Sec. 1272.060. UTILIZATION REVIEW. A delegation agreement required by Section 1272.052 must provide that:
(1) enrollees shall receive notification at the time of enrollment of which entity is responsible for performing utilization review;
(2) the delegated entity or third party performing utilization review shall perform that review in accordance with Chapter 4201; and
(3) the delegated entity or third party shall forward utilization review decisions made by the entity or third party to the health maintenance organization on a monthly basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.004, eff. April 1, 2009.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization
Subchapter B. Delegation Agreements
Section 1272.051. Applicability of Subchapter
Section 1272.052. Delegation Agreement Required
Section 1272.053. Monitoring Plan
Section 1272.054. Requirements for Termination Without Cause
Section 1272.055. Collection of Payments
Section 1272.056. Compliance With Statutory and Regulatory Requirements
Section 1272.057. Examination by Commissioner
Section 1272.058. Information Relating to Delegated Third Party
Section 1272.059. Contracts With Delegated Third Party
Section 1272.060. Utilization Review
Section 1272.061. Rights and Duties of Delegated Entity and Health Maintenance Organization
Section 1272.062. Information to Be Provided by Delegated Entity to Health Maintenance Organization