Tex. Ins. Code Section 1272.061
Rights and Duties of Delegated Entity and Health Maintenance Organization

A delegation agreement required by Section 1272.052 (Delegation Agreement Required) 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.

Source: Section 1272.061 — Rights and Duties of Delegated Entity and Health Maintenance Organization, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1272.­htm#1272.­061 (accessed May 18, 2024).

1272.001
Definitions 1272.002
Compliance of Limited Provider Network or Delegated Entity with Certain Legal Requirements 1272.051
Applicability of Subchapter 1272.052
Delegation Agreement Required 1272.053
Monitoring Plan 1272.054
Requirements for Termination Without Cause 1272.055
Collection of Payments 1272.056
Compliance with Statutory and Regulatory Requirements 1272.057
Examination by Commissioner 1272.058
Information Relating to Delegated Third Party 1272.059
Contracts with Delegated Third Party 1272.060
Utilization Review 1272.061
Rights and Duties of Delegated Entity and Health Maintenance Organization 1272.062
Information to Be Provided by Delegated Entity to Health Maintenance Organization 1272.063
Enrollee Complaints 1272.064
Rules 1272.101
Applicability of Subchapter 1272.102
Reporting Required 1272.103
Rules 1272.151
Applicability of Subchapter 1272.152
General Reserve Requirements 1272.153
Reserve Requirements for Medical Care and Hospital or Institutional Services 1272.154
Reserve Requirements for Prescription Drugs 1272.155
Form of Reserves 1272.156
Escrow Account 1272.201
Applicability of Subchapter 1272.202
Notice of Noncompliance or Hazardous Operating Condition 1272.203
Response to Notice 1272.204
Cooperation of Health Maintenance Organization 1272.205
Examination by Department 1272.206
Response to Department Report 1272.207
Request for Corrective Action 1272.208
Authority of Commissioner to Issue Order 1272.209
Public Documents 1272.210
Record of Complaints 1272.211
Rules 1272.251
Applicability of Subchapter 1272.252
Suspension or Revocation of License of Third-party Administrator or Utilization Review Agent 1272.253
Sanctions and Penalties Against Health Maintenance Organization 1272.254
Contractual Penalties Required 1272.255
Rules 1272.301
Access to Out-of-network Services 1272.302
Continuity of Care
Green check means up to date. Up to date

Accessed:
May 18, 2024

§ 1272.061’s source at texas​.gov