CHAPTER 844. CERTIFICATION OF CERTAIN NONPROFIT HEALTH CORPORATIONS
INSURANCE CODE
TITLE 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES
SUBTITLE C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED
ENTITIES
CHAPTER 844. CERTIFICATION OF CERTAIN NONPROFIT HEALTH
CORPORATIONS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 844.001. DEFINITIONS. In this chapter:
(1) "Approved nonprofit health corporation" means a nonprofit
health corporation certified under Section 162.001, Occupations
Code.
(2) "Certificate holder" means an approved nonprofit health
corporation that holds a certificate of authority issued under
this chapter.
(3) "Health care plan" has the meaning assigned by Section
843.002.
(4) "Health maintenance organization" means a health maintenance
organization licensed under Chapter 843.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.002. EXCEPTIONS. This chapter does not apply to:
(1) an approved nonprofit health corporation that contracts to
arrange for or provide health care services on a fee-for-service
basis;
(2) a contract entered into by a certificate holder to arrange
for or provide health care services on a fee-for-service basis;
or
(3) an activity exempt from regulation under Section 843.053 or
843.073.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.003. EXCEPTIONS TO TEXAS HEALTH MAINTENANCE
ORGANIZATION ACT. This chapter may not be construed to alter the
exceptions stated in Sections 843.053 and 843.073.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.004. RULES. Except as provided by Section 844.101(b),
the commissioner shall adopt rules to implement this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.005. PROVISION OF CERTAIN SERVICES ON BEHALF OF HEALTH
MAINTENANCE ORGANIZATIONS. (a) An approved nonprofit health
corporation may arrange for or provide health care services on a
risk-sharing or capitated risk arrangement on behalf of a health
maintenance organization.
(b) An approved nonprofit health corporation is not required to
obtain a certificate of authority under this chapter or under
Chapter 843 to arrange for or provide health care services as
provided by Subsection (a).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
SUBCHAPTER B. AUTHORITY TO ENGAGE IN BUSINESS
Sec. 844.051. CERTIFICATE OF AUTHORITY REQUIRED. An approved
nonprofit health corporation may not arrange for or provide a
health care plan to enrollees on a prepaid basis unless the
corporation holds a certificate of authority issued under this
chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.052. CERTIFICATE APPLICATION; ELIGIBILITY REQUIREMENTS.
(a) An approved nonprofit health corporation may apply to the
department for a certificate of authority under this chapter.
(b) The commissioner may issue a certificate of authority only
to an applicant that:
(1) meets the same requirements for the issuance of a
certificate of authority that a health maintenance organization
is required to meet under Chapter 843; and
(2) establishes accreditation by:
(A) the National Committee on Quality Assurance;
(B) the Joint Commission on Accreditation of Healthcare
Organization's accreditation for health care networks; or
(C) an accrediting organization recognized by rule of the
commissioner.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.053. PROVISIONAL CERTIFICATE OF AUTHORITY. The
commissioner shall grant a provisional certificate of authority
to an applicant if:
(1) the applicant has applied for accreditation from an
accrediting organization described by Section 844.052(b)(2);
(2) the applicant is diligently pursuing accreditation;
(3) the accrediting organization has not denied the application
for accreditation; and
(4) the applicant satisfies each other requirement of this
chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
Sec. 844.054. POWERS AND DUTIES OF CERTIFICATE HOLDER. (a) A
certificate holder has all the powers granted to and duties
imposed on a health maintenance organization under the insurance
laws of this state, including Chapter 843, and is subject to
regulation and regulatory enforcement under those laws in the
same manner as a health maintenance organization.
(b) A certificate holder shall maintain accreditation as
described by Section 844.052(b)(2).
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.
SUBCHAPTER C. PROHIBITED CONDUCT
Sec. 844.101. UNFAIR COMPETITION. (a) A certificate holder may
not engage in unfair and disruptive provider hiring or
contracting practices for the purpose of limiting competition
from traditional community providers.
(b) The Texas State Board of Medical Examiners shall adopt rules
to implement this section.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1,
2003.