Tex.
Ins. Code Section 848.103
Payment by Governmental or Private Entity
(a)
A health care collaborative may:(1)
contract for and accept payments from a governmental or private entity for all or part of the cost of services provided or arranged for by the health care collaborative; and(2)
distribute payments to participating physicians and health care providers.(b)
Notwithstanding any other law, a health care collaborative that is in compliance with this code, including Chapters 841 (Life, Health, or Accident Insurance Companies), 842 (Group Hospital Service Corporations), and 843 (Health Maintenance Organizations), as applicable, may contract for, accept, and distribute payments from governmental or private payors based on fee-for-service or alternative payment mechanisms, including:(1)
episode-based or condition-based bundled payments;(2)
capitation or global payments; or(3)
pay-for-performance or quality-based payments.(c)
Except as provided by Subsection (d), a health care collaborative may not contract for and accept payment from a governmental or private entity on a prepaid, capitation, or indemnity basis unless the health care collaborative is licensed as a health maintenance organization or insurer. The department shall review a health care collaborative’s proposed payment methodology in contracts with governmental or private entities to ensure compliance with this section.(d)
A health care collaborative may contract for and accept compensation on a prepaid or capitation basis from a health maintenance organization or insurer.
Source:
Section 848.103 — Payment by Governmental or Private Entity, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.848.htm#848.103 (accessed Jun. 5, 2024).
