In this subchapter:
(1) “Accounts receivable tracking system” means the system the commission uses to track experience rebates and other payments collected from managed care organizations.
(2) “Agreed-upon procedures engagement” means an evaluation of a managed care organization’s financial statistical reports or other data conducted by an independent auditing firm the commission engages as agreed in the managed care organization’s contract with the commission.
(3) “Experience rebate” means the amount a managed care organization is required to pay this state according to the graduated rebate method described in the organization’s contract with the commission.
(4) “External quality review organization” means an organization that performs an external quality review of a managed care organization in accordance with 42 C.F.R. § 438.350.

Text of section effective on April 01, 2025