Tex. Ins. Code Section 1305.102
Management Contracts


(a)

A network may not enter into a contract with another entity for management services unless the proposed contract is first filed with the department and approved by the commissioner.

(b)

The commissioner shall approve or disapprove the contract not later than the 30th day after the date the contract is filed, or within a reasonable extended period that the commissioner specifies by notice given within the 30-day period.

(c)

The contract must state that:

(1)

the contract may not be canceled without cause without at least 90 days’ prior written notice;

(2)

notice of any cancellation must be sent simultaneously to the commissioner by certified mail; and

(3)

the network is responsible for ensuring that all functions delegated by the contract are performed in accordance with applicable statutes and rules, subject to the carrier’s oversight and monitoring of the network’s performance.

(d)

The management contractor proposing to contract shall provide to the commissioner information sufficient to allow the commissioner to determine the competence, fitness, or reputation of each of the contractor’s officers and directors or other person having control of the contractor, including criminal history information demonstrating that none of those individuals has been convicted of a felony involving moral turpitude or breach of fiduciary duty.

(e)

The commissioner shall disapprove the proposed contract if the commissioner determines that the contract authorizes a person who is not sufficiently trustworthy, competent, experienced, and free from conflict of interest to manage the network with due regard for the interests of employers, employees, creditors, or the public.

(f)

The commissioner may not approve a proposed management contract unless the management contractor has in force in the management contractor’s own name a fidelity bond on the contractor’s officers and employees in the amount of $250,000 or a greater amount prescribed by the commissioner.

(g)

The fidelity bond must be issued by an insurer authorized to engage in business in this state and must be filed with the department. If the commissioner determines that a fidelity bond is not available from an insurer authorized to engage in business in this state, the management contractor may obtain a fidelity bond procured by a surplus lines agent under Chapter 981 (Surplus Lines Insurance).

(h)

The fidelity bond must obligate the surety to pay any loss of money or other property or damage that the network sustains because of an act of fraud or dishonesty by an employee or officer of the management contractor during the period that the management contract is in effect.

(i)

In lieu of a fidelity bond, and at the commissioner’s discretion, the management contractor may deposit with the comptroller cash or readily marketable liquid securities acceptable to the commissioner. The deposit must be maintained in the amount of, and is subject to the same conditions required for, a fidelity bond under this section.

(j)

A management contract approved by the commissioner under this section may not be assigned to any other entity.

(k)

A management contract filed with the department under this section is confidential and is not subject to disclosure as public information under Chapter 552 (Public Information), Government Code.
Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 4.02, eff. September 1, 2005.

Source: Section 1305.102 — Management Contracts, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1305.­htm#1305.­102 (accessed Jun. 5, 2024).

1305.001
Short Title
1305.002
Purpose
1305.003
Limitations on Applicability
1305.004
Definitions
1305.005
Participation in Network
1305.006
Insurance Carrier Liability for Out-of-network Health Care
1305.007
Rules
1305.008
Administrator Certificate of Authority Required
1305.051
Certification Required
1305.052
Certificate Application
1305.053
Contents of Application
1305.054
Action on Application
1305.055
Use of Certain Insurance Terms by Network Prohibited
1305.056
Restraint of Trade
1305.101
Providing or Arranging for Health Care
1305.102
Management Contracts
1305.103
Treating Doctor
1305.104
Selection of Treating Doctor
1305.106
Payment of Health Care Provider
1305.107
Telephone Access
1305.151
Transfer of Risk
1305.152
Network Contracts with Providers
1305.153
Provider Reimbursement
1305.154
Network-carrier Contracts
1305.155
Compliance Requirements
1305.201
Network Financial Requirements
1305.251
Examination of Network
1305.252
Examination of Provider or Third Party
1305.301
Network Organization
1305.302
Accessibility and Availability Requirements
1305.303
Quality of Care Requirements
1305.304
Guidelines and Protocols
1305.351
Utilization Review in Network
1305.353
Notice of Certain Utilization Review Determinations
1305.354
Reconsideration of Adverse Determination
1305.355
Independent Review of Adverse Determination
1305.356
Contested Case Hearing on and Judicial Review of Independent Review
1305.401
Complaint System Required
1305.402
Complaint Initiation and Initial Response
1305.403
Record of Complaints
1305.404
Retaliatory Action Prohibited
1305.405
Posting of Information on Complaint Process Required
1305.451
Employee Information
1305.502
Consumer Report Cards
1305.503
Confidentiality Requirements
1305.551
Determination of Violation
1305.552
Disciplinary Actions
1305.1545
Restrictions on Payment and Reimbursement

Accessed:
Jun. 5, 2024

§ 1305.102’s source at texas​.gov