4201.056
This chapter does not apply to the terms or benefits of an employee welfare benefit plan defined by Section 3(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002(1)). Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.057
(a) In this section, ” health maintenance organization” includes a health maintenance organization that contracts with the Health and Human Services Commission or with an agency operating part of the state Medicaid managed care program to provide health care services to recipients of medical assistance under Chapter 32, Human Resources Code. (b) This chapter applies […]
4201.058
(a) This chapter applies to an insurer subject to this code that delivers or issues for delivery a health insurance policy in this state except as expressly provided by this section. As a condition of holding a certificate of authority to engage in the business of insurance, an insurer that performs utilization review shall comply […]
4201.052
This chapter does not apply to a contract with the federal government to provide utilization review with respect to a patient who is eligible for services under Title XVIII or XIX of the Social Security Act (42 U.S.C. Section 1395 et seq. or Section 1396 et seq.). Added by Acts 2005, 79th Leg., ch. 727, […]
4201.055
This chapter does not apply to utilization review of a health care service provided under an automobile insurance policy or contract that is authorized under Chapter 2301 or Article 5.13-2 or that is issued under Chapter 981. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
4201.004
(a) A utilization review agent shall: (1) have appropriate personnel reasonably available, by toll-free telephone at least 40 hours per week during normal business hours in this state, to discuss patients’ care and allow response to telephone review requests; (2) have a telephone system capable, during hours other than normal business hours, of accepting or […]
4201.001
The purpose of this chapter is to: (1) promote the delivery of quality health care in a cost-effective manner; (2) ensure that a utilization review agent adheres to reasonable standards for conducting utilization review; (3) foster greater coordination and cooperation between a health care provider and utilization review agent; (4) improve communications and knowledge of […]
4203.002
A member or employee of the Texas Board of Chiropractic Examiners may not act as a consultant or perform any consultant activities for an insurer or business, individual, or utilization review agent that audits chiropractic claims, charges, or services. Added by Acts 2005, 79th Leg., ch. 727, § 4, eff. April 1, 2007.
1305.503
(a) As necessary to implement this subchapter, the department may access information from an executive agency that is otherwise confidential under any law of this state, including the Texas Workers’ Compensation Act. (b) Confidential information provided to or obtained by the department under this section remains confidential and is not subject to disclosure under Chapter […]
1305.551
(a) If the commissioner determines that a network, insurance carrier, or any other person or third party operating under this chapter, including a third party to which a network delegates a function, or any third party with which a network contracts for management services, is in violation of this chapter, rules adopted by the commissioner […]