28 Tex. Admin. Code § 10.27 - Modifications to Network Configuration
(a) A
network must file a modification request with and receive approval from the
department before the network makes a material modification to its network
configuration. The modification request must be filed not later than 30 days
prior to implementation of the material modification.
(b) A modification request for a modification
to network configuration must include:
(1) a
description and a map of the network's service area or areas, with key and
scale, that identifies each county, ZIP code, partial ZIP code, or part of a
county to be served as required by §
10.22 of this title (relating to
Contents of Application);
(2)
network configuration information, as required by §
10.22(11) of
this title; and
(3) if the
modification involves adding or modifying telehealth service, telemedicine
medical service, or teledentistry dental service, an explanation of how the
network would update its provider directory, and any statements or restrictions
on services that can be provided via telehealth service, telemedicine medical
service, or teledentistry dental service.
(c) The applicant must file a copy of the
form of any new contracts or amendment of any existing contracts as described
by and required under §
10.22(3), (4), and
(5) of this title if the modification of
network configuration causes changes.
(d) A modification request is not considered
complete and reviewable until the department has received all information
required under this section, including any additional information the
department requests as needed to make the determination.
(e) Before the department considers a
modification request to modify a network's configuration, the applicant must be
in good standing with the department and in compliance with all applicable
requirements under this chapter; Insurance Code Chapter 1305, concerning
Workers' Compensation Health Care Networks; and Labor Code Title 5, concerning
Workers' Compensation.
(f)
Prescribed modification request forms may be obtained from:
(1) the department's website;
(2) the department's workers' compensation
network email address; or
(3) the
MCQA mailing address.
(g)
For purposes of this section, a material modification includes a change to the
network configuration that alters the ability of the network to comply with the
availability and accessibility requirements described in §
10.80 of this title (relating to
Accessibility and Availability Requirements).
Notes
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