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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 13MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES
SUBCHAPTER EHEALTH CARE COLLABORATIVES
DIVISION 3EXAMINATIONS; REGULATORY REQUIREMENTS FOR AN HCC AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY; AND ADVERTISING AND SALES MATERIAL
RULE §13.425Compensation Arrangements

(a) An HCC must comply with Insurance Code §848.053, including requirements relating to committee membership, charges, fees, distributions, or other compensation assessed for services provided by HCC participants, and to the sharing of the data among nonparticipating physicians and health care providers.

(b) An HCC must establish and enforce procedures to maintain the confidentiality of charge, fee, and payment data and information between HCC participants and any individual or entity outside of the HCC, including information to be transmitted to the department.

(c) A participant in an HCC is prohibited from using charge, fee, and payment data collected by the HCC in any negotiation of charges, fees, or payments if the HCC is not a party to the negotiation.


Source Note: The provisions of this §13.425 adopted to be effective March 31, 2013, 38 TexReg 2100

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