| (a) TRS-ActiveCare may include separate contracts for:
(1) health benefit plans;
(2) prescription drug plans;
(3) utilization review services;
(4) administrative services; and
(5) ancillary services.
(b) Except for health maintenance organizations, which
must meet other requirements in this section, to be eligible to bid
on any of the contracts in subsection (a) of this section, a bidder
must comply with the minimum qualification standards contained in
the applicable solicitation from TRS.
(c) TRS may approve a health maintenance organization
(HMO) to offer a health benefit plan to participants in TRS-ActiveCare
in areas of the state determined by TRS. TRS may establish, for different
areas of the state, different criteria for HMOs to qualify to offer
a health benefit plan. TRS may at any time establish or change the
number, if any, of HMOs approved to offer a health benefit plan in
each area of the state. In order to be approved, an HMO must satisfy
all of the following conditions:
(1) The HMO must hold a valid certificate of authority
issued by the Texas Department of Insurance to operate in the State
of Texas.
(2) The HMO must demonstrate the capacity to provide
adequate services, as determined by TRS, to the participants in TRS-ActiveCare.
(3) Once adopted by TRS, the rates and benefits submitted
by an HMO may not be modified during a plan year without the prior
written approval of TRS.
(4) A request for expansion of a service area shall
require a separate responsive bid and approval by TRS.
(5) The HMO must comply with the other minimum qualification
standards contained in the applicable solicitation from TRS.
|
| Source Note: The provisions of this §41.31 adopted to be effective November 5, 2001, 26 TexReg 8850; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective August 15, 2019, 44 TexReg 4189 |
