1305.201
(a) Each network shall prepare financial statements in accordance with generally accepted accounting standards, which must include adequate provisions for liabilities, including incurred but not reported obligations relating to providing benefits or services. (b) Each network shall file the financial statement under Subsection (a) with the department in the manner prescribed by commissioner rule. Added […]
1305.252
If requested by the commissioner or the commissioner’s representative, each provider, provider group, or third party with which the network has contracted to provide health care services or any other services delegated to the network by an insurance carrier shall make available for examination by the department that portion of the books and records of […]
1305.301
(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 […]
1305.155
(a) An insurance carrier that becomes aware of any information that indicates that the network, any management contractor, or any third party to which the network delegates a function is not operating in accordance with the contract or is operating in a condition that renders the continuance of the network’s business hazardous to employees shall: […]
1305.107
(a) Each network shall have appropriate personnel reasonably available through a toll-free telephone service at least 40 hours per week during normal business hours, in both time zones in this state if applicable, to discuss an employee’s care and to allow response to requests for information, including information regarding adverse determinations. (b) A network must […]
1305.151
A contract under this subchapter may not involve a transfer of risk. Added by Acts 2005, 79th Leg., ch. 265, § 4.02, eff. Sept. 1, 2005.
1305.152
(a) A network shall enter into a written contract with each provider or group of providers that participates in the network. A provider contract under this section is confidential and is not subject to disclosure as public information under Chapter 552, Government Code. (b) A network is not required to accept an application for participation […]
1305.104
(a) An injured employee is entitled to the employee’s initial choice of a treating doctor from the list provided by the network of all treating doctors under contract with the network who provide services within the service area in which the injured employee lives. The following does not constitute an initial choice of treating doctor: […]
1305.105
(a) Notwithstanding any other provision of this chapter, an injured employee required to receive health care services within a network may select as the employee’s treating doctor a doctor who the employee selected, prior to injury, as the employee’s primary care physician or provider under Chapter 843, as the terms “physician” and “provider” are defined […]
1305.106
Notwithstanding any other provision of this chapter, an insurance carrier shall pay, reduce, deny, or determine to audit, a claim for services provided through a workers’ compensation health care network only in accordance with Section 408.027, Labor Code. Added by Acts 2005, 79th Leg., ch. 265, § 4.02, eff. Sept. 1, 2005.