Sec. 1272.205. EXAMINATION BY DEPARTMENT; REPORT. (a) On receipt of a notice under Section 1272.202 or if complaints are filed with the department, the department may conduct an examination regarding:
(1) any matter contained in the notice; and
(2) any other matter relating to the financial solvency of the delegated entity or the entity's ability to meet the entity's responsibilities in connection with a function delegated to the entity by the health maintenance organization.
(b) Except as provided by Subsection (c), the department, on completion of an examination under this section, shall report to the delegated entity and the health maintenance organization:
(1) the results of the examination; and
(2) any action the department determines is necessary to ensure that:
(A) the health maintenance organization meets the health maintenance organization's responsibilities under this code, any other insurance laws of this state, and rules adopted by the commissioner; and
(B) the entity is able to meet the entity's responsibilities in connection with a function delegated to the entity by the health maintenance organization.
(c) The department may not report to the health maintenance organization information relating to fee schedules, prices, or cost of care or other information not relevant to the monitoring plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Section: Previous 1272.154 1272.155 1272.156 1272.201 1272.202 1272.203 1272.204 1272.205 1272.206 1272.207 1272.208 1272.209 1272.210 1272.211 1272.251 NextLast modified: September 28, 2016