28 Tex. Admin. Code § 3.9803 - Provider Network Contracting Entity Exemption of Affiliates Form Filing Required

(a) TDI adopts the Provider Network Contracting Entity Exemption of Affiliates Form by reference.

(b) Unless the commissioner has granted an affiliate exemption to the contracting entity under this section, each contracting entity that is a health maintenance organization or other entity holding a certificate of authority issued by TDI to engage in the business of insurance in this state must submit to TDI a fully completed Provider Network Contracting Entity Exemption of Affiliates Form and the required fee established under § 3.9804 of this title before the later of:

(1) the 30th day after the date on which the submitting person begins acting as a contracting entity in this state; or

(2) December 1, 2014.

(c) The person submitting the Provider Network Contracting Entity Exemption of Affiliates Form must:

(1) list each affiliate of the contracting entity that will access the provider networks disclosed in the submission or state that the contracting entity has no affiliates;

(2) disclose the provider network contracting relationships between the person who holds a certificate of authority and all affiliates of the person, including:

(A) primary provider networks and the affiliates that have access to the primary provider networks;

(B) subsidiary provider networks and the affiliates that have access to the subsidiary provider networks; and

(C) other provider networks and the affiliates that have access to the other provider networks;

(3) disclose if the contracting entity or an affiliate allows a nonaffiliate to access any network of the contracting entity or affiliate and the name of the contracting entity or affiliate allowing such access.

(d) An affiliate exemption under this section is not effective until the commissioner grants the exemption in writing. The commissioner may grant the requested exemption to all listed affiliates, grant the exemption to some listed affiliates, or deny the requested exemption for one or more affiliates.

(e) Not later than August 1 of each year, a contracting entity that has submitted the Provider Network Contracting Entity Exemption of Affiliates Form under this section must report to the commissioner any changes to the information the contracting entity provided in its Provider Network Contracting Entity Exemption of Affiliates Form or subsequent annual reports, including the addition or removal of any affiliates.

(f) A contracting entity must submit the Provider Network Contracting Entity Exemption of Affiliates Form and subsequent annual reports in a written or electronic format to the address TDI will provide on the Provider Network Contracting Entity Exemption of Affiliates Form.

Notes

28 Tex. Admin. Code § 3.9803

Adopted by Texas Register, Volume 39, Number 46, November 14, 2014, TexReg 9020, eff. 11/19/2014