Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter AA - DELEGATED ENTITIES
Section 11.2608 - Department May Order Corrective Action
Universal Citation: 28 TX Admin Code § 11.2608
Current through Reg. 50, No. 13; March 28, 2025
(a) The department may require at any time that a delegated entity take corrective action to comply with the department's statutory and regulatory requirements that:
(1) relates to any matters delegated by
the HMO to the delegated entity;
(2) is necessary to ensure the HMO's
compliance with statutory and regulatory requirements; or
(3) relates to the financial solvency and
operations of the delegated entity.
(b) The commissioner may order the HMO to take any action the commissioner determines is necessary to ensure that the HMO maintains compliance with the Insurance Code, this chapter, and other applicable insurance laws and regulations of this state, including but not limited to:
(1) resumption of any or all
functions delegated to the delegated entity, including claims processing,
adjudication, and payments for health care previously rendered to enrollees of
the HMO;
(2) temporarily or
permanently ceasing assignment of new enrollees to the delegated
entity;
(3) temporarily or
permanently transferring enrollees to alternative delivery systems to receive
health care; or
(4) termination of
the HMO's delegation agreement with the delegated entity.
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