Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter S - SOLVENCY STANDARDS FOR MANAGED CARE ORGANIZATIONS PARTICIPATING IN MEDICAID OR CHILDREN'S HEALTH INSURANCE PROGRAM
Section 11.1801 - Entities Covered

Universal Citation: 28 TX Admin Code § 11.1801

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

(a) As used in this subchapter, a managed care organization is an entity holding a certificate of authority to operate as an HMO under Insurance Code Chapter 843 (concerning Health Maintenance Organizations) and Insurance Code Chapter 1271 (concerning Benefits Provided by Health Maintenance Evidence of Coverage; Charges), or as an ANHC under Insurance Code Chapter 844 (concerning Certification of Certain Nonprofit Health Corporations).

(b) Any managed care organization or other entity providing the services specified in 42 United States Code § 1396b(m)(2)(A) and participating in the State Medicaid Program or Children's Health Insurance Program (CHIP) (MCO) must comply with the requirements of Insurance Code § 843.403 (concerning Minimum Net Worth) and § 7.402 of this title (relating to Risk-Based Capital and Surplus Requirements for Insurers and HMOs).

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