Section 5.6412 - Operational Review Plan(a) A group shall annually adopt an operational review plan that provides for sufficient oversight of any person who is required to enter into a written agreement pursuant to §5.6411(a) or (b) of this division (relating to Contract Provisions). The group may modify the operational review plan at any time in order to meet the group's needs.(b) The operational review plan shall, at a minimum:(1) include the group's estimated projections for the information enumerated in paragraph (2) of this subsection for each quarter of the group's upcoming fund year;(2) require any person that is required to enter into a written agreement pursuant to §5.6411(a) or (b) of this division to submit quarterly reports to the group containing the following information, as applicable:(A) projected premium revenue for the current fund year and a comparison to premium revenue for the previous fund year;(B) membership counts, including members lost and gained in the current fund year; and(C) a summary of the performance of the group for each fund year in which the group has been in existence, including:(i) number of claims reported;(vi) delineation of claims likely to exceed the specific retention; and(vii) delineation of fund years likely to exceed any aggregate retention; and(3) provide for corrective action, as determined by the board of trustees of the group, if the performance of the group does not meet its estimated projections required under this section.(c) The board of trustees of a group shall consider the reports submitted pursuant to subsection (b) of this section. The reports, the board's consideration of the reports, and the board's recommendations for the group based upon the reports shall be noted in the minutes of the board of trustees of the group and shall be maintained in the books and records of the group.28 Tex. Admin. Code § 5.6412
The provisions of this §5.6412 adopted to be effective February 15, 2009, 34 TexReg 813