Sec. 1272.208. AUTHORITY OF COMMISSIONER TO ISSUE ORDER. (a) Regardless of whether a delegated entity complies with a request for corrective action under Section 1272.207, the commissioner may order a health maintenance organization with which the entity has entered into a delegation agreement to take any action the commissioner determines is necessary to ensure that the health maintenance organization is complying with this chapter, Chapter 843, 1271, or 1367, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507.
(b) Actions the commissioner may order a health maintenance organization to take under this section include:
(1) reassuming the functions delegated to the delegated entity, including claims payments for services previously provided to enrollees;
(2) temporarily or permanently ceasing assignment of new enrollees to the entity;
(3) temporarily or permanently transferring enrollees to alternative delivery systems to receive services; or
(4) terminating the delegation agreement with the entity.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(h), eff. September 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