1. (a) Prior to obtaining a certificate of authority under the Insurance Code Chapter 844 (concerning Certification of Certain Nonprofit Health Corporations), an applicant ANHC must:

   1. (1) comply with each requirement for the issuance of a certificate of authority imposed on an HMO under the Insurance Code Chapters 1271 and 843; this chapter; and applicable insurance laws and regulations of this state; and

   2. (2) demonstrate by appropriate documentation that the applicant ANHC has established and maintains accreditation by:

      1. (A) the National Committee on Quality Assurance; or
      2. (B) the Joint Commission on Accreditation of Health Care Organizations-network accreditation program.

2. (b) The commissioner shall grant a provisional certificate of authority to an applicant ANHC under the Insurance Code Chapter 844, if:

   1. (1) the applicant ANHC complies with each requirement for the issuance of a certificate of authority imposed on an HMO under the Insurance Code Chapters 1271 and 843; this chapter; and applicable insurance laws and regulations of this state.
   2. (2) the applicant ANHC demonstrates that it has applied for accreditation;
   3. (3) the applicant ANHC is diligently pursuing accreditation as determined by the commissioner; and
   4. (4) the accrediting organization has not denied the accreditation.
3. (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 the Insurance Code Chapters 1271 and 843; this chapter; and applicable insurance laws and regulations of this state in order to maintain a certificate of authority.
4. (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.

Source Note:The provisions of this §11.1702 adopted to be effective April 1, 1996, 21 TexReg 2253; amended to be effective February 24, 2005, 30 TexReg 854; amended to be effective November 15, 2006, 31 TexReg 9298.