Sec. 843.251. COMPLAINT SYSTEM REQUIRED; COMMISSIONER RULES AND EXAMINATION. (a) A health maintenance organization shall implement and maintain a complaint system that provides reasonable procedures to resolve an oral or written complaint initiated by a complainant concerning health care services. The complaint system must include a process for the notice and appeal of a complaint.
(b) The commissioner may adopt reasonable rules as necessary or proper to implement the provisions of this subchapter relating to the complaint system and administer matters relating to the complaint system.
(c) The commissioner may examine a complaint system for compliance with this subchapter and may require the health maintenance organization to make corrections as the commissioner considers necessary.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Structure Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities
Chapter 843 - Health Maintenance Organizations
Subchapter G. Dispute Resolution
Section 843.251. Complaint System Required; Commissioner Rules and Examination
Section 843.252. Complaint Initiation and Initial Response; Deadlines for Response and Resolution
Section 843.253. Complaint Investigation and Resolution
Section 843.254. Appeal to Complaint Appeal Panel; Deadlines
Section 843.255. Composition of Complaint Appeal Panel
Section 843.256. Information Provided to Complainant Relating to Complaint Appeal Panel
Section 843.257. Rights of Complainant at Complaint Appeal Panel Meeting
Section 843.258. Appeal Involving Ongoing Emergency or Continued Hospitalization
Section 843.259. Notice of Decision on Appeal
Section 843.260. Record of Complaints
Section 843.261. Special Provisions for Appeals of Adverse Determinations