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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle D. PROVIDER PLANS |
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Chapter 1305. WORKERS' COMPENSATION HEALTH CARE NETWORKS |
| Subchapter A. GENERAL PROVISIONS |
| § 1305.001. SHORT TITLE |
| § 1305.002. PURPOSE |
| § 1305.003. LIMITATIONS ON APPLICABILITY |
| § 1305.004. DEFINITIONS |
| § 1305.005. PARTICIPATION IN NETWORK; NOTICE OF NETWORK REQUIREMENTS |
| § 1305.006. INSURANCE CARRIER LIABILITY FOR OUT-OF-NETWORK HEALTH CARE |
| § 1305.007. RULES |
| § 1305.008. ADMINISTRATOR CERTIFICATE OF AUTHORITY REQUIRED |
| Subchapter B. CERTIFICATION |
| § 1305.051. CERTIFICATION REQUIRED |
| § 1305.052. CERTIFICATE APPLICATION |
| § 1305.053. CONTENTS OF APPLICATION |
| § 1305.054. ACTION ON APPLICATION; RENEWAL OF CERTIFICATION |
| § 1305.055. USE OF CERTAIN INSURANCE TERMS BY NETWORK PROHIBITED |
| § 1305.056. RESTRAINT OF TRADE; APPLICATION OF CERTAIN LAWS |
| Subchapter C. GENERAL POWERS AND DUTIES OF WORKERS' COMPENSATION HEALTH CARE NETWORKS |
| § 1305.101. PROVIDING OR ARRANGING FOR HEALTH CARE |
| § 1305.102. MANAGEMENT CONTRACTS |
| § 1305.103. TREATING DOCTOR; REFERRALS |
| § 1305.104. SELECTION OF TREATING DOCTOR |
| § 1305.105. TREATMENT BY A PRIMARY CARE PHYSICIAN OR PROVIDER UNDER CHAPTER 843; RECOMMENDATIONS REGARDING USE OF PREFERRED PROVIDER PLAN |
| § 1305.106. PAYMENT OF HEALTH CARE PROVIDER |
| § 1305.107. TELEPHONE ACCESS |
| Subchapter D. CONTRACTING PROVISIONS |
| § 1305.151. TRANSFER OF RISK |
| § 1305.152. NETWORK CONTRACTS WITH PROVIDERS |
| § 1305.153. PROVIDER REIMBURSEMENT |
| § 1305.154. NETWORK-CARRIER CONTRACTS |
| § 1305.1545. RESTRICTIONS ON PAYMENT AND REIMBURSEMENT |
| § 1305.155. COMPLIANCE REQUIREMENTS |
| Subchapter E. FINANCIAL REQUIREMENTS |
| § 1305.201. NETWORK FINANCIAL REQUIREMENTS |
| Subchapter F. EXAMINATIONS |
| § 1305.251. EXAMINATION OF NETWORK |
| § 1305.252. EXAMINATION OF PROVIDER OR THIRD PARTY |
| Subchapter G. PROVISION OF SERVICES BY NETWORK; QUALITY IMPROVEMENT PROGRAM |
| § 1305.301. NETWORK ORGANIZATION; SERVICE AREAS |
| § 1305.302. ACCESSIBILITY AND AVAILABILITY REQUIREMENTS |
| § 1305.303. QUALITY OF CARE REQUIREMENTS |
| § 1305.304. GUIDELINES AND PROTOCOLS |
| Subchapter H. UTILIZATION REVIEW |
| § 1305.351. UTILIZATION REVIEW IN NETWORK |
| § 1305.353. NOTICE OF CERTAIN UTILIZATION REVIEW DETERMINATIONS; PREAUTHORIZATION REQUIREMENTS |
| § 1305.354. RECONSIDERATION OF ADVERSE DETERMINATION |
| § 1305.355. INDEPENDENT REVIEW OF ADVERSE DETERMINATION |
| § 1305.356. CONTESTED CASE HEARING ON AND JUDICIAL REVIEW OF INDEPENDENT REVIEW |
| Subchapter I. COMPLAINT RESOLUTION |
| § 1305.401. COMPLAINT SYSTEM REQUIRED |
| § 1305.402. COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE AND RESOLUTION |
| § 1305.403. RECORD OF COMPLAINTS |
| § 1305.404. RETALIATORY ACTION PROHIBITED |
| § 1305.405. POSTING OF INFORMATION ON COMPLAINT PROCESS REQUIRED |
| Subchapter J. EMPLOYEE INFORMATION AND RESPONSIBILITIES |
| § 1305.451. EMPLOYEE INFORMATION; RESPONSIBILITIES OF EMPLOYEE |
| Subchapter K. EVALUATION OF NETWORKS; CONSUMER REPORT CARD |
| § 1305.501. EVALUATION OF NETWORKS |
| § 1305.502. CONSUMER REPORT CARDS |
| § 1305.503. CONFIDENTIALITY REQUIREMENTS |
| Subchapter L. DISCIPLINARY ACTIONS |
| § 1305.551. DETERMINATION OF VIOLATION; NOTICE |
| § 1305.552. DISCIPLINARY ACTIONS |