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RULE §10.27Modifications to Network Configuration

(a) A network must file a modification request with and receive approval from the department before the network makes a material modification to its network configuration. The modification request must be filed not later than 30 days prior to implementation of the material modification.

(b) A modification request for a modification to network configuration must include:

  (1) a description and a map of the network's service area or areas, with key and scale, that identifies each county, ZIP code, partial ZIP code, or part of a county to be served as required by §10.22 of this title (relating to Contents of Application);

  (2) network configuration information, as required by §10.22(11) of this title; and

  (3) if the modification involves adding or modifying telehealth service, telemedicine medical service, or teledentistry dental service, an explanation of how the network would update its provider directory, and any statements or restrictions on services that can be provided via telehealth service, telemedicine medical service, or teledentistry dental service.

(c) The applicant must file a copy of the form of any new contracts or amendment of any existing contracts as described by and required under §10.22(3), (4), and (5) of this title if the modification of network configuration causes changes.

(d) A modification request is not considered complete and reviewable until the department has received all information required under this section, including any additional information the department requests as needed to make the determination.

(e) Before the department considers a modification request to modify a network's configuration, the applicant must be in good standing with the department and in compliance with all applicable requirements under this chapter; Insurance Code Chapter 1305, concerning Workers' Compensation Health Care Networks; and Labor Code Title 5, concerning Workers' Compensation.

(f) Prescribed modification request forms may be obtained from:

  (1) the department's website;

  (2) the department's workers' compensation network email address; or

  (3) the MCQA mailing address.

(g) For purposes of this section, a material modification includes a change to the network configuration that alters the ability of the network to comply with the availability and accessibility requirements described in §10.80 of this title (relating to Accessibility and Availability Requirements).

Source Note: The provisions of this §10.27 adopted to be effective December 5, 2005, 30 TexReg 8099; amended to be effective August 2, 2022, 47 TexReg 4534

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