Tex.
Ins. Code 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 (Fees and Assessments) if the commissioner is satisfied that:(1)
the applicant meets the requirements of Section 848.056 (Application for Certificate of Authority);(2)
with respect to health care services to be provided, the applicant:(A)
has demonstrated the willingness and potential ability to ensure that the health care services will be provided in a manner that:(i)
increases collaboration among health care providers and integrates health care services;(ii)
promotes improvement in quality-based health care outcomes, patient safety, patient engagement, and coordination of services; and(iii)
reduces the occurrence of potentially preventable events;(B)
has processes that contain health care costs without jeopardizing the quality of patient care;(C)
has processes to develop, compile, evaluate, and report statistics on performance measures relating to the quality and cost of health care services, the pattern of utilization of services, and the availability and accessibility of services; and(D)
has processes to address complaints made by patients receiving services provided through the organization;(3)
the applicant is in compliance with all rules adopted by the commissioner under Section 848.151 (Rules);(4)
the applicant has working capital and reserves sufficient to operate and maintain the health care collaborative and to arrange for services and expenses incurred by the health care collaborative;(5)
the applicant’s proposed health care collaborative is not likely to reduce competition in any market for physician, hospital, or ancillary health care services due to:(A)
the size of the health care collaborative; or(B)
the composition of the collaborative, including the distribution of physicians by specialty within the collaborative in relation to the number of competing health care providers in the health care collaborative’s geographic market; and(6)
the pro-competitive benefits of the applicant’s proposed health care collaborative are likely to substantially outweigh the anticompetitive effects of any increase in market power.(b)
A certificate of authority is effective for a period of one year, subject to Section 848.060 (Renewal of Certificate of Authority and Determination of Approval)(d).
Source:
Section 848.057 — Requirements for Approval of Application, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.848.htm#848.057 (accessed Jun. 5, 2024).
