shall disapprove the exercise of a power described by Subsection (a) that would in the commissioner's opinion:(1)  substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations;  or(2)  impair the interests of the public or the health maintenance organization's enrollees or creditors in this state.(d)  If the commissioner does not disapprove the exercise of a power described by Subsection (a) before the 31st day after the date notice is filed under this section, the exercise of the power is considered approved.  The commissioner may, by official order, delay action as necessary for proper consideration for not more than an additional 30 days.(e)  The commissioner may adopt rules exempting from the filing requirements of Subsection (b) an activity that has a de minimis effect.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.104 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.104. Contracts for Certain Administrative Functions

Sec. 843.104.  CONTRACTS FOR CERTAIN ADMINISTRATIVE FUNCTIONS.  A health maintenance organization may contract with any person to perform functions such as marketing, enrollment, and administration on behalf of the health maintenance organization.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.105 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.105. Management and Exclusive Agency Contracts

Sec. 843.105.  MANAGEMENT AND EXCLUSIVE AGENCY CONTRACTS.  (a)  A health maintenance organization may not enter into a management contract or exclusive agency contract unless the proposed contract is first filed with and approved by the commissioner.(b)  The commissioner must approve or disapprove the contract not later than the 30th day after the date the contract is filed or within a reasonable extended period that the commissioner specifies by notice given within the 30-day period.(c)  The commissioner shall disapprove the proposed contract if the commissioner determines that the contract:(1)  subjects the health maintenance organization to excessive charges;(2)  extends for an unreasonable time;(3)  does not contain fair and adequate standards of performance;(4)  authorizes persons to manage the health maintenance organization who are not sufficiently trustworthy, competent, experienced, and free from conflict of interest to manage the health maintenance organization with due regard for the interests of the health maintenance organization's enrollees or creditors or the public;  or(5)  contains provisions that impair the interests of the public in this state or the health maintenance organization's enrollees or creditors.(d)  The commissioner shall disapprove a proposed management contract unless the commissioner determines that the management contractor has in force in its own name a fidelity bond on its officers and employees in the amount of at least $100,000 or another amount prescribed by the commissioner. (e)  The fidelity bond must be issued by an insurer that holds a certificate of authority in this state.  If, after notice and hearing, the commissioner determines that a fidelity bond is not available from an insurer that holds a certificate of authority in this state, the management contractor may obtain a fidelity bond procured by a surplus lines agent resident in this state in compliance with Chapter 981.(f)  The fidelity bond must obligate the surety to pay any loss of money or other property that the health maintenance organization sustains because of an act of fraud or dishonesty by an employee or officer of the management contractor during the period that the management contract is in effect.(g)  Instead of a fidelity bond, the management contractor may deposit with the comptroller cash or securities acceptable to the commissioner.  The deposit must be maintained in the amount and is subject to the same conditions required for a fidelity bond under this section.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.106 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.106. Insurance, Reinsurance, Indemnity, and Reimbursement

Sec. 843.106.  INSURANCE, REINSURANCE, INDEMNITY, AND REIMBURSEMENT.  A health maintenance organization may contract with an insurer or group hospital service corporation authorized to engage in business in this state to provide insurance, reinsurance, indemnification, or reimbursement against the cost of health care and medical care services provided by the health maintenance organization.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.107 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.107. Indemnity Benefits; Point-of-Service Provisions

Sec. 843.107.  INDEMNITY BENEFITS;  POINT-OF-SERVICE PROVISIONS.  A health maintenance organization may offer:(1)  indemnity benefits covering out-of-area emergency care;(2)  indemnity benefits, in addition to those relating to out-of-area and emergency care, provided through an insurer or group hospital service corporation;(3)  a point-of-service plan under Subchapter A, Chapter 1273; or(4)  a point-of-service rider under Section 843.108.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.038, eff. April 1, 2009.|
TX Ins Code § 843.108 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.108. Point-of-Service Rider

Sec. 843.108.  POINT-OF-SERVICE RIDER.  (a)  In this section, "point-of-service rider" means a rider under which indemnity benefits for the cost of health care services are provided by a health maintenance organization in conjunction with corresponding benefits arranged for or provided by a health maintenance organization.(b)  A health maintenance organization may offer a point-of-service rider for out-of-network coverage without obtaining a separate certificate of authority as an insurer if the expenses incurred under the point-of-service rider do not exceed 10 percent of the total medical and hospital expenses incurred for all health plan products sold by the health maintenance organization.  If the expenses exceed that level, the health maintenance organization may not issue new point-of-service riders until the expenses fall below that level or until the health maintenance organization obtains a certificate of authority as an insurer.(c)  Indemnity benefits for services provided under a point-of-service rider may be limited to those services defined in the evidence of coverage and may be subject to different cost-sharing provisions.  The cost-sharing provisions for indemnity benefits may be higher than the cost-sharing provisions for in-network health maintenance organization coverage.  For enrollees in a limited provider network, higher cost-sharing may be imposed only when benefits or services are obtained outside the health maintenance organization delivery network.(d)  A health maintenance organization that issues a point-of-service rider under this section must meet additional net worth requirements prescribed by the commissioner.  The commissioner shall base the net worth requirements on the actuarial relation of the amount of insurance risk assumed through the point-of-service rider to the amount of solvency and reserve requirements otherwise required of the health maintenance organization.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.109 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.109. Payment by Governmental or Private Entity

Sec. 843.109.  PAYMENT BY GOVERNMENTAL OR PRIVATE ENTITY.  A health maintenance organization may accept from a governmental or private entity payments for all or part of the cost of services provided or arranged for by the health maintenance organization.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.110 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.110. Corporation, Partnership, or Association Powers

Sec. 843.110.  CORPORATION, PARTNERSHIP, OR ASSOCIATION POWERS.  A health maintenance organization has all powers of a partnership, association, or corporation, including a professional association or corporation, as appropriate under the organizational documents of the health maintenance organization, that are not in conflict with this chapter or other applicable law.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.111 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.111. Group Model Health Maintenance Organizations

Sec. 843.111.  GROUP MODEL HEALTH MAINTENANCE ORGANIZATIONS.  (a)  In this section, "group model health maintenance organization" means a health maintenance organization that provides the majority of its professional services through a single group medical practice that is formally affiliated with the medical school component of a state-supported public college or university in this state.(b)  Unless this section and a power specified in Section 843.101, 843.103, 843.104, 843.106, 843.107, 843.109, or 843.110 are specifically amended by law, a law, without regard to the time of enactment, may not be construed to prohibit or restrict a group model health maintenance organization from:(1)  selectively contracting with or declining to contract with a provider as the group model health maintenance organization considers necessary;(2)  contracting for or declining to contract for an individual health care service or full range of health care services as the group model health maintenance organization considers necessary, if the service or services may be legally provided by the contracting provider;  or(3)  requiring enrolled members of the group model health maintenance organization who wish to obtain the services covered by the group model health maintenance organization to use the providers specified by the group model health maintenance organization.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.113 (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 843 - Health Maintenance Organizations|Subchapter D. General Powers and Duties of Health Maintenance Organizations|Section 843.113. Specified Powers Not Exclusive

Sec. 843.113.  SPECIFIED POWERS NOT EXCLUSIVE.  The powers of a health maintenance organization are not limited to the powers specified by this subchapter.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.151 (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 843 - Health Maintenance Organizations|Subchapter E. Regulation of Health Maintenance Organizations|Section 843.151. Rules

Sec. 843.151.  RULES.  The commissioner may adopt reasonable rules as necessary and proper to:(1)  implement this chapter and Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapters 222, 251, and 258, as applicable to a health maintenance organization, and Chapters 1271 and 1272, including rules to:(A)  prescribe authorized investments for a health maintenance organization for all investments not otherwise addressed in this chapter;(B)  ensure that enrollees have adequate access to health care services; and(C)  establish minimum physician-to-patient ratios, mileage requirements for primary and specialty care, maximum travel time, and maximum waiting time for obtaining an appointment; and(2)  meet the requirements of federal law and regulations.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.039, eff. April 1, 2009.|