1. (a) A health maintenance organization that provides coverage for health care services or medical care through one or more providers or physicians is required by the provisions of Insurance Code §843.305 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 providing health care services or medical care under the terms and conditions established by the health maintenance organization for the provision of such services and the designation of such providers and physicians. Section 843.305 may not be construed to:

   1. (1) require that a health maintenance organization utilize a particular type of provider or physician in its operation;
   2. (2) require that a health maintenance organization accept a provider or physician of a category or type that does not meet the practice standards and qualifications established by the health maintenance organization; or
   3. (3) require that a health maintenance organization contract directly with such providers or physicians.
2. (b) An HMO which is covered by Insurance Code §843.305 must publish a notice of an application period to physicians and providers in the public notice section of at least one major newspaper with general circulation in each of its service areas. The notice must be published for five consecutive days during the period of January 2 through January 23 of each calendar year and must include this caption in bold type: Notice to Physicians and Providers, the name and address of the HMO, what type of services 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.
3. (c) A health maintenance organization must notify a physician or provider of acceptance or non-acceptance, in writing, no later than 90 days from receipt of an application for participation by that physician or provider.

4. (d) A health maintenance organization must file a copy of the published notice with the HMO Division, for information, within 15 days of publication. The filing must include the following:

   1. (1) the name of the newspaper; and
   2. (2) the beginning and ending date of the publication.

Source Note:The provisions of this §11.1402 adopted to be effective August 17, 1992, 17 TexReg 5361; amended to be effective February 24, 2005, 30 TexReg 854.