| (a) Whenever requested by the department, an MCO participating
in Medicaid must file with the department a complete set of financial
exhibits pertaining to the state Medicaid program, in the format of
the Managed Care Financial Statistical Report, as may be modified
or amended by the Texas Health and Human Services Commission. When
a request is received, the MCO must then file a Managed Care Financial
Statistical Report reflecting the state Medicaid program operations
for each contract year in the same format as the monthly Managed Care
Financial Statistical Report. These reports must comply with the instructions
issued by the Texas Health and Human Services Commission.
(b) For any new or modified request to the Texas Health
and Human Services Commission for participation in the Medicaid managed
care program, all financial projections, including enrollment projections,
from the effective or renewal date of a Medicaid contract that are
submitted to the Texas Health and Human Services Commission, must
also be submitted to the department. The MCO must submit the same
financial projections, including a cash flow statement, submitted
to the Texas Health and Human Services Commission with the request
to participate in the Medicaid program. This information must be submitted
with the application for a certificate of authority if the MCO is
not already a licensed MCO. If the MCO is a licensed operation, then
the financial projections must be sent with the application for service
area expansion.
(c) The MCO must notify the department of any similar
financial or statistical reports required by other contracting state
agencies and must submit copies of these reports to the department
when requested by the department.
(d) Information submitted under this section must be
sent to the Financial Analysis Section, Mail Code 303-1A, Texas Department
of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.
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