Section 18. Delegation

Delegation is a process whereby a MCO gives another entity the authority and responsibilities to perform certain functions on its behalf. The MCO is fully accountable for all pre-delegation and delegation activities and decisions made. The MCO shall document its oversight of the entity that performs the delegated activity. The MCO may assign, transfer, or delegate to a subcontractor key management functions with the explicit written approval of HSD. A. Each contract or written agreement between the MCO and delegated entity shall describe: 8.308.2 NMAC 10 (1) the responsibilities of the MCO and the entity to which the activity is delegated; (2) the delegated activities or obligations; (3) the reporting responsibilities to include the frequency and method of reporting to the MCO; (4) the process by which the MCO evaluates the delegated entity’s performance; (5) the remedies up to, and including, revocation of the delegation, available to the MCO if the delegated entity does not fulfill its obligations; and (6) the requirements specified in 42 CFR § 438.214, if the delegated entity will be providing or securing covered services to members. B. The MCO shall provide evidence to HSD that it: (1) evaluated the delegated entity’s capacity to perform the delegated activities prior to delegation; (2) monitors the delegated entity’s performance on an ongoing basis and identifies deficiencies or areas for improvement that require the delegated entity to take corrective action as necessary; and (3) conducts an annual evaluation of its delegated entity in accordance with the MCO’s expectations and HSD’s standards.