Sec. 1272.061. RIGHTS AND DUTIES OF DELEGATED ENTITY AND HEALTH MAINTENANCE ORGANIZATION. A delegation agreement required by Section 1272.052 must provide that the delegated entity acknowledges and agrees that:
(1) the health maintenance organization:
(A) is required to establish, operate, and maintain a health care delivery system, quality assurance system, provider credentialing system, and other systems and programs that meet statutory and regulatory standards;
(B) is directly accountable for compliance with those standards; and
(C) is not precluded from contractually requesting that the delegated entity provide proof of financial viability;
(2) the role of another delegated entity with which the delegated entity subcontracts through a delegated third party is limited to performing certain delegated functions of the health maintenance organization, using standards that are approved by the health maintenance organization and that are in compliance with applicable statutes and rules and subject to the health maintenance organization's oversight and monitoring of the entity's performance; and
(3) if the delegated entity fails to meet monitoring standards established to ensure that functions delegated or assigned to the entity under the delegation agreement are in full compliance with all statutory and regulatory requirements, the health maintenance organization may cancel delegation of any or all delegated functions.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
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