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Subchapter A. General Provisions
Section 1272.001. Definitions - Sec. 1272.001. DEFINITIONS. (a) In this chapter: (1) "Delegated entity"...
Section 1272.002. Compliance of Limited Provider Network or Delegated Entity With Certain Legal Requirements - Sec. 1272.002. COMPLIANCE OF LIMITED PROVIDER NETWORK OR DELEGATED ENTITY...
Subchapter B. Delegation Agreements
Section 1272.051. Applicability of Subchapter - Sec. 1272.051. APPLICABILITY OF SUBCHAPTER. This subchapter does not apply...
Section 1272.052. Delegation Agreement Required - Sec. 1272.052. DELEGATION AGREEMENT REQUIRED. (a) A health maintenance organization...
Section 1272.053. Monitoring Plan - Sec. 1272.053. MONITORING PLAN. A delegation agreement required by Section...
Section 1272.054. Requirements for Termination Without Cause - Sec. 1272.054. REQUIREMENTS FOR TERMINATION WITHOUT CAUSE. A delegation agreement...
Section 1272.055. Collection of Payments - Sec. 1272.055. COLLECTION OF PAYMENTS. A delegation agreement required by...
Section 1272.056. Compliance With Statutory and Regulatory Requirements - Sec. 1272.056. COMPLIANCE WITH STATUTORY AND REGULATORY REQUIREMENTS. A delegation...
Section 1272.057. Examination by Commissioner - Sec. 1272.057. EXAMINATION BY COMMISSIONER. A delegation agreement required by...
Section 1272.058. Information Relating to Delegated Third Party - Sec. 1272.058. INFORMATION RELATING TO DELEGATED THIRD PARTY. A delegation...
Section 1272.059. Contracts With Delegated Third Party - Sec. 1272.059. CONTRACTS WITH DELEGATED THIRD PARTY. A delegation agreement...
Section 1272.060. Utilization Review - Sec. 1272.060. UTILIZATION REVIEW. A delegation agreement required by Section...
Section 1272.061. Rights and Duties of Delegated Entity and Health Maintenance Organization - Sec. 1272.061. RIGHTS AND DUTIES OF DELEGATED ENTITY AND HEALTH...
Section 1272.062. Information to Be Provided by Delegated Entity to Health Maintenance Organization - Sec. 1272.062. INFORMATION TO BE PROVIDED BY DELEGATED ENTITY TO...
Section 1272.063. Enrollee Complaints - Sec. 1272.063. ENROLLEE COMPLAINTS. (a) A delegation agreement required by...
Section 1272.064. Rules - Sec. 1272.064. RULES. The commissioner may adopt rules as necessary...
Subchapter C. Information Reporting to Delegated Entity
Section 1272.101. Applicability of Subchapter - Sec. 1272.101. APPLICABILITY OF SUBCHAPTER. This subchapter does not apply...
Section 1272.102. Reporting Required - Sec. 1272.102. REPORTING REQUIRED. (a) The commissioner shall determine the...
Section 1272.103. Rules - Sec. 1272.103. RULES. The commissioner may adopt rules as necessary...
Subchapter D. Reserve Requirements
Section 1272.151. Applicability of Subchapter - Sec. 1272.151. APPLICABILITY OF SUBCHAPTER. This subchapter does not apply...
Section 1272.152. General Reserve Requirements - Sec. 1272.152. GENERAL RESERVE REQUIREMENTS. (a) A delegated network shall...
Section 1272.153. Reserve Requirements for Medical Care and Hospital or Institutional Services - Sec. 1272.153. RESERVE REQUIREMENTS FOR MEDICAL CARE AND HOSPITAL OR...
Section 1272.154. Reserve Requirements for Prescription Drugs - Sec. 1272.154. RESERVE REQUIREMENTS FOR PRESCRIPTION DRUGS. A delegated network...
Section 1272.155. Form of Reserves - Sec. 1272.155. FORM OF RESERVES. The reserves required under this...
Section 1272.156. Escrow Account - Sec. 1272.156. ESCROW ACCOUNT. (a) A delegated network required to...
Subchapter E. Compliance
Section 1272.201. Applicability of Subchapter - Sec. 1272.201. APPLICABILITY OF SUBCHAPTER. This subchapter does not apply...
Section 1272.202. Notice of Noncompliance or Hazardous Operating Condition - Sec. 1272.202. NOTICE OF NONCOMPLIANCE OR HAZARDOUS OPERATING CONDITION. (a)...
Section 1272.203. Response to Notice - Sec. 1272.203. RESPONSE TO NOTICE. A delegated entity shall respond...
Section 1272.204. Cooperation of Health Maintenance Organization - Sec. 1272.204. COOPERATION OF HEALTH MAINTENANCE ORGANIZATION. A health maintenance...
Section 1272.205. Examination by Department; Report - Sec. 1272.205. EXAMINATION BY DEPARTMENT; REPORT. (a) On receipt of...
Section 1272.206. Response to Department Report; Corrective Plan - Sec. 1272.206. RESPONSE TO DEPARTMENT REPORT; CORRECTIVE PLAN. The delegated...
Section 1272.207. Request for Corrective Action - Sec. 1272.207. REQUEST FOR CORRECTIVE ACTION. The department may request...
Section 1272.208. Authority of Commissioner to Issue Order - Sec. 1272.208. AUTHORITY OF COMMISSIONER TO ISSUE ORDER. (a) Regardless...
Section 1272.209. Public Documents - Sec. 1272.209. PUBLIC DOCUMENTS. (a) Except as provided by Subsection...
Section 1272.210. Record of Complaints; Report - Sec. 1272.210. RECORD OF COMPLAINTS; REPORT. (a) The department shall:...
Section 1272.211. Rules - Sec. 1272.211. RULES. The commissioner may adopt rules as necessary...
Subchapter F. Penalties
Section 1272.251. Applicability of Subchapter - Sec. 1272.251. APPLICABILITY OF SUBCHAPTER. This subchapter does not apply...
Section 1272.252. Suspension or Revocation of License of Third-Party Administrator or Utilization Review Agent - Sec. 1272.252. SUSPENSION OR REVOCATION OF LICENSE OF THIRD-PARTY ADMINISTRATOR...
Section 1272.253. Sanctions and Penalties Against Health Maintenance Organization - Sec. 1272.253. SANCTIONS AND PENALTIES AGAINST HEALTH MAINTENANCE ORGANIZATION. The...
Section 1272.254. Contractual Penalties Required - Sec. 1272.254. CONTRACTUAL PENALTIES REQUIRED. A health maintenance organization by...
Section 1272.255. Rules - Sec. 1272.255. RULES. The commissioner may adopt rules as necessary...
Subchapter G. Provision of Services by Limited Provider Network or Delegated Entity
Section 1272.301. Access to Out-of-Network Services - Sec. 1272.301. ACCESS TO OUT-OF-NETWORK SERVICES. (a) A contract between...
Section 1272.302. Continuity of Care - Sec. 1272.302. CONTINUITY OF CARE. (a) In this section, "special...