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Texas Insurance Code - INS § 1272.061. Rights and Duties of Delegated Entity and Health Maintenance Organization

Current as of January 01, 2024 | Updated by Findlaw Staff

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.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 1272.061. Rights and Duties of Delegated Entity and Health Maintenance Organization - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1272-061/

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