An HMO must provide written notification to affected group contract holders of a substantive change in the payment arrangement for physicians and providers within 30 days of any change in the type of payment arrangement; for example, a change from capitation to fee for service, or from fee for service to capitation, for any type of service. The notification of the change must include a description of the changed payment arrangement and a description of the new payment arrangement.

Source Note: The provisions of this §11.1603 adopted to be effective August 1, 2017, 42 TexReg 2169