| (a) On receipt of a financial statement indicating
that a delegated entity or delegated third party has an amount of
total liabilities greater than its total assets, the HMO must immediately
forward a copy of the financial statement to the department.
(b) An HMO that becomes aware of any information, including
the information described in subsection (a) of this section, that
suggests or indicates that the delegated entity or delegated third
party is not operating in compliance with its written agreement or
is operating in a condition that may render the continuance of its
business hazardous to the enrollees, must immediately:
(1) notify the delegated entity in writing of those
findings; and
(2) request, in writing, a written explanation with
supporting documentation of:
(A) the delegated entity's or delegated third party's
apparent noncompliance with the written agreement; or
(B) the existence of the condition that apparently
renders the continuance of the delegated entity's or delegated third
party's business hazardous to the enrollees.
(c) A delegated entity must respond in writing to a
request from an HMO under subsection (b) of this section not later
than the 30th day after the date the request is received. The response
must include a corrective action plan.
(d) A copy of all written communications required by
subsections (b) and (c) of this section must be sent to the department
simultaneously with transmission to the HMO or delegated entity or
delegated third party.
(e) The HMO must cooperate with the delegated entity
to correct any failure by the delegated entity to comply with the
applicable statutes and rules relating to any matters:
(1) delegated to the delegated entity by the HMO; or
(2) necessary for the HMO to ensure compliance with
statutory or regulatory requirements.
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