SECTION 11.1806. Additional Information That May be Requested from an MCO Participating in Medicaid

(a) Whenever requested by the department, an MCO participating in Medicaid must file with the department a complete set of financial exhibits pertaining to the state Medicaid program, in the format of the Managed Care Financial Statistical Report, as may be modified or amended by the Texas Health and Human Services Commission. When a request is received, the MCO must then file a Managed Care Financial Statistical Report reflecting the state Medicaid program operations for each contract year in the same format as the monthly Managed Care Financial Statistical Report. These reports must comply with the instructions issued by the Texas Health and Human Services Commission.

(b) For any new or modified request to the Texas Health and Human Services Commission for participation in the Medicaid managed care program, all financial projections, including enrollment projections, from the effective or renewal date of a Medicaid contract that are submitted to the Texas Health and Human Services Commission, must also be submitted to the department. The MCO must submit the same financial projections, including a cash flow statement, submitted to the Texas Health and Human Services Commission with the request to participate in the Medicaid program. This information must be submitted with the application for a certificate of authority if the MCO is not already a licensed MCO. If the MCO is a licensed operation, then the financial projections must be sent with the application for service area expansion.

(c) The MCO must notify the department of any similar financial or statistical reports required by other contracting state agencies and must submit copies of these reports to the department when requested by the department.

(d) Information submitted under this section must be sent to the Financial Analysis Section, Mail Code 303-1A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.

Source Note: The provisions of this §11.1806 adopted to be effective August 1, 2017, 42 TexReg 2169