SECTION 1.809. HMO Certificate of Authority

(a) Notice to applicant. Within 180 days from receipt of an application for an HMO certificate of authority, the commissioner shall determine an application to be complete or deficient and shall immediately issue written notice to the applicant regarding the status of the application.

(1) Complete application.

(A) The written notice for a complete application shall state that the application is complete and accepted for filing and shall include the information contained in subsection (b) of this section unless such information has previously been furnished to the applicant.

(B) For purposes of this section, an application is complete upon agency determination that it is in compliance with the Texas Health Maintenance Organization Act, §4.

(2) Deficient application.

(A) The written notice for a deficient application shall state that the application is not complete and shall set out what specific additional information is required for completion. Such notice shall further state that the process prescribed in subsection (b) of this section shall not begin until written notice for a complete application is issued and shall also state that an application which remains deficient may be disapproved under subsection (c) of this section. After one written notice of deficiency has been issued, another is not required for an application resubmitted in whole or in part with deficiencies.

(B) In addition to notice issued under subparagraph (A) of this paragraph, the agency may notify the applicant, in any manner, of deficiencies in the application as needed within the period established in this subsection.

(b) Processing of application.

(1) Upon determination that an application is complete, the agency shall send a copy of the application to the State Board of Health for certification under the Texas Health Maintenance Organization Act, §5(a)(3).

(2) The Texas Health Maintenance Organization Act, §5(a)(3), requires that, within 45 days of receipt of the application, the State Board of Health shall certify to the commissioner of insurance that the proposed health maintenance organization meets or does not meet the requirements of the Texas Health Maintenance Organization Act, §5.

(3) Within 75 days from receipt of certification by the State Board of Health, the commissioner, after notice and hearing, shall issue or deny the certificate of authority, except as provided in subsection (d) of this section.

(c) Application disapproved. Unless a delay is granted under subsection (d) of this section, an application that is not complete within the period prescribed in subsection (a) of this section may be disapproved.

(d) Delay of action. On written request of the applicant, the commissioner may grant a delay of final action on the application pursuant to the Texas Health Maintenance Organization Act, §5(b).

Source Note: The provisions of this §1.809 adopted to be effective January 20, 1989, 14 TexReg 114.