tx-May82026-43: 28 TAC §11.1604 (Amendment) — Health Maintenance Organizations
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STATUTORY AUTHORITY. TDI proposes amendments to §11.1604 under Insurance Code §§843.151, 844.004, and 36.001. Insurance Code §843.151 authorizes the commissioner to adopt reasonable rules to implement various parts of the Insurance Code related to HMOs and ensure that enrollees have adequate access to health care services. Insurance Code §844.004 authorizes the commissioner to adopt rules to implement Insurance Chapter 844. Insurance Code §36.001 provides that the commissioner may adopt any rules necessary and appropriate to implement the powers and duties of TDI under the Insurance Code and other laws of this state. CROSS-REFERENCE TO STATUTE. The amendments to §11.1604 implement Insurance Code Chapter 843. §11.1604. Requirements for Certain Contracts Between Primary HMOs and ANHCs and Between Primary HMOs and Provider HMOs. A primary HMO that enters into a contract with an ANHC in which the ANHC agrees to arrange for or provide health care services other than medical care or services ancillary to the practice of medicine, or with a provider HMO in which the provider HMO agrees to arrange for or provide health care services on a risk-sharing or capitated risk arrangement on...
The agency’s own summary, as published.
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