Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter D - REGULATORY REQUIREMENTS FOR AN HMO AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY
Section 11.302 - Service Area Expansion or Reduction Applications

Universal Citation: 28 TX Admin Code § 11.302

Current through Reg. 50, No. 13; March 28, 2025

(a) An HMO must file an application with the department for approval before the HMO may expand an existing service area, reduce an existing service area, or add a new service area.

(b) For the purposes of an application to expand an existing service area, reduce an existing service area, or add a new service area, an HMO must file the following items:

(1) a description and a map with key and scale, showing both the currently approved service area and the proposed new service area as required by § 11.204(13) of this title (relating to Contents);

(2) network configuration information, as required by § 11.204(19) of this title;

(3) combined financial projections as described in § 11.204(10)(B) of this title, including a breakdown of the income statement for existing business, and the effect of the proposed service area expansion or reduction; and

(4) if any of the items specified in § 11.301 of this title (relating to Filing Requirements) are changed by a service area expansion or reduction application, the new item or any amendments to an existing item must be filed for approval or filed for information, as outlined in § 11.301(4) and (5) of this title.

(c) The department will not accept an application for review until the application is complete. An application to modify the certificate of authority that requires the commissioner's approval under Insurance Code § 843.080 (concerning Modification or Amendment of Application Information) or Chapter 1271 Subchapter C, (concerning Commissioner Approval) is considered complete when all information required by § 11.301 of this title; this section; and Chapter 11, Subchapter T, of this title (relating to Quality of Care) that is reasonably necessary for a final determination by the department has been filed with the department.

(d) Before consideration of a service area expansion or reduction application, an HMO must comply with the requirements of Chapter 11, Subchapter T, of this title, in the existing service areas and in the proposed service areas.

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