Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 3 - EXAMINATIONS; REGULATORY REQUIREMENTS FOR AN HCC AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY; AND ADVERTISING AND SALES MATERIAL › Section 13.422 - Filing Requirements That Apply After Issuance of Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) After the
					 issuance of a certificate of authority, each HCC must file certain information
					 with the commissioner, either for approval prior to effectuation or for
					 information only, as provided in this section.
(b) In accord with Insurance Code §
											848.060(e),
					 an HCC must report to the department a material change in the size,
					 composition, or control of the HCC.
(c) An HCC must make the filings outlined in
					 paragraphs (2) and (3) of this subsection and in §
											13.423
					 of this title (relating to Service Area Change Applications). These
					 requirements include filing changes necessitated by federal or state law or
					 regulations.
(1) Complete filings required.
					 The department will not accept a filing for review until the filing is
					 complete.
(2) Filings requiring
					 approval. After the issuance of a certificate of authority, an HCC must file
					 for approval with the commissioner a written request to implement or modify the
					 following operations or documents and receive the commissioner's approval prior
					 to effectuating those modifications:
(A) a
					 description and a map of the service area, with key and scale, that identifies
					 the county, counties, or portions of counties to be served;
(B) any material change in size, composition,
					 or control of the HCC;
(C) proposed
					 dividends for any calendar year that if declared and paid will, individually
					 and in the aggregate, have a distribution value equal to or exceeding the
					 greater of:
(i) 10 percent of the HCC's net
					 asset value for the prior year; or
(ii) 10 percent of the HCC's net income for
					 the prior year;
(D) any
					 new or revised loan agreements evidencing loans made by the HCC to any
					 affiliated individual or entity or to any physician or health care provider,
					 whether providing services currently, previously, or potentially in the future;
					 and any guarantees of any affiliated individual's or entity's or of any
					 physician's or health care provider's obligations to any third party;
(E) a copy of any proposed material amendment
					 to basic organizational documents; however, if the approved amendment must be
					 filed with the secretary of state, an original or a certified copy of the
					 document with the original file mark of the secretary of state must be filed
					 with the commissioner;
(F) a copy
					 of any material amendments to bylaws of the HCC, with a notarized certification
					 bearing the original or electronic signature of the corporate secretary of the
					 HCC that it is a true, accurate, and complete copy of the original;
(G) any name, or assumed name, on a form, as
					 specified in §
													13.404
					 of this title (relating to Use of the Term "HCC;" Service Mark; Trademarks;
					 d/b/a);
(H) original or renewal
					 service contracts and management agreements, the terms of which must comply
					 with Insurance Code §
													823.101
					 as if the HCC were an insurer; and
(I) any proposed new or revised payment
					 methodology for use in any contract between the HCC and any payor that
					 addresses the applicant arranging for medical and health care services for the
					 payor in exchange for payments in cash or in kind as provided in Insurance Code
					 Chapter 848.
(3) Filings
					 for information. Material filed under this paragraph is not to be considered
					 approved, but may be subject to review for compliance with Texas law and
					 consistency with other HCC documents. On or before 30 days after the effective
					 date of a change, an HCC must file with the commissioner, for information only,
					 deletions and modifications to the following previously approved or filed
					 operations and documents:
(A) the list of
					 officers and directors, a biographical data sheet for each individual listed on
					 the officers and directors page, and biographical affidavit forms in §
													13.413(c)(6)(A) and
					 (B) of this title (relating to Contents of
					 the Application);
(B) any change in
					 the physical address of the books and records described in §
													13.415
					 of this title (relating to Documents to be Available for Quality of Care and
					 Financial Examinations);
(C) any
					 new trademark or service mark or any changes to an existing trademark or
					 service mark;
(D) a copy of the
					 form of any new contract or subcontracts or any substantive changes to
					 previously filed copies of forms of all contracts described in §
													13.413(d)(3) and
					 (e)(5) of this title, not including
					 management agreements or proposed new or revised payment methodologies filed
					 for approval, with amended contract forms accompanied by an additional copy of
					 the contract form that reflects the revisions made;
(E) notice of the cancellation of any
					 management contracts described in §
													13.413(e)(5)(D)
					 of this title;
(F) any insurance
					 contracts or amendments to those contracts, guarantees, or other protection
					 against insolvency, including the stop-loss or reinsurance agreements, if
					 changing the insurer or description of coverage, as described in §
													13.413(d)(4)(A)
					 of this title;
(G) any change in
					 the affiliate chart as described in §
													13.413(c)(7)
					 of this title;
(H) modifications to
					 any types of compensation arrangements, such as compensation based on
					 fee-for-service arrangements, risk-sharing arrangements, prepaid funding
					 arrangements, or capitated risk arrangements, made or to be made with
					 physicians and health care providers in exchange for the provision of, or the
					 arrangement to provide, health care services to patients, including any
					 financial incentives for physicians and providers. The HCC must maintain the
					 confidentiality of these compensation arrangements;
(I) any material change in network
					 configuration; and
(J) a
					 description of the quality assurance and quality improvement program, as set
					 forth in §
													13.481
					 and §
													13.482
					 of this title (relating to Quality Improvement Structure for HCCs and Quality
					 Assurance and Quality Improvement, respectively).
(4) Approval period. Any modification for
					 which commissioner's approval is required is considered approved unless
					 disapproved within 60 days from the date the filing is determined by the
					 department to be complete. The commissioner may postpone the action for a
					 period not to exceed 60 days, as necessary for proper consideration. The
					 commissioner will notify the HCC by letter of any postponement. The
					 commissioner, after notice and opportunity for hearing, may withdraw approval
					 of a filing made under paragraph (2) of this subsection or reject any
					 informational filing made under paragraph (3) of this subsection.
(5) Filing review procedure. Within 20 days
					 from the department's receipt of an initial filing for commissioner's approval
					 under this section, the department will determine whether the filing is
					 complete or incomplete for purposes of acceptance for review and, if found to
					 be incomplete, the department will issue a written notice in paper or
					 electronic form to the HCC of its incomplete filing.
(A) Incomplete filing. The written notice of
					 an incomplete filing will state that the filing is not complete and has not
					 been accepted for review. In addition, the notice will specify the information,
					 documentation, and corrections necessary to make the filing complete for
					 purposes of this section. If a filing is resubmitted in whole or in part and is
					 still incomplete, an additional written notice will be issued. The notice will
					 specify the corrections or information necessary for completeness and state
					 that the 60-day period for official action will not begin until the date the
					 department determines the filing to be complete. If a filing is not resubmitted
					 within 30 days of the date of the written notice of incompleteness, the
					 department will consider the filing withdrawn and will close it.
(B) Processing of complete filing. The
					 department will in writing approve or disapprove a complete filing within the
					 period of time set forth in paragraph (4) of this subsection, beginning on the
					 date the filing is determined to be complete. The HCC may waive in writing the
					 deemed approval time line set forth in paragraph (4) of this
					 subsection.
(C) Conversion to
					 renewal review. If the filing by the HCC under this subsection is sufficiently
					 material, the department may require the HCC to file an application for renewal
					 before the date required by Insurance Code §
													848.060(a).