A health maintenance organization (HMO) may delegate one or more required HMO functions, such as contracting with providers, credentialing physicians, handling enrollee complaints or operating the HMO's quality improvement program (defined at 28 TAC §11.1902 and 28 tac §11.2207) to another entity through an HMO " Delegation Agreement".
HMO delegation agreements are primarily governed by Texas Insurance Code Chapter 1272 and related rules. The rules adopted at 28 TAC § §112603-11.2606 describe the requirements that apply when an HMO delegates one or more required HMO function to another entity. The HMO Delegated entities & Delegated Third Parties checklist, LHL719, is available on-line and refers to the applicable statues and rules.
Delegation Information
For more information, contact: MCQA@tdi.texas.gov
Last updated:
10/25/2022