SECTION 13.474. Requirements for HMO or Insurer Delegation of Functions to HCCs

(a) An HMO's delegation of functions to an HCC is subject to the requirements of Insurance Code Chapter 1272 and Chapter 11, Subchapter AA of this title (relating to Delegated Entities).

(b) An insurer's delegation of functions to an HCC is subject to the requirements of Insurance Code Chapter 1272 and Chapter 11, Subchapter AA of this title as if the insurer were an HMO.

(c) If a provision of this subchapter imposes a compliance requirement that is greater than or in conflict with those contained in Insurance Code Chapter 1272 or Chapter 11, Subchapter AA of this title, the requirement of this subchapter governs.

(d) A delegation agreement between an HMO or insurer and an HCC must mandate that the HMO or insurer disclose in all provider listings distributed to insureds or enrollees those providers participating in the HCC within the HMO's or insurer's approved service area.

(e) If an insurer contracts for services with an HCC on a basis other than fee-for-service, the insurer must disclose the nature of its payment arrangement with the HCC in either the insurance policy and certificates or in any provider listing distributed to insureds.

Source Note: The provisions of this §13.474 adopted to be effective March 31, 2013, 38 TexReg 2100