Section 11.205 - Additional Documents to be Available for Review(a) The following documents must be made available for review at the applicant's office in Texas or another location within Texas agreed to by the department and on request during the application process: (1) administrative: policy and procedure manuals;(2) health information systems: policies and procedures for accessing enrollee health records and a plan to provide for confidentiality of those records complying with applicable law;(3) executed agreements, including: (A) management services agreements;(B) administrative services agreements; and(C) delegation agreements;(4) executed physician and provider contracts: a copy of the first page, including the form number, and signature page;(5) executed subcontracts: a copy of the first page, including the form number, and signature page of all contracts with subcontracting physicians and providers;(6) manuals: current physician manual and current provider manual provided to each contracting physician or provider, which must contain details of the provisions that govern the physicians and providers;(7) credentialing files: as specified in § 11.1902(4) of this title (relating to Quality Improvement Program for Basic, Single Service, and Limited Service HMOs);(8) reporting system: the statistical reporting system developed and maintained by the applicant that allows for compiling, developing, evaluating, and reporting statistics relating to the cost of operation, the pattern of utilization of services, and the accessibility and availability of services;(9) claims systems: policies and procedures that demonstrate the capacity to pay claims timely and to comply with all applicable statutes and rules;(10) financial records: financial information, including statements, ledgers, checkbooks, inventory records, evidence of expenditures, investments, and debts; and(11) any other records: demonstrating compliance with applicable statutes and rules, including audits or examination reports by other entities, including governmental authorities or accrediting agencies.(b) After approval of the application, the following documents may be maintained outside Texas if the HMO has received prior approval by the commissioner in compliance with Insurance Code § 803.003 (concerning Authority to Locate Out of State): (1) the financial records listed in subsection (a)(10) of this section;(2) minutes of HMO organizational meetings, which indicate the type and date of each meeting and the officer or officers who are responsible for the handling of the funds of the applicant;(3) minutes of meetings of the HMO board of directors; and(4) management committee meeting minutes.28 Tex. Admin. Code § 11.205
The provisions of this §11.205 adopted to be effective January 1, 1980, 4 TexReg 4625; amended to be effective December 6, 1984, 9 TexReg 6008; amended to be effective December 4, 1987, 12 TexReg 4259; amended to be effective August 17, 1992, 17 TexReg 5352; amended to be effective December 8, 1997, 22 TexReg 11684; amended to be effective November 2, 1998, 23 TexReg 11347; amended to be effective February 24, 2005, 30 TexReg 854; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2222, eff. 8/1/2017