28 Tex. Admin. Code § 13.423 - Service Area Change Applications
(a) An HCC
must file an application for approval with the department before the HCC may
expand or reduce an existing service area or add a new service area.
(b) If any of the following items are changed
by a proposed service area expansion or reduction, the new item or any
amendments to an existing item must be submitted for approval or filed for
information, as specified in §
13.422 of this title (relating to
Filing Requirements That Apply After Issuance of Certificate of Authority):
(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 §
13.413(e)(1) of
this title (relating to Contents of the Application);
(2) a form of any new contracts or amendment
of any existing contracts in the new area, as described in §
13.413(e)(5) of
this title;
(3) network
configuration information, as required by §
13.413(e)(2) of
this title;
(4) a brief narrative
description of the administrative arrangements and organizational charts as
described in §
13.413(c)(7) of
this title and any other information the HCC considers to be
pertinent;
(5) biographical data
sheets for any new management staff assigned to the new area;
(6) copies of leases, loans, agreements, and
contracts to be used in the proposed new area, including information described
in §
13.422(c)(2)(D)
of this title;
(7) separate and
combined sources of financing and financial projections as described in §
13.413(d)(1) -
(3) of this title; and
(8) any new or amended reinsurance
agreements, insurance, or other protection against insolvency, as specified in
§
13.413(d)(4) 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 is considered
complete when all information required by §
13.422 of this title, this
section, and §
13.481 and §
13.482 of this title (relating to
Quality Improvement Structure for HCCs and Quality Assurance and Quality
Improvement, respectively), that is reasonably necessary for a final
determination by the department has been filed with the department.
(d) A service area expansion or reduction
application will be considered only if both the existing and proposed service
areas of the HCC comply with the requirements of §
13.481 and §
13.482 of this title, and §
13.483 of this title (relating to
Credentialing).
(e) If the filing
for proposed service area change might materially affect the HCC's ability to
arrange for or provide health care services, or might materially change the
antitrust analysis of the HCC, the department may require the HCC to file an
application for renewal before the date required by Insurance Code §
848.060(a).
Notes
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