Chapter
843
Health Maintenance Organizations
Sections
843.001
Short Title
843.002
Definitions
843.003
Powers of Insurers and Group Hospital Service Corporations
843.004
Governing Body of Health Maintenance Organization
843.005
Use of Insurance-related Terms by Health Maintenance Organization
843.006
Public Documents
843.007
Confidentiality of Medical and Health Information
843.008
Costs of Administering Health Maintenance Organization Laws
843.009
Appeals; Judicial Review
843.010
Applicability of Certain Provisions to Governmental Health Benefit Plans
843.051
Applicability of Insurance and Group Hospital Service Corporation Laws
843.052
Laws Relating to Solicitation or Advertising
843.053
Laws Relating to Restraint of Trade
843.054
Laws Requiring Certificate of Need for Health Care Facility or Service
843.055
Laws Relating to Practice of Medicine
843.056
Inapplicability of Bankruptcy Law
843.072
Authorization Required to Act as Health Maintenance Organization
843.073
Certificate of Authority Requirement: Applicability to Physicians and Providers
843.074
Certificate of Authority Requirement: Applicability to Medical School and Medical and Dental Unit
843.075
Certificate of Authority for Single Health Care Service Plan
843.076
Application
843.077
Eligibility of Foreign Corporation
843.078
Contents of Application
843.079
Contents of Application: Limited Health Care Service Plan
843.080
Modification or Amendment of Application Information
843.082
Requirements for Approval of Application
843.083
Denial of Certificate of Authority
843.084
Duration of Certificate of Authority
843.085
Change in Control: Commissioner Approval
843.101
Providing or Arranging for Care
843.102
Health Maintenance Organization Quality Assurance
843.103
Acquisition and Operation of Facilities; Certain Loans; Commissioner Approval of Affiliate Transactions
843.104
Contracts for Certain Administrative Functions
843.105
Management and Exclusive Agency Contracts
843.106
Insurance, Reinsurance, Indemnity, and Reimbursement
843.107
Indemnity Benefits; Point-of-service Provisions
843.108
Point-of-service Rider
843.109
Payment by Governmental or Private Entity
843.110
Corporation, Partnership, or Association Powers
843.111
Group Model Health Maintenance Organizations
843.112
Dental Point-of-service Option
843.113
Specified Powers Not Exclusive
843.151
Rules
843.152
Subpoena Authority
843.153
Authority to Contract
843.154
Fees
843.155
Annual Report
843.156
Examinations
843.157
Rehabilitation, Liquidation, Supervision, or Conservation of Health Maintenance Organization
843.201
Disclosure of Information About Health Care Plan Terms
843.202
Disclosure of Information to Medicare Recipients
843.203
Selection of Primary Care Physician or Provider
843.204
Untrue or Misleading Information
843.205
Member's Handbook; Information About Complaints and Appeals
843.206
Notice of Change in Payment Arrangements
843.207
Notice of Change in Operations
843.208
Cancellation or Nonrenewal of Coverage
843.209
Identification Card
843.210
Terms of Enrollee Eligibility
843.211
Applicability of Subchapter to Entities Contracting with Health Maintenance Organization
843.251
Complaint System Required; Commissioner Rules and Examination
843.252
Complaint Initiation and Initial Response; Deadlines for Response and Resolution
843.253
Complaint Investigation and Resolution
843.254
Appeal to Complaint Appeal Panel; Deadlines
843.255
Composition of Complaint Appeal Panel
843.256
Information Provided to Complainant Relating to Complaint Appeal Panel
843.257
Rights of Complainant at Complaint Appeal Panel Meeting
843.258
Appeal Involving Ongoing Emergency or Continued Hospitalization
843.259
Notice of Decision on Appeal
843.260
Record of Complaints
843.261
Special Provisions for Appeals of Adverse Determinations
843.262
Certain Decisions Binding
843.281
Retaliatory Action Prohibited
843.282
Submitting Complaints to Department
843.283
Posting of Information on Complaint Process Required
843.301
Practice of Medicine Not Affected
843.302
Disclosure of Application Procedures and Qualification Requirements to Physician or Provider
843.303
Denial of Initial Contract to Physician or Provider
843.304
Exclusion of Provider Based on Type of License Prohibited
843.305
Annual Application Period for Physicians and Providers to Contract
843.306
Termination of Participation; Advisory Review Panel
843.307
Expedited Review Process on Termination or Deselection
843.308
Notification of Patients of Deselected Physician or Provider
843.309
Contracts with Physicians or Providers: Notice to Certain Enrollees of Termination of Physician or Provider Participation in Plan
843.310
Contracts with Physicians or Providers: Certain Indemnity Clauses Prohibited
843.311
Contracts with Podiatrists
843.312
Physician Assistants and Advanced Practice Nurses
843.313
Economic Profiling
843.314
Inducement to Limit Medically Necessary Services Prohibited
843.315
Payment of Capitation; Assignment of Primary Care Physician or Provider
843.316
Alternative Capitation System
843.317
Exclusion of Physician or Provider Based on Affiliation with Health Maintenance Organization Prohibited
843.318
Certain Contracts of Participating Physician or Provider Not Prohibited
843.319
Certain Required Contracts
843.320
Use of Hospitalist
843.321
Availability of Coding Guidelines
843.323
Contract Provisions Prohibiting Rejection of Batched Claims
843.336
Definition
843.337
Time for Submission of Claim; Duplicate Claims; Acknowledgment of Receipt of Claim
843.338
Deadline for Action on Clean Claims
843.339
Deadline for Action on Prescription Claims; Payment
843.340
Audited Claims
843.341
Claims Processing Procedures
843.342
Violation of Certain Claims Payment Provisions; Penalties
843.343
Attorney's Fees
843.344
Applicability of Subchapter to Entities Contracting with Health Maintenance Organization
843.345
Exception
843.346
Payment of Claims
843.347
Verification
843.348
Preauthorization of Health Care Services
843.349
Coordination of Payment
843.350
Overpayment
843.351
Services Provided by Certain Physicians and Providers
843.352
Conflict with Other Law
843.353
Waiver Prohibited
843.354
Legislative Declaration
843.361
Enrollees Held Harmless
843.362
Continuity of Care; Obligation of Health Maintenance Organization
843.363
Protected Physician or Provider Communications with Patients
843.401
Fiduciary Responsibility
843.402
Officers' and Employees' Bond
843.403
Minimum Net Worth
843.404
Additional Net Worth Requirements
843.405
Deposit with Comptroller
843.406
Hazardous Financial Condition
843.407
Receivership and Delinquency Proceedings
843.408
Insolvency and Allocation to Other Health Maintenance Organizations
843.409
Examination Expenses
843.410
Assessments
843.461
Enforcement Actions
843.462
Operations During Suspension or After Revocation of Certificate of Authority
843.463
Injunctions
843.464
Criminal Penalty
843.2015
Information Available Through Internet Site
843.2071
Notice of Increase in Charge for Coverage
843.3041
Acupuncturist Services
843.3042
Chiropractic Services
843.3045
Nurse First Assistant
843.3115
Contracts with Dentists
843.3385
Additional Information
843.3405
Investigation and Determination of Payment
843.3481
Posting of Preauthorization Requirements
843.3482
Changes to Preauthorization Requirements
843.3483
Remedy for Noncompliance
