Sec. 1305.301. NETWORK ORGANIZATION; SERVICE AREAS. (a) The chief executive officer, operations officer, or governing body of a network is responsible for:
(1) the development, approval, implementation, and enforcement of:
(A) administrative, operational, personnel, and patient care policies; and
(B) network procedures; and
(2) the development of any documents necessary for the operation of the network.
(b) Each network shall have a chief executive officer or operations officer who:
(1) is accountable for the day-to-day administration of the network; and
(2) shall ensure compliance with all applicable statutes and rules pertaining to the operation of the network.
(c) Each network shall have a medical director, who must be an occupational medicine specialist or employ or contract with an occupational medicine specialist, and who must be licensed to practice medicine in the United States. The medical director shall:
(1) be available at all times to address complaints, clinical issues, and any quality improvement issues on behalf of the network;
(2) be actively involved in all quality improvement activities; and
(3) comply with the network's credentialing requirements.
(d) The network shall establish one or more service areas within this state. For each defined service area, the network must:
(1) demonstrate to the satisfaction of the department the ability to provide continuity, accessibility, availability, and quality of services;
(2) specify the counties and zip code areas, or any parts of a county or zip code area, included in the service area; and
(3) provide a complete provider directory to all policyholders who have selected a network in the service area.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.
Section: Previous 1305.153 1305.154 1305.1545 1305.155 1305.201 1305.251 1305.252 1305.301 1305.302 1305.303 1305.304 1305.351 1305.353 1305.354 1305.355 NextLast modified: September 28, 2016