Texas Insurance Code Title 6, Chapter 848 - Health Care Collaboratives

SUBCHAPTER A GENERAL PROVISIONS

• Texas Section 848.001 - Definitions
  In this chapter: (1) "Affiliate" means a person who controls, is controlled by, or is under common control with one or more other persons. (2)...
• Texas Section 848.002 - Exception: Delegated Entities
  (a) This section applies only to an entity, other than a health maintenance organization, that: (1) by itself or through a subcontract with another entity,...
• Texas Section 848.003 - Use Of Insurance-related Terms By Health Care Collaborative
  A health care collaborative that is not an insurer or health maintenance organization may not use in its name, contracts, or literature: (1) the following...
• Texas Section 848.004 - Applicability Of Insurance Laws
  (a) An organization may not arrange for or provide health care services to enrollees on a prepaid or indemnity basis through health insurance or a...
• Texas Section 848.005 - Certain Information Confidential
  (a) Except as provided by Subsection (b), an application, filing, or report required under this chapter is public information subject to disclosure under Chapter 552,...

SUBCHAPTER B AUTHORITY TO ENGAGE IN BUSINESS

• Texas Section 848.006 - Coverage By Health Care Collaborative Not Required
  (a) Except as provided by Subsection (b) and subject to Chapter 843 and Section 1301.0625, an individual may not be required to obtain or maintain...
• Texas Section 848.051 - Operation Of Health Care Collaborative
  A health care collaborative that is certified by the department under this chapter may provide or arrange to provide health care services under contract with...
• Texas Section 848.052 - Formation And Governance Of Health Care Collaborative
  (a) A health care collaborative is governed by a board of directors. (b) The person who establishes a health care collaborative shall appoint an initial...
• Texas Section 848.053 - Compensation Advisory Committee; Sharing Of Certain Data
  (a) The board of directors of a health care collaborative shall establish a compensation advisory committee to develop and make recommendations to the board regarding...
• Texas Section 848.054 - Certificate Of Authority And Determination Of Approval Required
  (a) An organization may not organize or operate a health care collaborative in this state unless the organization holds a certificate of authority issued under...
• Texas Section 848.055 - Exceptions
  (a) An organization is not required to obtain a certificate of authority under this chapter if the organization holds an appropriate certificate of authority issued...
• Texas Section 848.056 - Application For Certificate Of Authority
  (a) An organization may apply to the commissioner for and obtain a certificate of authority to organize and operate a health care collaborative. (b) An...
• Texas Section 848.057 - Requirements For Approval Of Application
  (a) The commissioner shall issue a certificate of authority on payment of the application fee prescribed by Section 848.152 if the commissioner is satisfied that:...
• Texas Section 848.058 - Denial Of Certificate Of Authority
  (a) The commissioner may not issue a certificate of authority if the commissioner determines that the applicant's proposed plan of operation does not meet the...
• Texas Section 848.059 - Concurrence Of Attorney General
  (a) If the commissioner determines that an application for a certificate of authority filed under Section 848.056 complies with the requirements of Section 848.057, the...

SUBCHAPTER C GENERAL POWERS AND DUTIES OF HEALTH CARE COLLABORATIVE

• Texas Section 848.060 - Renewal Of Certificate Of Authority And Determination Of Approval
  (a) Not later than the 180th day before the one-year anniversary of the date on which a health care collaborative's certificate of authority was issued...
• Texas Section 848.101 - Providing Or Arranging For Services
  (a) A health care collaborative may provide or arrange for health care services through contracts with physicians and health care providers or with entities contracting...
• Texas Section 848.102 - Insurance, Reinsurance, Indemnity, And Reimbursement
  A health care collaborative may contract with an insurer authorized to engage in business in this state to provide insurance, reinsurance, indemnification, or reimbursement against...
• Texas Section 848.103 - Payment By Governmental Or Private Entity
  (a) A health care collaborative may: (1) contract for and accept payments from a governmental or private entity for all or part of the cost...
• Texas Section 848.104 - Contracts For Administrative Or Management Services
  A health care collaborative may contract with any person, including an affiliated entity, to perform administrative, management, or any other required business functions on behalf...
• Texas Section 848.105 - Corporation, Partnership, Or Association Powers
  A health care collaborative has all powers of a partnership, association, corporation, or limited liability company, including a professional association or corporation, as appropriate under...
• Texas Section 848.106 - Quality And Cost Of Health Care Services
  (a) A health care collaborative shall establish policies to improve the quality and control the cost of health care services provided by participating physicians and...
• Texas Section 848.107 - Complaint Systems
  (a) A health care collaborative shall implement and maintain complaint systems that provide reasonable procedures to resolve an oral or written complaint initiated by: (1)...
• Texas Section 848.108 - Delegation Agreements
  (a) Except as provided by Subsection (b), a health care collaborative that enters into a delegation agreement described by Section 1272.001 is subject to the...
• Texas Section 848.109 - Validity Of Operations And Trade Practices Of Health Care Collaboratives
  The operations and trade practices of a health care collaborative that are consistent with the provisions of this chapter, the rules adopted under this chapter,...

SUBCHAPTER D REGULATION OF HEALTH CARE COLLABORATIVES

• Texas Section 848.110 - Rights Of Physicians; Limitations On Participation
  (a) Before a complaint against a physician under Section 848.107 is resolved, or before a physician's association with a health care collaborative is terminated, the...
• Texas Section 848.151 - Rules
  The commissioner and the attorney general may adopt reasonable rules as necessary and proper to implement the requirements of this chapter. Added by Acts 2011,...
• Texas Section 848.152 - Fees And Assessments
  (a) The commissioner shall, within the limits prescribed by this section, prescribe the fees to be charged and the assessments to be imposed under this...

SUBCHAPTER E ENFORCEMENT

• Texas Section 848.153 - Examinations
  (a) The commissioner may examine the financial affairs and operations of any health care collaborative or applicant for a certificate of authority under this chapter....
• Texas Section 848.201 - Enforcement Actions
  (a) After notice and opportunity for a hearing, the commissioner may: (1) suspend or revoke a certificate of authority issued to a health care collaborative...
• Texas Section 848.202 - Operations During Suspension Or After Revocation Of Certificate Of Authority
  (a) During the period a certificate of authority of a health care collaborative is suspended, the health care collaborative may not: (1) enter into a...
• Texas Section 848.203 - Injunctions
  If the commissioner believes that a health care collaborative or another person is violating or has violated this chapter or a rule adopted under this...
• Texas Section 848.204 - Notice
  The commissioner shall: (1) report any action taken under this subchapter to: (A) the relevant state licensing or certifying agency or board; and (B) the...
• Texas Section 848.205 - Independent Authority Of Attorney General
  (a) The attorney general may: (1) investigate a health care collaborative with respect to anticompetitive behavior that is contrary to the goals and requirements of...

Last modified: September 28, 2016