28 Tex. Admin. Code § 11.302 - Service Area Expansion or Reduction Applications
(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.
Notes
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