Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter AA - DELEGATED ENTITIES
Section 11.2607 - Examinations of Delegated Entities

(a) On receipt of complaints, a notice under § 11.2606 of this title (relating to Reporting Requirements), or as otherwise permitted under the Insurance Code or related rules, the department may examine any matter relating to the financial solvency of the delegated entity or delegated third party or the delegated entity's ability to meet its responsibilities under the delegation agreement.

(b) The department may request documents, perform on-site examinations, and require any other action of the delegated entity and any delegated third party that the department determines necessary to perform an examination under this section.

(c) A delegated entity's failure to comply with a request under subsection (b) of this section may result in either or both:

(d) The department will issue a report to the delegated entity and HMO on completion of the department's examination. The report will detail the results of the examination and any corrective actions necessary by the delegated entity or HMO.

(e) The delegated entity and the HMO must respond to the department's report and submit a corrective action plan to the department not later than the 30th day after the date of receipt of the department's report.