Texas Insurance Code 843.304 – Exclusion of Provider Based On Type of License Prohibited
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(a) A provider licensed or otherwise authorized to practice in this state may not be denied the opportunity to participate in providing health care services that are delivered by a health maintenance organization and that are within the scope of the provider’s license or authorization solely because of the type of license or authorization held by the provider.
(b) If a hospital, facility, agency, or supplier is certified by the Medicare program, Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.), or accredited by the Joint Commission on Accreditation of Healthcare Organizations or another national accrediting body, a health maintenance organization shall accept that certification or accreditation.
Terms Used In Texas Insurance Code 843.304
- Contract: A legal written agreement that becomes binding when signed.
(c) This section does not require that a health maintenance organization:
(1) use a particular type of provider in its operation;
(2) accept each provider of a category or type, except as provided by Article 21.52B; or
(3) contract directly with providers of a particular category or type.
(d) This section does not limit a health maintenance organization’s authority to establish the terms under which health care services are provided by providers.
(e) A provider must comply with the terms established by the health maintenance organization for the provision of health services and for designation as a provider by the health maintenance organization.
