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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES |
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Subtitle C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES |
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Chapter 843. HEALTH MAINTENANCE ORGANIZATIONS |
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Subchapter D. GENERAL POWERS AND DUTIES OF HEALTH MAINTENANCE ORGANIZATIONS |
Sec. 843.101. PROVIDING OR ARRANGING FOR CARE
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(a) A health maintenance organization may provide or arrange for medical care services only through:
(1) other health maintenance organizations; or
(2) physicians or groups of physicians who have independent contracts with the health maintenance organizations.
(b) A health maintenance organization may provide or arrange for health care services only through:
(1) other health maintenance organizations;
(2) providers or groups of providers who are under contract with or are employed by the health maintenance organization; or
(3) additional health maintenance organizations or physicians or providers who have contracted for health care services with:
(A) the other health maintenance organizations;
(B) physicians with whom the health maintenance organization has contracted; or
(C) providers who are under contract with or are employed by the health maintenance organization.
(c) Notwithstanding Subsections (a) and (b), a health maintenance organization may provide or authorize the following in a manner approved by the commissioner:
(1) emergency care;
(2) services by referral; and
(3) services provided outside the service area.
(d) A health maintenance organization may not employ or contract with other health maintenance organizations or physicians or providers in a manner that is prohibited by a law of this state under which those health maintenance organizations or physicians or providers are licensed or otherwise authorized.
(e) A health maintenance organization may serve as a workers' compensation health care network, as defined by Section 1305.004, in accordance with Chapter 1305.