By:  Harris                                            S.B. No. 955
         Line and page numbers may not match official copy.
         Bill not drafted by TLC or Senate E&E.
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to the delegation of certain functions by health
 1-3     maintenance organizations.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5     SECTION 1.  Section 2, Texas Health Maintenance Organization Act
 1-6     (Article 20A.02, Vernon's Texas Insurance Code), is amended by
 1-7     amending Subsection (ee) and adding Subsections (ff) to read as
 1-8     follows:
 1-9           (ee)  "Delegated entity [network]" means an entity, other than
1-10     a health maintenance organization authorized to do business under
1-11     this Act [or an insurer authorized to do business under Chapter 3,
1-12     Insurance Code], which:
1-13                 (1)  by itself, or through subcontracts with one or
1-14     more entities including delegated third party, undertakes to
1-15     arrange for or to provide medical care or health care to an
1-16     enrollee in exchange for a predetermined payment on a prospective
1-17     basis; and
1-18                 (2)  accepts responsibility to perform, on behalf of
1-19     the health maintenance organization, any function regulated by this
1-20     Act as defined by subsection (d).  [The term does not include an
1-21     individual physician or a group of employed physicians practicing
1-22     medicine under one federal tax identification number and whose
1-23     total claims paid to providers not employed by the group is less
 2-1     than 20 percent of the total collected revenue of the group
 2-2     calculated on a calendar year basis.]
 2-3           (ff)  "delegated network" means an entity, other than a
 2-4     health maintenance organization authorized to do business under
 2-5     this Act but does not meet the requirements of subsection (ee),
 2-6     which:
 2-7                 (1)  by itself, or through subcontracts with one or
 2-8     more entities delegated third party, undertakes to arrange for or
 2-9     to provide medical care or health care to an enrollee in exchange
2-10     for a predetermined payment on a prospective basis; and
2-11                 (2)  accepts responsibility to perform, on behalf of
2-12     the health maintenance organization, any function regulated by this
2-13     Act.  The term does not include contracts between a delegated
2-14     entity and an individual physician or a group of employed
2-15     physicians practicing medicine under one federal tax identification
2-16     number and whose total claims paid to providers not employed by the
2-17     group is less than 20 percent of the total collected revenue of the
2-18     group calculated on a calendar year basis.
2-19           (gg)  "delegated third party" means a third party that
2-20     contracts with a delegated entity, either directly or through
2-21     another third party, in which the third party:
2-22                       (i)  accepts responsibility to perform any
2-23     function regulated by this Act; or
2-24                       (ii)  receives or handles funds, if the receipt
2-25     or handling of such funds is directly or indirectly related to a
2-26     function regulated by this Act.  The term includes a third party
 3-1     that administers such funds.
 3-2     SECTION 2.  The Texas Health Maintenance Organization Act (Article
 3-3     20A.18C, Vernon's Texas Insurance Code) is amended as follows:
 3-4           Sec. 18C.  REQUIREMENTS FOR DELEGATED ENTITIES AND NETWORKS
 3-5     ]LDELEGATION OF CERTAIN FUNCTIONS TO DELEGATED NETWORKS  .  (a)  A
 3-6     health maintenance organization that [enters into a delegation
 3-7     agreement with a delegated network] delegates any function required
 3-8     by this Act shall execute a written agreement with each delegated
 3-9     network and entity.  The health maintenance organization shall file
3-10     these ]Lthe   written agreements with the department not later than the
3-11     30th day after the date the agreement is executed.  It shall be the
3-12     responsibility of the parties to each agreement to determine the
3-13     party that bears the expense of any provision required by this
3-14     subsection including the cost of any examinations conducted by the
3-15     department pursuant to Article 1.15 if applicable.  The written
3-16     agreement must contain:
3-17                 (1)  a monitoring plan which allows the health
3-18     maintenance organization to track the minimum solvency requirements
3-19     ]Lto be   established in this section, if applicable, which includes:
3-20                       (A)  a description of financial practices that
3-21     will ensure that the delegated network tracks and reports
3-22     liabilities that have been incurred but not reported;
3-23                       (B)  a summary of the total amount paid by the
3-24     delegated network to physicians and providers on a monthly basis;
3-25     and
3-26                       (C)  a summary of complaints from physicians,
 4-1     enrollees, and providers regarding delays in payments of claims or
 4-2     nonpayment of claims, including the status of each complaint, on a
 4-3     monthly basis;
 4-4                 (2)  a provision that the agreement cannot be
 4-5     terminated without cause by the delegated network or the health
 4-6     maintenance organization without written notice provided before the
 4-7     90th day preceding the termination date;
 4-8                 (3)  a provision that prohibits the delegated entity
 4-9     and the physicians and providers with whom it has contracted from
4-10     billing or attempting to collect from an enrollee under any
4-11     circumstance, including the insolvency of the health maintenance
4-12     organization or other delegated entities, payments for covered
4-13     services other than authorized copayments and deductibles;
4-14                 (4)  a provision that the delegation agreement may not
4-15     be construed to limit in any way the health maintenance
4-16     organization's authority or responsibility, including financial
4-17     responsibility, to comply with all statutory and regulatory
4-18     requirements;
4-19                 (5)  a provision that requires the delegated entity to
4-20     deposit funds as described in the section, at a location in Texas
4-21     with a financial institution chartered by the United States or this
4-22     state.  The funds accepted through the agreement by the delegated
4-23     entity are held by the delegated entity in a fiduciary capacity
4-24                 (6)  a provisions that requires the delegated entity
4-25     and network to comply with all statutory and regulatory
4-26     requirements relating to any function, duty, responsibility, or
 5-1     delegation assumed by or carried out by the delegated entity or
 5-2     network;
 5-3                 (7)(6)  a provision that requires the [a] delegated
 5-4     entity or network to permit the commissioner to examine at any time
 5-5     any and all information that the commissioner reasonably believes
 5-6     would be relevant to:
 5-7                       (A)  the financial solvency of the delegated
 5-8     entity;
 5-9                       (B)  the financial solvency of the delegated
5-10     third party; or
5-11                       (B)  the ability of the delegated entity to meet
5-12     its responsibilities in connection with any function delegated to
5-13     the enity by the health maintenance organization;
5-14                 (8) [(6)]  a provision that requires the [a] delegated
5-15     entity or network [or a third party] to provide the [a] license number
5-16     [and to certify that the network] of any third party performing any
5-17     function for which a license as a [or third party is licensed as a]
5-18     third party administrator under Article 21.07-6, Insurance Code, or
5-19     as a utilization review agent under Article 21.58A or for which any
5-20     other license is required under this code, and that: [if the health
5-21     maintenance organization delegates its claims payment function to
5-22     the delegated network or a third party];
5-23                       (A)  enrollees will receive notification at the
5-24     time of enrollment which entity has responsibility for performing
5-25     utilization review; and
5-26                       (B)  the delegated entity or network or third
 6-1     party performing utilization review shall do so in accordance with
 6-2     Art. 21.58A, Insurance Code; and
 6-3                       (C)  utilization review decisions made by the
 6-4     delegated entity or network or a third party shall be forwarded to
 6-5     the health maintenance organization on a monthly basis;
 6-6                 (8) [(7)]  for delegated entities that handle funds
 6-7     meant, at least in part, for the benefit of, or to provide services
 6-8     to, enrollees of a health maintenance organization, a provision
 6-9     that requires a delegated entity to establish and maintain reserves
6-10     which are:
6-11                 (A)  adequate for the liabilities and risks assumed by
6-12     the delegated entity as calculated in accordance with accepted
6-13     standards, practices and procedures in regard for the liabilities
6-14     and risks being reserved for, including known and unknown
6-15     components and anticipated expenses to provide such benefits or
6-16     services; and
6-17                       (B)  in the amount defined in section (d):
6-18                             (i)  must be secured by and only consist of
6-19     lawful money of the United States or bonds of the United States or
6-20     of this State or of any government insured mortgage loans; and
6-21                 [(9)]]L(7)  [  a provision that requires a delegated network
6-22     or a third party to provide a license number and to certify that
6-23     the network or third party is licensed as a utilization review
6-24     agent under Article 21.58A, Insurance Code, if the health
6-25     maintenance organization delegates its utilization review function
6-26     to the delegated network or a third party, and that:]
 7-1     [(A)  enrollees will receive notification at the time of enrollment
 7-2     which entity has responsibility for performing utilization review;
 7-3     and]
 7-4     [(B)  the delegated network or third party performing utilization
 7-5     review shall do so in accordance with Art. 21.58A, Insurance Code;
 7-6     and]
 7-7     [(C)  utilization review decisions made by the delegated network or
 7-8     a third party shall be forwarded to the health maintenance
 7-9     organization on a monthly basis];
7-10                 (9)  a provision that requires that any agreement in
7-11     which the delegated entity or delegated network delegates either
7-12     directly or indirectly any function required by this Act, including
7-13     the handling of funds, if applicable, as defined in Article
7-14     20A.02(ee), to a delegated third party shall be in writing;
7-15                 (10) [(8)]  a provision that requires the delegated
7-16     entity or network, in contracting either directly or through
7-17     another third party with any delegated third party to require the
7-18     delegated third party to comply with the all requirements that are
7-19     mandated by state law for an entity of its type.
7-20                 (11) ([12])  an acknowledgment and agreement by the
7-21     delegated network that:
7-22                       (A)  the health maintenance organization is:
7-23                             (i)  required to establish, operate, and
7-24     maintain a health care delivery system, quality assurance system,
7-25     provider credentialing system, and other systems and programs that
7-26     meet statutory and regulatory standards;
 8-1                             (ii)  directly accountable for compliance
 8-2     with those standards; and
 8-3                             (iii)  not precluded from contractually
 8-4     requesting that the delegated network or entity provide proof of
 8-5     financial viability;
 8-6                       (B)  the role of the delegated network and [any]
 8-7     entity with which it subcontracts through a delegated third party
 8-8     [in contracting with the health maintenance organization] is limited
 8-9     to performing certain delegated functions of the health maintenance
8-10     organization, using standards approved by the health maintenance
8-11     organization and which are in compliance with applicable statutes
8-12     and rules and subject to the health maintenance organization's
8-13     oversight and monitoring of the delegated network's performance;
8-14     and
8-15                       (C)  if the delegated network or entity fails to
8-16     meet monitoring standards established to ensure that functions
8-17     delegated or assigned to the network under the delegation contract
8-18     are in full compliance with all statutory and regulatory
8-19     requirements, the health maintenance organization may cancel
8-20     delegation of any or all delegated functions; and
8-21                 (11) [(9)]  a provision that requires the delegated
8-22     network or entity to make available to the health maintenance
8-23     organization samples of contracts with physicians and providers to
8-24     ensure compliance with the contractual requirements described by
8-25     Subdivisions (2) and (3) of this subsection, except that the
8-26     agreement may not require that the delegated network or entity make
 9-1     available to the health maintenance organization contractual
 9-2     provisions relating to financial arrangements with the delegated
 9-3     network's physicians and providers;
 9-4                 (12[0])  the delegated network or entity to provide the
 9-5     health maintenance organization, in a usable format necessary for
 9-6     audit purposes and at most quarterly unless otherwise specified in
 9-7     the agreement, the data necessary for the health maintenance
 9-8     organization to comply with the department's reporting requirements
 9-9     with respect to any delegated functions performed under the
9-10     delegation agreement, including:
9-11                       (A)  a summary:
9-12                             (i)  describing the methods, including
9-13     capitation, fee-for-service, or other risk arrangements, that the
9-14     delegated network used to pay its physicians and providers; and
9-15                             (ii)  including the percentage of
9-16     physicians and providers paid for each payment category;
9-17                       (B)  the period that claims and debts for medical
9-18     services owed by the delegated network have been pending and the
9-19     aggregate dollar amount of those claims and debts;
9-20                       (C)  information that will enable the health
9-21     maintenance organization to file claims for reinsurance,
9-22     coordination of benefits, and subrogation, if required by the
9-23     health maintenance organization's contract with the delegated
9-24     network; and
9-25                       (D)  documentation, except for information,
9-26     documents, and deliberations related to peer review that are
 10-1    confidential or privileged under Section 5.06, Medical Practice Act
 10-2    Article 4495b, Vernon's Texas Civil Statutes), that relates to:
 10-3                            (i)  a regulatory agency's inquiry or
 10-4    investigation of the delegated network or entity or of an
 10-5    individual physician or provider with whom the delegated network or
 10-6    entity contracts that relates to an enrollee of the health
 10-7    maintenance organization; and
 10-8                            (ii)  the final resolution of a regulatory
 10-9    agency's inquiry or investigation; and
10-10                (13[1])  a provision relating to enrollee complaints that
10-11    requires the delegated network or entity to ensure that upon
10-12    receipt of a complaint, as defined by this Act, the delegated
10-13    network or entity shall report the complaint to the health
10-14    maintenance organization within two business days, except in the
10-15    case of a complaint involving emergency care as defined in this
10-16    Act.  In the case of a complaint involving emergency care, the
10-17    delegated network or entity shall forward the complaint immediately
10-18    to the health maintenance organization.  Nothing herein shall
10-19    prohibit the delegated network or entity from attempting to resolve
10-20    a complaint.
10-21          (b)  The commissioner shall determine the information that a
10-22    [A] health maintenance organization shall provide to each delegated
10-23    entity or network which shall include the following information
10-24    provided in standard electronic format, at least monthly unless
10-25    otherwise stated [provided] in the agreement:
10-26                (1)  the names and dates of birth or social security
 11-1    numbers of the enrollees of the health maintenance organization who
 11-2    are eligible or assigned to receive services from the delegated
 11-3    network or entity, including the enrollees added and terminated
 11-4    since the previous reporting period;
 11-5                (2)  the age, sex, benefit plan and any riders to that
 11-6    benefit plan, and employer for the enrollees of the health
 11-7    maintenance organization who are eligible or assigned to receive
 11-8    services from the delegated network or entity;
 11-9                (3)  if the health maintenance organization  pays any
11-10    claims for the delegated network or entity, a summary of the number
11-11    and amount of claims paid by the health maintenance organization on
11-12    behalf of the delegated network or entity during the previous
11-13    reporting period.  A delegated entity or network is not precluded
11-14    from receiving, upon request, additional nonproprietary information
11-15    regarding such claims;
11-16                (4)  if the health maintenance organization pays any
11-17    claims for the delegated network or entity, a summary of the number
11-18    and amount of pharmacy prescriptions paid for each enrollee for
11-19    which the delegated entity or network has taken partial risk during
11-20    the previous reporting period.  A delegated entity or network is
11-21    not precluded from receiving, upon request, additional
11-22    nonproprietary information regarding such claims;
11-23                (5)  information that enables the delegated entity or
11-24    network to file claims for reinsurance, coordination of benefits,
11-25    and subrogation; and
11-26                (6)  patient complaint data that relates to the
 12-1    delegated network or entity.
 12-2          (c)  In addition to the information required by Subsection
 12-3    (b) of this section, a health maintenance organization shall
 12-4    provide to a delegated entity or network [with which it has a
 12-5    delegation agreement]:
 12-6                (1)  detailed risk-pool data, reported quarterly and on
 12-7    settlement; and
 12-8                (2)  the percent of premium attributable to hospital or
 12-9    facility costs, if hospital or facility costs impact the delegated
12-10    entity's or network's costs, reported quarterly, and, if there are
12-11    changes in hospital or facility contracts with the health
12-12    maintenance organization, the projected impact of those changes on
12-13    the percent of premium attributable to hospital and facility costs
12-14    within 30 days of such changes.
12-15                (d)  A delegated entity that accepts financial risk
12-16    from an health maintenance organization for health care services to
12-17    be provided to enrollees of the health maintenance organization
12-18    shall establish and maintain reserves which are adequate for the
12-19    liabilities and risks assumed by the delegated entity, as
12-20    calculated in accordance with accepted standards, practices and
12-21    procedures in regard for the liabilities and risks being reserved
12-22    for, including known and unknown components and anticipated
12-23    expenses to provide such benefits or services.  If the delegated
12-24    entity accepts financial risk for;
12-25          (1)  more than one category of service for medical care,
12-26    hospital or other institutional services or prescription drugs, as
 13-1    defined by section 551.003 of the Occupations Code, the delegated
 13-2    entity shall establish and maintain reserves as described in
 13-3    subsection (2) (i),(ii) or (iii) and shall only establish and
 13-4    maintain reserves for the portion of services that are not within
 13-5    their respective scope of licensure for medical care or hospital or
 13-6    other institutional services, or
 13-7          (2)  in the event the scope of licensure includes both
 13-8    medical care and hospital or institutional services, the entity
 13-9    shall establish and maintain reserves that are adequate to cover
13-10    the liabilities and risks associated with the services, either
13-11    medical care or hospital and other institutional services, which
13-12    has been allocated the largest portion of the premium by the health
13-13    maintenance organization and assumed by the delegated network.  If
13-14    the delegated network accepts financial risk for either medical
13-15    care or hospital and other institutional services, and prescription
13-16    drugs, as defined by section 551.003 of the Occupations Code, the
13-17    entity also shall establish and maintain reserves that are adequate
13-18    to cover the liabilities and risks associated with these
13-19    pharmaceutical services.  At a minimum, the delegated entity must
13-20    maintain financial reserves equal to the greater of:
13-21                      (i)  80 percent of the risks and liabilities that
13-22    must be reserved pursuant to this Subsection and that have been
13-23    incurred but not paid by the delegated entity; or
13-24                      (ii)  two months of the premium amount assumed by
13-25    the delegated entity for services that must be reserved pursuant to
13-26    this Subsection.
 14-1                      (iii)  in no event does subsection (d) apply to a
 14-2    delegated entity that shares risk with a health maintenance
 14-3    organization.
 14-4          (e)  The financial reserves required by Subsection (d) must
 14-5    be secured by and only consist of legal tender of the United States
 14-6    or bonds of the United States or the State of Texas and shall be
 14-7    held at a location in Texas with a financial institution chartered
 14-8    by the United States or the State of Texas, in trust for benefit
 14-9    of, or to provide health care services to, enrollees of the health
14-10    maintenance organization pursuant to the agreement between the
14-11    health maintenance organization and the delegated network.
14-12          (f) ([d])  A health maintenance organization that becomes aware
14-13    of any information [receives information through the monitoring plan
14-14    required by Subsection (a)(1) of this section] that indicates the
14-15    delegated entity or network is not operating in accordance with its
14-16    written agreement or is operating in a condition that renders the
14-17    continuance of its business hazardous to the enrollees, shall, in
14-18    writing:
14-19                (1)  notify the delegated entity or network of those
14-20    findings and
14-21                (2)  request a written explanation, along with
14-22    documentation in support of its explanation of:
14-23                      (A)  the delegated entity's or the delegated
14-24    network's apparent [network's] noncompliance with the written
14-25    agreement; or
14-26                      (B)  the delegated entity's or the delegated
 15-1    network's apparent [network's] business hazardous to the enrollees;
 15-2    and
 15-3                (3)  provide the commissioner with copies of all
 15-4    notices and requests submitted to the delegated entity as well as
 15-5    the responses and other documentation it generates or receives in
 15-6    response to the notices and requests.
 15-7          (g) ([e])  A delegated entity or network shall respond to a
 15-8    request from a health maintenance organization under Subsection (d)
 15-9    of this section in writing not later than the 30th day after the
15-10    date the request is received.
15-11          (h) [(f)]  The health maintenance organization shall cooperate
15-12    with the delegated entity or network to correct any failure by the
15-13    delegated entity or network to comply with the regulatory
15-14    requirements of the department relating to any matters:
15-15                (1)  delegated to the delegated entity or network by
15-16    the health maintenance organization; or
15-17                (2)  necessary for the health maintenance organization
15-18    to ensure compliance with statutory or regulatory requirements.
15-19          [(g);]  [The health maintenance organization shall notify the
15-20    department and request intervention if:]
15-21                [(1)  the health maintenance organization does not
15-22    receive a timely response from the delegated network as required by
15-23    Subsection (e) of this section; or]
15-24                [(2)  the health maintenance organization receives a
15-25    timely response from the delegated network as required by
15-26    Subsection (e) of this section, but the health maintenance
 16-1    organization and the delegated network are unable to reach an
 16-2    agreement as to whether the delegated network:]
 16-3                [(A)  is complying with the written agreement; or]
 16-4                [(B)  has corrected any problem regarding a practice
 16-5    that is hazardous to an enrollee of the health maintenance
 16-6    organization.]
 16-7          (i) [(h)]  On receipt of a notice, a request [for intervention]
 16-8    under Subsection (f[d]) of this section, or in the event of
 16-9    complaints filed with the department, the department may[;] examine
16-10    the matters contained in the notice as well as any other matters
16-11    relating to the financial solvency of the delegated entity or
16-12    network or its ability to meet its responsibilities in connection
16-13    with any function delegated to the entity or network by the health
16-14    maintenance organization
16-15                [(1)  request financial and operational documents from
16-16    the delegated network to further investigate deficiencies indicated
16-17    by the monitoring plan]
16-18                [(2)  conduct an on site audit of the delegated network
16-19    if the department determines that the delegated network is not
16-20    complying with the monitoring standards required under
16-21    Subsection(a)(1) of this section; or]
16-22                [(3)  notwithstanding any other provisions, upon
16-23    violation of a monitoring plan, suspend or revoke the third party
16-24    administrator license or utilization review agent license of:]
16-25                            [(A)  the delegated network; or]
16-26                      [(B)  A third party with which the delegated
 17-1    network has contracted].
 17-2          (j) [(i)]  Upon completion of its examination [The] the
 17-3    department shall report to the delegated entity or network and the
 17-4    health maintenance organization the results of its examination
 17-5    along with any actions that the department determines are necessary
 17-6    to ensure that:
 17-7                (1)  the health maintenance organization meets its
 17-8    responsibilities under the code and applicable rules adopted by the
 17-9    department; and
17-10                (2)  the delegated entity or network can meet its
17-11    responsibilities in connection with any function delegated to the
17-12    entity by the health maintenance organization [review not later than
17-13    the 60th day after the date of the department's initial request for
17-14    documentation; provided, h]However, the department shall not report
17-15    to the health maintenance organization any information regarding
17-16    fee schedules, prices, cost of care, or other information not
17-17    relevant to the monitoring plan.
17-18          (k) [(j)]  The delegated entity or network and the health
17-19    maintenance organization [network] shall respond to the department's
17-20    report and submit a corrective plan to the department [and to the
17-21    health maintenance organization] not later than the 30th day after
17-22    the date of receipt of [the delegated network receives] the
17-23    department's report.  The department shall not report to the health
17-24    maintenance organization [The delegated network may withhold]
17-25    information regarding fee schedules, prices, cost of care, or other
17-26    information not relevant to the monitoring plan.
 18-1          (l) [(k).  reports and corrective plans required under
 18-2    Subsection (i) or (j) of this section shall be treated as public
 18-3    documents, except that h] Health care provider fee schedules,
 18-4    prices, costs of care, reports and corrective plans or other
 18-5    information not relevant to the monitoring plan and any other
 18-6    information that is considered confidential by law shall be
 18-7    considered confidential.  A listing of all delegated network
 18-8    agreements, indicating the parties to the agreement, filed under
 18-9    Subsection (a) shall be considered public information and subject
18-10    to disclosure under Chapter 552, Government Code.
18-11          (m) [(l)]  At any time, the [The] department may request that a
18-12    delegated network or entity take corrective action to comply with
18-13    the department's statutory and regulatory requirements that:
18-14                (1)  relate to any matters delegated by the health
18-15    maintenance organization to the delegated entity or network; or
18-16                (2)  are necessary to ensure the health maintenance
18-17    organization's compliance with statutory and regulatory
18-18    requirements.
18-19          (n) [(m)]  Regardless of whether [If] a delegated entity or
18-20    network [does not comply] complies with the department's request for
18-21    corrective action, the department may order the health maintenance
18-22    organization to take any steps the commissioner deems necessary to
18-23    ensure that the health maintenance organization is in compliance
18-24    with this Act including but not limited to:
18-25                (1)  reassumption of the functions delegated to the
18-26    delegated entity or network including claims payments for services
 19-1    previously rendered to enrollees of the health maintenance
 19-2    organization.
 19-3                (2) [(1)]  temporarily or permanently ceasing [cease]
 19-4    assignment of new enrollees to the delegated network or entity;
 19-5                (3) [(2)]  the temporary or permanent [temporarily or
 19-6    permanently] transfer of enrollees to alternative delivery systems
 19-7    to receive services; [or]
 19-8                (4) [(3)]  immediate termination of [modify or terminate]
 19-9    its contract with the delegated entity or network[.]; or
19-10          (o)[(n)]  The commissioner shall maintain enrollee and provider
19-11    complaints in a manner that identifies complaints made about
19-12    delegated network or entities.
19-13          (p)  notwithstanding any other provisions of this code, the
19-14    commissioner may suspend or revoke the license of any third party
19-15    administrator or utilization review agent that fails to comply with
19-16    this section.
19-17          (q)  Section 18C of this Act does not apply to a group model
19-18    health maintenance organization as defined in section 6A of this
19-19    Act.
19-20          (r) [(o)]  The commissioner shall adopt such rules [as] necessary
19-21    to [interpret,] implement, [and enforce] this section.
19-22          SECTION 3.  This Act takes effect September 1, 2001.  This
19-23    Act applies to contracts entered into by health maintenance
19-24    organizations that are entered into or renewed on or after January
19-25    1, 2002.
19-26          SECTION 4.  The importance of this legislation and the
 20-1    crowded condition of the calendars in both houses create an
 20-2    emergency and an imperative public necessity that the
 20-3    constitutional rule requiring bills to be read on three several
 20-4    days in each house be suspended, and this rule is hereby suspended,
 20-5    and that this Act take effect and be in force from and after its
 20-6    passage, and it is so enacted.