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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 11HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER IFINANCIAL REQUIREMENTS
RULE §11.805Other Assets

(a) Other assets an HMO may find necessary in its operations include, but are not limited to, the following:

  (1) uncollected premiums or subscriptions with an adequate provision for uncollectable premiums or subscriptions;

  (2) advances of capitation or other fees expected to be paid for the next month to medical and other health care service providers under contract with the HMO, provided that no termination of the contract may take place before the end of the period for which advances were paid;

  (3) the following items, provided that a detailed inventory is maintained with each item marked by any identifying number and the proof of cost maintained:

    (A) furniture, labor-saving devices, machines, and all other office equipment used in the administration of the HMO;

    (B) furniture, medical equipment, and vehicles used in connection with the direct provision of health care services; and

    (C) electronic machines, constituting a data processing system or systems and operating systems software used directly for the provision of medical services and the administration of the HMO;

  (4) inventories of necessary pharmaceutical and surgical supplies used directly in the treatment of medical conditions, it being the duty of the HMO to sufficiently prove the value of the inventories;

  (5) real estate and leasehold estates, including buildings and improvements, and leasehold improvements on rented space, for the accommodation of the HMO's current or expected business operations used in the provision or support of health care services, including space for rent to any physician or provider under contract with the HMO, which property will be used in the provision of health care services to members of the HMO by that physician or provider; and

  (6) claims overpayments, with the right of offset supported by a contractual agreement, which are specifically identifiable payments, may be admitted to the extent a liability to that physician or provider exists.

(b) All noninvested assets of an HMO must be accounted for in compliance with §11.801 of this title (relating to Accounting Guidance) except that the assets listed in subsection (a) of this section are admissible.


Source Note: The provisions of this §11.805 adopted to be effective August 1, 2017, 42 TexReg 2169

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