§ 1305.301 — NETWORK ORGANIZATION; SERVICE AREAS.

Texas § 1305.301

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 1305.301. NETWORK ORGANIZATION; SERVICE AREAS. (a) The chief executive officer, operations officer, or governing body of a network is responsible for:
(1) the development, approval, implementation, and enforcement of:
(A) administrative, operational, personnel, and patient care policies; and
(B) network procedures; and
(2) the development of any documents necessary for the operation of the network.
(b) Each network shall have a chief executive officer or operations officer who:
(1) is accountable for the day-to-day administration of the network; and
(2) shall ensure compliance with all applicable statutes and rules pertaining to the operation of the network.
(c) Each network shall have a medical director, who must be an occupational medicine specialist or employ or contract with an occupational medicine specialist, and who must be licensed to practice medicine in the United States. The medical director shall:
(1) be available at all times to address complaints, clinical issues, and any quality improvement issues on behalf of the network;
(2) be actively involved in all quality improvement activities; and
(3) comply with the network's credentialing requirements.
(d) The network shall establish one or more service areas within this state. For each defined service area, the network must:
(1) demonstrate to the satisfaction of the department the ability to provide continuity, accessibility, availability, and quality of services;
(2) specify the counties and zip code areas, or any parts of a county or zip code area, included in the service area; and
(3) provide a complete provider directory to all policyholders who have selected a network in the service area.

Legislative History

Added by Acts 2005, 79th Leg., Ch. 265 (H.B. 7 ), Sec. 4.02, eff. September 1, 2005.