| (D) as provided in §11.203(a) of this title, a
copy of any proposed amendment to basic organizational documents,
bylaws, rules, or any similar document regulating the conduct of the
internal affairs of the applicant and, if the approved amendment must
be filed with the secretary of state, a certified copy of the amendment
with the file mark of the secretary of state; and
(E) as provided in Chapter 11, Subchapter B, of this
title (relating to Name Application Procedure), any name or assumed
name on a form, as specified in §11.105 of this title (relating
to Use of the Term "HMO," Service Marks, Trademarks, Assumed Name).
(5) Filings for information. Material filed under this
paragraph is not to be considered approved, but may be subject to
review for compliance with Texas law and consistency with other HMO
documents. Each item filed under this paragraph must be accompanied
by a completed HMO certification and transmittal form in addition
to those attachments required under paragraph (3) of this section.
Within 30 days of the effective date, an HMO must file with the commissioner,
for information, deletions and modifications to the following previously
approved or filed operations and documents:
(A) electronically through the NAIC's System for Electronic
Rate and Form Filing:
(i) the formula or method for calculating the schedule
of charges as specified in Chapter 11, Subchapter H, of this title
(relating to Schedule of Charges);
(ii) any modification of drug coverage under Insurance
Code §1369.0541 (concerning Modification of Drug Coverage Under
Plan); and
(iii) the member handbook for CHIP plans, together
with a certification from the HMO that the handbook has been approved
by the Texas Health and Human Services Commission and a copy of the
document approving the handbook;
(B) on paper or electronically through the NAIC's System
for Electronic Rate and Form Filing or any other method acceptable
to the department:
(i) a copy of the form of any new contract or subcontract
or any substantive change to previously filed copies of forms of all
contracts between the HMO and any physician or provider described
in §11.204(14)(B) of this title, and copies of forms of all contracts
between the HMO and an insurer or group hospital service corporation
to offer indemnity benefits, whether used with all contracts or on
an individual basis. All copies of amended contracts must be marked
to indicate revisions. In addition, the HMO must answer all questions
listed on the HMO certification and transmittal form;
(ii) a copy of the executed agreement between the HMO
and any delegated entities and delegated networks as defined in §11.2602
of this title (relating to Definitions); and
(iii) any change in the quality assurance program,
including the peer review program, as required by Insurance Code §843.082(1)
(concerning Requirements for Approval of Application) or §843.102
(concerning Health Maintenance Organization Quality Assurance), with
descriptions of arrangements for sharing pertinent medical records
between physicians and providers contracting or subcontracting under §11.204(14)(B)
of this title with the HMO and ensuring the records' confidentiality;
(C) as provided in §7.201 of this title, a copy
of any notice of cancellation of fidelity bonds, new fidelity bonds,
or amendments to fidelity bonds, for officers and employees, including
notarized certification by the corporate secretary or corporate president
that the material is true, accurate, and complete, as described in §11.204(7)
and (14)(D) of this title;
(D) as provided in §11.203(a) of this title:
(i) a list of officers and directors and a biographical
data sheet for each person listed on the officers and directors page
under Insurance Code §843.078(b) (concerning Contents of Application)
and biographical data forms in §11.204(5)(A), (B), and (C) of
this title; and
(ii) any change of the certificate of authority for
a domestic or foreign HMO, and, if a foreign HMO, a certified copy
of the certificate of authority and power of attorney.
(6) Approval period. Any modification for which the
commissioner's approval is required may be considered approved, unless
it is disapproved within 30 days from the date the filing is determined
by the department to be complete. The commissioner may postpone the
action for a period not to exceed 30 days, as necessary for proper
consideration. The department will notify the HMO in writing if it
postpones a decision on a modification.
(7) Approval, disapproval, and pending.
(A) Filings requiring approval under paragraph (4)(A)(i)-
(iii) of this section will be approved or disapproved in writing within
the period set forth in paragraph (6) of this section unless, before
the department's issuance of notice of proposed negative action under §1.704(a)
of this title (relating to Summary Procedure; Notice), the HMO has
been contacted by the department regarding corrections or additional
information necessary for commissioner's approval, and files a written
consent to waive the approval period with the department.
(B) The department may waive the approval period on
its receipt of the HMO's written consent.
(C) The department may hold the filing in a pending
status for a reasonable period, but not more than 15 calendar days
after the date of the department's request.
(D) If the HMO has not addressed the department's request
for corrections or additional information within 15 calendar days,
then the HMO may withdraw the filing before the end of the applicable
review period, which is either the 30th day after filing or the 60th
day after filing for an extended review period.
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