Sec. 4201.204. COMPLAINT SYSTEM. (a) A utilization review agent shall establish and maintain a complaint system that provides reasonable procedures for the resolution of oral or written complaints initiated by enrollees, patients, or health care providers concerning the utilization review.
(b) The complaint procedure must include a requirement that the utilization review agent provide a written response to the complainant within 30 days.
(c) Repealed by Acts 2015, 84th Leg., R.S., Ch. 42 , Sec. 3.01(7), eff. September 1, 2015.
(d) A utilization review agent shall maintain a record of each complaint until the third anniversary of the date the complainant filed the complaint.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 42 (S.B. 784), Sec. 3.01(7), eff. September 1, 2015.
Structure Texas Statutes
Title 14 - Utilization Review and Independent Review
Chapter 4201 - Utilization Review Agents
Subchapter E. Utilization Review: Relations With Patients and Health Care Providers
Section 4201.201. Repetitive Contacts With Health Care Provider or Patient; Frequency of Reviews
Section 4201.202. Observing or Participating in Patient's Care
Section 4201.203. Mental Health Therapy
Section 4201.204. Complaint System
Section 4201.205. Designated Initial Contact
Section 4201.206. Opportunity to Discuss Treatment Before Adverse Determination
Section 4201.207. Charges by Health Care Provider for Providing Medical Information