All codes › Insurance Code › Title 8

Chapter 1305

Workers' Compensation Health Care Networks

Subchapter A. General Provisions

1305.001 Short Title 1305.002 Purpose 1305.003 Limitations on Applicability 1305.004 Definitions 1305.005 Participation in Network; Notice of Network Requirements 1305.006 Insurance Carrier Liability for Out-of-Network Health Care 1305.007 Rules 1305.008 Administrator Certificate of Authority Required

Subchapter B. Certification

1305.051 Certification Required 1305.052 Certificate Application 1305.053 Contents of Application 1305.054 Action on Application; Renewal of Certification 1305.055 Use of Certain Insurance Terms by Network Prohibited 1305.056 Restraint of Trade; Application of Certain Laws

Subchapter C. General Powers and Duties of Workers' Compensation Health Care Networks

1305.101 Providing or Arranging for Health Care 1305.102 Management Contracts 1305.103 Treating Doctor; Referrals 1305.104 Selection of Treating Doctor 1305.105 Treatment by a Primary Care Physician or Provider under Chapter 1305.106 Payment of Health Care Provider 1305.107 Telephone Access

Subchapter D. Contracting Provisions

1305.151 Transfer of Risk 1305.152 Network Contracts with Providers 1305.153 Provider Reimbursement 1305.154 Network-Carrier Contracts 1305.1545 Restrictions on Payment and Reimbursement 1305.155 Compliance Requirements

Subchapter E. Financial Requirements

1305.201 Network Financial Requirements

Subchapter F. Examinations

1305.251 Examination of Network 1305.252 Examination of Provider or Third Party

Subchapter G. Provision of Services by Network; Quality Improvement Program

1305.301 Network Organization; Service Areas 1305.302 Accessibility and Availability Requirements 1305.303 Quality of Care Requirements 1305.304 Guidelines and Protocols

Subchapter H. Utilization Review

1305.351 Utilization Review in Network 1305.353 Notice of Certain Utilization Review Determinations; Preauthorization Requirements 1305.354 Reconsideration of Adverse Determination 1305.355 Independent Review of Adverse Determination 1305.356 Contested Case Hearing on and Judicial Review of Independent Review

Subchapter I. Complaint Resolution

1305.401 Complaint System Required 1305.402 Complaint Initiation and Initial Response; Deadlines for Response and Resolution 1305.403 Record of Complaints 1305.404 Retaliatory Action Prohibited 1305.405 Posting of Information on Complaint Process Required

Subchapter J. Employee Information and Responsibilities

1305.451 Employee Information; Responsibilities of Employee

Subchapter K. Evaluation of Networks; Consumer Report Card

1305.502 Consumer Report Cards 1305.503 Confidentiality Requirements

Subchapter L. Disciplinary Actions

1305.551 Determination of Violation; Notice 1305.552 Disciplinary Actions