Sec. 1272.202. NOTICE OF NONCOMPLIANCE OR HAZARDOUS OPERATING CONDITION. (a) If a health maintenance organization becomes aware of information that indicates a delegated entity with which the health maintenance organization has entered into a delegation agreement is not operating in accordance with the agreement or is operating in a condition that renders continuing the entity's business hazardous to the enrollees, the health maintenance organization shall in writing:
(1) notify the entity of those findings; and
(2) request a written explanation and documentation supporting that explanation of the entity's apparent noncompliance or the existence of the hazardous condition.
(b) A health maintenance organization shall provide to the commissioner a copy of each notice and request submitted to a delegated entity under this section and each response or other documentation the health maintenance organization receives or generates in response to the notice and request.
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
Section 1272.201. Applicability of Subchapter
Section 1272.202. Notice of Noncompliance or Hazardous Operating Condition
Section 1272.203. Response to Notice
Section 1272.204. Cooperation of Health Maintenance Organization
Section 1272.205. Examination by Department; Report
Section 1272.206. Response to Department Report; Corrective Plan
Section 1272.207. Request for Corrective Action
Section 1272.208. Authority of Commissioner to Issue Order
Section 1272.209. Public Documents