28 Tex. Admin. Code § 11.503

Current through Reg. 49, No. 24; June 14, 2024
Section 11.503 - Filing Requirements for Evidence of Coverage after Receipt of Certificate of Authority
(a) After receipt of a certificate of authority, no evidence of coverage filing may be amended or altered in any manner, and no new evidence of coverage filing may be used, unless the proposed new or revised evidence of coverage filing has been filed for review and has received the approval of the commissioner. The evidence of coverage must be filed as provided in § 11.301 of this title (relating to Filing Requirements).
(b) The department will notify the HMO of the department's action in compliance with § 1.704 of this title (relating to Summary Procedure; Notice).
(c) The department will base its approval or disapproval on the content of drafts submitted to the department. Filings must comply with the specifications described in § 11.505 of this title (relating to Specifications for the Evidence of Coverage and Matrix Filings). Any discrepancy in content between the final document to be issued and the approved draft is grounds for revocation of the certificate of authority.
(d) The review period for an evidence of coverage filing begins on the date an acceptable, typed draft of the form is received.
(e) The review period may be extended on 30-days written notice of extension to the HMO before the expiration of the initial review period.
(f) At the end of the review period, the evidence of coverage filing is considered approved unless it has already been withdrawn, affirmatively approved, or disapproved by the commissioner.

28 Tex. Admin. Code § 11.503

The provisions of this §11.503 adopted to be effective January 1, 1980, 4 TexReg 4622; amended to be effective December 4, 1987, 12 TexReg 4363; amended to be effective August 17, 1992, 17 TexReg 5356; amended to be effective November 2, 1998, 23 TexReg 11347; amended to be effective February 24, 2005, 30 TexReg 854; amended to be effective November 15, 2006, 31 TexReg 9298; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2232, eff. 8/1/2017