Texas Insurance Code

Sec. § 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)

“Health care collaborative” means an entity:

(A)

that undertakes to arrange for medical and health care services for insurers, health maintenance organizations, and other payors in exchange for payments in cash or in kind;

(B)

that accepts and distributes payments for medical and health care services;

(C)

that consists of:

(i)

physicians;

(ii)

rural hospitals;

(iii)

physicians and other health care providers;

(iv)

physicians and insurers or health maintenance organizations; or

(v)

physicians, other health care providers, and insurers or health maintenance organizations; and

(D)

that is certified by the commissioner under this chapter to lawfully accept and distribute payments to physicians and other health care providers using the reimbursement methodologies authorized by this chapter.

(3)

“Health care services” means services provided by a physician or health care provider to prevent, alleviate, cure, or heal human illness or injury. The term includes:

(A)

pharmaceutical services;

(B)

medical, chiropractic, or dental care; and

(C)

hospitalization.

(4)

“Health care provider” means any person, partnership, professional association, corporation, facility, or institution licensed, certified, registered, or chartered by this state to provide health care services. The term includes a hospital but does not include a physician.

(5)

“Health maintenance organization” means an organization operating under Chapter 843 (Health Maintenance Organizations).

(6)

“Hospital” means a general or special hospital, including a public or private institution licensed under Chapter 241 (Hospitals) or 577 (Private Mental Hospitals and Other Mental Health Facilities), Health and Safety Code.

(7)

Repealed by Acts 2015, 84th Leg., R.S., Ch. 946 , Sec. 1.14(e)(2), eff. September 1, 2015, and Ch. 837 , Sec. 3.40(d), eff. January 1, 2016.

(8)

“Physician” means:

(A)

an individual licensed to practice medicine in this state;

(B)

a professional association organized under the Texas Professional Association Act (Article 1528f, Vernon’s Texas Civil Statutes) or the Texas Professional Association Law by an individual or group of individuals licensed to practice medicine in this state;

(C)

a partnership or limited liability partnership formed by a group of individuals licensed to practice medicine in this state;

(D)

a nonprofit health corporation certified under Section 162.001 (Certification by Board), Occupations Code;

(E)

a company formed by a group of individuals licensed to practice medicine in this state under the Texas Limited Liability Company Act (Article 1528n, Vernon’s Texas Civil Statutes) or the Texas Professional Limited Liability Company Law; or

(F)

an organization wholly owned and controlled by individuals licensed to practice medicine in this state.

(9)

“Potentially preventable event” has the meaning assigned by Section 1002.001, Health and Safety Code.

(10)

“Rural hospital” means a licensed hospital with 75 beds or fewer that:

(A)

is located in a county with a population of 50,000 or less; or

(B)

has been designated by the Centers for Medicare and Medicaid Services as a critical access hospital, rural referral center, or sole community hospital.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.40(d), eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 1.14(e)(2), eff. September 1, 2015.
Acts 2019, 86th Leg., R.S., Ch. 915 (H.B. 3934), Sec. 1, eff. June 10, 2019.
Source

Last accessed
Jun. 7, 2021