| (a) An HMO must file an application with the department
for approval before the HMO may expand an existing service area, reduce
an existing service area, or add a new service area.
(b) For the purposes of an application to expand an
existing service area, reduce an existing service area, or add a new
service area, an HMO must file the following items:
(1) a description and a map with key and scale, showing
both the currently approved service area and the proposed new service
area as required by §11.204(13) of this title (relating to Contents);
(2) network configuration information, as required
by §11.204(19) of this title;
(3) combined financial projections as described in §11.204(10)(B)
of this title, including a breakdown of the income statement for existing
business, and the effect of the proposed service area expansion or
reduction; and
(4) if any of the items specified in §11.301 of
this title (relating to Filing Requirements) are changed by a service
area expansion or reduction application, the new item or any amendments
to an existing item must be filed for approval or filed for information,
as outlined in §11.301(4) and (5) of this title.
(c) The department will not accept an application for
review until the application is complete. An application to modify
the certificate of authority that requires the commissioner's approval
under Insurance Code §843.080 (concerning Modification or Amendment
of Application Information) or Chapter 1271 Subchapter C, (concerning
Commissioner Approval) is considered complete when all information
required by §11.301 of this title; this section; and Chapter
11, Subchapter T, of this title (relating to Quality of Care) that
is reasonably necessary for a final determination by the department
has been filed with the department.
(d) Before consideration of a service area expansion
or reduction application, an HMO must comply with the requirements
of Chapter 11, Subchapter T, of this title, in the existing service
areas and in the proposed service areas.
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