Tex. Ins. Code § 4201.057 · Subchapter B. APPLICABILITY OF CHAPTER
HEALTH MAINTENANCE ORGANIZATIONS.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) In this section, "health maintenance organization" includes a health maintenance organization that contracts with the Health and Human Services Commission or with an agency operating part of the state Medicaid managed care program to provide health care services to recipients of medical assistance under Chapter 32, Human Resources Code.
(b) This chapter applies to a health maintenance organization except as expressly provided by this section.
(c) As a condition of holding a certificate of authority to engage in the business of a health maintenance organization, a health maintenance organization that performs utilization review must:
(1) comply with this chapter, except Subchapter C; and
(2) submit to assessment of a maintenance tax under Chapter 258 to cover the costs of administering compliance with this subsection.
(d) The commissioner shall adopt rules for appropriate verification and enforcement of compliance with Subsection (c).
(e) Notwithstanding Subsection (c)(1), a health maintenance organization that performs utilization review for a person or entity subject to this chapter, other than a person or entity for which the health maintenance organization is the payor, must obtain a certificate of registration under Subchapter C and shall comply with all of the provisions of this chapter.
(f) This chapter does not prohibit or limit the distribution of a portion of the savings from the reduction or elimination of unnecessary medical services, treatment, supplies, confinements, or days of confinement in a health care facility through profit sharing, bonus, or withholding arrangements to a participating physician or participating health care provider for providing health care services to an enrollee.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.4201.htm
- Text hash
- sha256 34adeabb9fbab2e7139cf882dd110263c3efc7cc4d446e7e61639f9cbc8f3374
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
This section cites
Provisions in this library that the text above cites, as it prints each citation. A range cited as “ss. 61.13-61.16” links its first and last provisions.
Cited by 1 provision
Provisions in this library whose text cites Tex. Ins. Code § 4201.057. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.