Sec. 1458.001. GENERAL DEFINITIONS. In this chapter:
(1) "Affiliate" means a person who, directly or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with another person.
(2) "Contracting entity" means a person who:
(A) enters into a direct contract with a provider for the delivery of health care services to covered individuals; and
(B) in the ordinary course of business establishes a provider network or networks for access by another party.
(3) "Covered individual" means an individual who is covered under a health benefit plan.
(4) "Express authority" means a provider's consent that is obtained through separate signature lines for each line of business.
(5) "Health care services" means services provided for the diagnosis, prevention, treatment, or cure of a health condition, illness, injury, or disease.
(6) "Person" has the meaning assigned by Section 823.002.
(7)(A) "Provider" means:
(i) an advanced practice nurse;
(ii) an optometrist;
(iii) a therapeutic optometrist;
(iv) a physician;
(v) a physician assistant;
(vi) a professional association composed solely of physicians, optometrists, or therapeutic optometrists;
(vii) a single legal entity authorized to practice medicine owned by two or more physicians;
(viii) a nonprofit health corporation certified by the Texas Medical Board under Chapter 162, Occupations Code;
(ix) a partnership composed solely of physicians, optometrists, or therapeutic optometrists;
(x) a physician-hospital organization that acts exclusively as an administrator for a provider to facilitate the provider's participation in health care contracts; or
(xi) an institution that is licensed under Chapter 241, Health and Safety Code.
(B) "Provider" does not include a physician-hospital organization that leases or rents the physician-hospital organization's network to another party.
(8) "Provider network contract" means a contract between a contracting entity and a provider for the delivery of, and payment for, health care services to a covered individual.
Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.
Section: 1458.001 1458.002 1458.003 1458.004 1458.051 1458.052 1458.053 1458.054 1458.055 1458.101 1458.102 NextLast modified: September 28, 2016