| (a) An HMO that provides coverage for health care services
or medical care through one or more physicians or providers is required
by Insurance Code §843.305 (concerning Annual Application Period
for Physician and Providers to Contract) to provide a 20-calendar
day period each calendar year during which any provider or physician
in the geographic service area may apply to participate in each of
the HMO's networks providing health care services or medical care
under the terms and conditions established by the HMO for the provision
of the services and the designation of the physicians and providers.
Section 843.305 may not be construed to:
(1) require that an HMO use a particular type of provider
or physician in its operation;
(2) require that an HMO accept a physician or provider
of a category or type that does not meet the practice standards and
qualifications established by the HMO; or
(3) require that an HMO contract directly with the
physicians or providers.
(b) An HMO subject to Insurance Code §843.305
must publish a notice of an application period to physicians and providers
both in the public notice section of at least one major newspaper
with general circulation in each of its service areas and on the HMO's
website. The notice must be published for at least five consecutive
days during the period of January 2 through January 23 of each calendar
year and must include the caption "Notice to Physicians and Providers"
in bold type, the name and address of the HMO, what networks the HMO
provides, and the specific dates of the 20-day period during which
physicians and providers may make application to be a participating
physician or provider in each network.
(c) An HMO must notify a physician or provider of acceptance
or nonacceptance, in writing, no later than 90 days from receipt of
an application for participation by that physician or provider in
a network.
(d) An HMO must file a copy of the published notice
with the department in compliance with §11.301 of this title
(relating to Filing Requirements), for information, within 30 days
of publication. The filing must include the following:
(1) the name of the newspaper and the beginning and
ending date of the publication; and
(2) a copy of the website screen shots and the beginning
and ending date of the publication.
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