Texas Insurance Code

§ 843.316 — ALTERNATIVE CAPITATION SYSTEM

IN § 843.316Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES · Part C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES · Ch. 843. HEALTH MAINTENANCE ORGANIZATIONS · Art. I. RELATIONS WITH PHYSICIANS AND PROVIDERS

Statute text

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As an alternative to the procedures prescribed by Section 843.315, a health maintenance organization may request approval from the department of a capitation payment system that ensures:

(1)immediate availability and accessibility of a primary care physician or primary care provider; and

(2)payment to a primary care physician or primary care provider of a capitated amount certified by a qualified actuary to be actuarially sufficient to compensate the primary care physician or primary care provider for the risk assumed.

Legislative history

Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.