| (a) Before obtaining a certificate of authority under
Insurance Code Chapter 844 (concerning Certification of Certain Nonprofit
Health Corporations), an applicant ANHC must:
(1) comply with each requirement for the issuance of
a certificate of authority imposed on an HMO under Insurance Code
Chapter 843 (concerning Health Maintenance Organizations) and Insurance
Code Chapter 1271 (concerning Benefits Provided by Health Maintenance
Evidence of Coverage; Charges), this chapter, and other applicable
insurance laws and regulations of this state; and
(2) demonstrate by appropriate documentation that the
applicant ANHC has established and maintains accreditation by the:
(A) NCQA; or
(B) Joint Commission on Accreditation of Health Care
Organizations network accreditation program.
(b) The commissioner may grant a provisional certificate
of authority to an applicant ANHC under Insurance Code Chapter 844,
if the:
(1) applicant ANHC complies with each requirement for
the issuance of a certificate of authority imposed on an HMO under
Insurance Code Chapters 843 and 1271, this chapter, and other applicable
insurance laws and regulations of this state;
(2) applicant ANHC demonstrates that it has applied
for accreditation;
(3) applicant ANHC is diligently pursuing accreditation
as determined by the commissioner; and
(4) accrediting organization has not denied the accreditation.
(c) An ANHC with a certificate of authority or a provisional
certificate of authority must comply with all the appropriate requirements
that an HMO must comply with under Insurance Code Chapter 843 and
1271, this chapter, and other applicable insurance laws and regulations
of this state in order to maintain a certificate of authority.
(d) This subchapter does not apply to an activity exempt
from regulation under Insurance Code Chapters 843 and 844, including
an ANHC that contracts to arrange for or provide only medical care
as defined in Insurance Code §843.002 (concerning Definitions).
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