(a) An HCC must file an application for approval with
the department before the HCC may expand or reduce an existing service
area or add a new service area.
(b) If any of the following items are changed by a
proposed service area expansion or reduction, the new item or any
amendments to an existing item must be submitted for approval or filed
for information, as specified in §13.422 of this title (relating
to Filing Requirements That Apply After Issuance of Certificate of
Authority):
(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 §13.413(e)(1) of this title (relating to
Contents of the Application);
(2) a form of any new contracts or amendment of any
existing contracts in the new area, as described in §13.413(e)(5)
of this title;
(3) network configuration information, as required
by §13.413(e)(2) of this title;
(4) a brief narrative description of the administrative
arrangements and organizational charts as described in §13.413(c)(7)
of this title and any other information the HCC considers to be pertinent;
(5) biographical data sheets for any new management
staff assigned to the new area;
(6) copies of leases, loans, agreements, and contracts
to be used in the proposed new area, including information described
in §13.422(c)(2)(D) of this title;
(7) separate and combined sources of financing and
financial projections as described in §13.413(d)(1) - (3) of
this title; and
(8) any new or amended reinsurance agreements, insurance,
or other protection against insolvency, as specified in §13.413(d)(4)
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 is considered complete when all information
required by §13.422 of this title, this section, and §13.481
and §13.482 of this title (relating to Quality Improvement Structure
for HCCs and Quality Assurance and Quality Improvement, respectively),
that is reasonably necessary for a final determination by the department
has been filed with the department.
(d) A service area expansion or reduction application
will be considered only if both the existing and proposed service
areas of the HCC comply with the requirements of §13.481 and §13.482
of this title, and §13.483 of this title (relating to Credentialing).
(e) If the filing for proposed service area change
might materially affect the HCC's ability to arrange for or provide
health care services, or might materially change the antitrust analysis
of the HCC, the department may require the HCC to file an application
for renewal before the date required by Insurance Code §848.060(a).
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