1. (a) Purpose. The purpose of this subchapter is to set forth the requirements that must be met by any HMO that delegates any function as described in the Insurance Code Chapters 843 and 1272, this chapter, and applicable insurance laws and regulations of this state that apply to HMOs. These requirements are designed to ensure that a delegating HMO:

   1. (1) identifies all responsibilities relating to the function being delegated;
   2. (2) creates an agreement that enables the HMO and department to monitor both the delegated entity's financial solvency and performance or subsequent delegation of all delegated functions; and
   3. (3) retains ultimate responsibility for ensuring that all delegated functions are performed in accordance with applicable statutes and rules.
2. (b) Severability. Where any terms or sections of this subchapter are determined by a court of competent jurisdiction to be inconsistent with the Insurance Code Chapters 843 and 1272 and applicable insurance laws of this state related to health maintenance organization regulation, as identified by this subchapter, the Insurance Code Chapters 843 and 1272 and applicable insurance laws of this state that apply to HMOs will apply and the remaining terms and provisions of this subchapter shall continue in effect.
3. (c) Applicability to Group Model HMO. This subchapter does not apply to a group model HMO, as defined by Insurance Code §843.111.

Source Note:The provisions of this §11.2601 adopted to be effective October 13, 2002, 27 TexReg 9585; amended to be effective February 24, 2005, 30 TexReg 854; amended to be effective November 15, 2006, 31 TexReg 9298.