28 Tex. Admin. Code § 11.808 - Liabilities

(a) Each HMO must account for liabilities as provided for in § 11.801 of this title (relating to Accounting Guidance), and must segregate its liabilities into classifications of "covered" or "uncovered." Agreements to loan money or to make future capital or surplus contributions do not, in themselves, cause liabilities to be covered. Any guarantee of future contributions to surplus that are directed and based on the payment of a debt will allow that debt to be reflected as a covered liability. A liability, for which provision is made other than by the assets of the HMO, may qualify as a covered liability if the amount owed is:

(1) based on a physician or provider contract with a hold-harmless clause as provided in § 11.901 of this title (relating to Required and Prohibited Provisions);

(2) subordinated in writing to the uncovered health care liabilities of the HMO; or

(3) unconditionally guaranteed and the guarantee is without monetary limit, as specified in § 11.810 of this title (relating to Guarantee from a Sponsoring Organization), by a sponsoring organization that has a tangible net worth of at least $10 million in excess of all amounts that the sponsoring organization has guaranteed.

(b) An HMO may not decrease its liabilities or establish an asset on its balance sheet for any capitated risk or other risk-sharing arrangement with a network physician or provider relating to out-of-service area or emergency care provided by any non-network physician or provider. For purposes of this subsection, non-network physician or provider means a physician or provider who has not directly or indirectly contracted with an HMO or an HMO's network physicians or providers to provide medical or health care services to the HMO's enrollees.

Notes

28 Tex. Admin. Code § 11.808

The provisions of this §11.808 adopted to be effective November 2, 1998, 23 TexReg 11347; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2243, eff. 8/1/2017