SECTION 13.423. Service Area Change Applications

(a) An HCC must file an application for approval with the department before the HCC may expand or reduce an existing service area or add a new service area.

(b) If any of the following items are changed by a proposed service area expansion or reduction, the new item or any amendments to an existing item must be submitted for approval or filed for information, as specified in §13.422 of this title (relating to Filing Requirements That Apply After Issuance of Certificate of Authority):

(1) a description and a map with key and scale, showing both the currently approved service area and the proposed new service area as required by §13.413(e)(1) of this title (relating to Contents of the Application);

(2) a form of any new contracts or amendment of any existing contracts in the new area, as described in §13.413(e)(5) of this title;

(3) network configuration information, as required by §13.413(e)(2) of this title;

(4) a brief narrative description of the administrative arrangements and organizational charts as described in §13.413(c)(7) of this title and any other information the HCC considers to be pertinent;

(5) biographical data sheets for any new management staff assigned to the new area;

(6) copies of leases, loans, agreements, and contracts to be used in the proposed new area, including information described in §13.422(c)(2)(D) of this title;

(7) separate and combined sources of financing and financial projections as described in §13.413(d)(1) - (3) of this title; and

(8) any new or amended reinsurance agreements, insurance, or other protection against insolvency, as specified in §13.413(d)(4) of this title.

(c) The department will not accept an application for review until the application is complete. An application to modify the certificate of authority is considered complete when all information required by §13.422 of this title, this section, and §13.481 and §13.482 of this title (relating to Quality Improvement Structure for HCCs and Quality Assurance and Quality Improvement, respectively), that is reasonably necessary for a final determination by the department has been filed with the department.

(d) A service area expansion or reduction application will be considered only if both the existing and proposed service areas of the HCC comply with the requirements of §13.481 and §13.482 of this title, and §13.483 of this title (relating to Credentialing).

(e) If the filing for proposed service area change might materially affect the HCC's ability to arrange for or provide health care services, or might materially change the antitrust analysis of the HCC, the department may require the HCC to file an application for renewal before the date required by Insurance Code §848.060(a).

Source Note: The provisions of this §13.423 adopted to be effective March 31, 2013, 38 TexReg 2100