| (a) The department may require at any time that a delegated
entity take corrective action to comply with the department's statutory
and regulatory requirements that:
(1) relates to any matters delegated by the HMO to
the delegated entity;
(2) is necessary to ensure the HMO's compliance with
statutory and regulatory requirements; or
(3) relates to the financial solvency and operations
of the delegated entity.
(b) The commissioner may order the HMO to take any
action the commissioner determines is necessary to ensure that the
HMO maintains compliance with the Insurance Code, this chapter, and
other applicable insurance laws and regulations of this state, including
but not limited to:
(1) resumption of any or all functions delegated to
the delegated entity, including claims processing, adjudication, and
payments for health care previously rendered to enrollees of the HMO;
(2) temporarily or permanently ceasing assignment of
new enrollees to the delegated entity;
(3) temporarily or permanently transferring enrollees
to alternative delivery systems to receive health care; or
(4) termination of the HMO's delegation agreement with
the delegated entity.
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