Common use of Eligible Respondents Clause in Contracts

Eligible Respondents. Except as provided herein, eligible Respondents include insurers that are licensed by the TDI as HMOs in accordance with Chapter 843 of the Texas Insurance Code, or a certified Approved Non-Profit Health Corporation (ANHC), formed in compliance with Chapter 844 of the Texas Insurance Code. For the STAR and STAR+PLUS Xxxxxxx Service Area, eligible respondents include HMOs, ANHCs, and EPOs with TDI-approved EPBPs. Note that under current state law, HHSC is precluded from providing services to Medicaid recipients through an HMO model in the following three (3) counties in the Xxxxxxx Service Area: Cameron, Hidalgo, and Maverick. HHSC will not implement any form of capitated managed care in these three (3) counties in the Xxxxxxx Service Area without guidance from the Texas Legislature. Respondents who are interested in bidding on the Xxxxxxx Service Area should nevertheless pursue one or more forms of TDI approval appropriate to these counties. For the Medicaid Rural Service Area for STAR, eligible respondents include HMOs, ANHCs, EPOs with TDI-approved EPBPs. Note that, for purposes of bidding, HHSC has subdivided the Medicaid Rural Service Area into three (3) areas – West, Central, and Northeast Texas. Respondents may seek TDI approval in one (1) or more of these areas, but should note that HHSC will more favorably evaluate responses that propose to serve all three (3) areas. Should HHSC determine that it is in the state’s best interest to subdivide the Medicaid Rural Service Area for purposes of award, the Medicaid Rural Service Area will still be treated as one (1) Service Area for rate-setting purposes. Throughout this RFP, the term “MCO” is used to refer to HMOs, ANHCs, and EPOs. A Respondent that has submitted its application for licensure as an HMO, for certification as an ANHC, or for approval of an EPBP prior to the Proposal due date is also eligible to respond to this RFP; however, the Respondent must receive TDI approval no later than 60 days after HHSC executes the Contract (see Section 1.2, “Procurement Schedule”). Failure to receive the required approval within 60 days after HHSC executes the Contract will result in the cancellation of the award. For more information on the reasons for HHSC’s disqualification of Respondents, see Section 3.3.2, “Conflicts of Interest,” and Section 3.3.3, “Former Employees of a State Agency.”