Monitoring Plan

Sec. 1272.053. MONITORING PLAN. A delegation agreement required by Section 1272.052 must establish a monitoring plan that: (1) allows the health maintenance organization to monitor compliance with the minimum solvency requirements established under Subchapter D, if applicable; and (2) includes: (A) a description of financial practices that will ensure that the delegated entity tracks and reports liabilities that have been incurred but not reported; (B) a summary of the total amount paid by the entity to physicians and providers on a monthly basis; and (C) a summary of complaints from physicians, providers, and enrollees regarding delays in payment or nonpayment of claims, including the status of each complaint, on a monthly basis. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.