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Chapter 1272

Delegation of Certain Functions by Health Maintenance Organization

Subchapter A. General Provisions

1272.001 Definitions 1272.002 Compliance of Limited Provider Network or Delegated Entity with Certain Legal Requirements

Subchapter B. Delegation Agreements

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

Subchapter C. Information Reporting to Delegated Entity

1272.101 Applicability of Subchapter 1272.102 Reporting Required 1272.103 Rules

Subchapter D. Reserve Requirements

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

Subchapter E. Compliance

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; Report 1272.206 Response to Department Report; Corrective Plan 1272.207 Request for Corrective Action 1272.208 Authority of Commissioner to Issue Order 1272.209 Public Documents 1272.210 Record of Complaints; Report 1272.211 Rules

Subchapter F. Penalties

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

Subchapter G. Provision of Services by Limited Provider Network or Delegated Entity

1272.301 Access to Out-of-Network Services 1272.302 Continuity of Care