4202.013
An independent review organization operating under this chapter must maintain the organization’s primary office in this state. Added by Acts 2013, 83rd Leg., ch. 1024 (H.B. 2645), § 5, eff. Sept. 1, 2013.
4202.004
(a) To be certified as an independent review organization under this chapter, an organization must submit to the commissioner an application in the form required by the commissioner. The application must include: (1) for an applicant that is publicly held, the name of each shareholder or owner of more than five percent of any of […]
4202.005
(a) An independent review organization shall biennially submit the information required in an application for certification under Section 4202.004. Anytime there is a material change in the information the organization included in the application, the organization shall submit updated information to the commissioner. (b) The commissioner shall designate biennially each organization that meets the standards […]
4202.002
(a) The commissioner shall adopt standards and rules for: (1) the certification, selection, and operation of independent review organizations to perform independent review described by Subchapter I, Chapter 4201; and (2) the suspension and revocation of the certification. (b) The standards adopted under this section must ensure: (1) the timely response of an independent review […]
1305.451
(a) An insurance carrier that establishes or contracts with a network shall provide to employers, and the employer shall provide to its employees, an accurate written description of the terms and conditions for obtaining health care within the network’s service area. (b) The written description required under Subsection (a) must be in English, Spanish, and […]
1305.103
(a) A network shall determine the specialty or specialties of doctors who may serve as treating doctors. (b) For each injury, an injured employee shall select a treating doctor from the list of all treating doctors under contract with the network in that service area. (c) An employee who lives within the service area of […]
4201.003
(a) The commissioner may adopt rules to implement this chapter. (b) A rule adopted under this chapter relates only to a person or entity subject to this chapter. (c) Repealed by Acts 2011, 82nd Leg., ch. 1147 (H.B. 1951), § 2.008(11). (d) Repealed by Acts 2011, 82nd Leg., ch. 1147 (H.B. 1951), § 2.008(11). Added […]
1305.101
(a) Except for emergencies and out-of-network referrals, a network shall provide or arrange for health care services only through providers or provider groups that are under contract with or are employed by the network. (b) A network doctor may not serve as a designated doctor or perform a required medical examination, as those terms are […]
1305.352
Repealed by Acts 2009, 81st Leg., Ch. 1330, § 19, eff. Sept. 1, 2009 Added by Acts 2005, 79th Leg., ch. 265, § 4.02, eff. Sept. 1, 2005.
1305.353
(a) The entity performing utilization review shall notify the employee or the employee’s representative, if any, and the requesting provider of a determination made in a utilization review. (b) Notification of an adverse determination must include: (1) the principal reasons for the adverse determination; (2) the clinical basis for the adverse determination; (3) a description […]