Texas Insurance Code
§ 843.102 — HEALTH MAINTENANCE ORGANIZATION QUALITY ASSURANCE
IN § 843.102Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES · Part C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES · Ch. 843. HEALTH MAINTENANCE ORGANIZATIONS · Art. D. GENERAL POWERS AND DUTIES OF HEALTH MAINTENANCE ORGANIZATIONS
Statute text
View on source(a)A health maintenance organization shall establish procedures to ensure that health care services are provided to enrollees under reasonable standards of quality of care that are consistent with prevailing professionally recognized standards of medical practice. The procedures must include mechanisms to ensure availability, accessibility, quality, and continuity of care.
(b)A health maintenance organization shall operate a continuing internal quality assurance program to monitor and evaluate its health care services, including primary and specialist physician services and ancillary and preventive health care services, in all institutional and noninstitutional settings.
(c)The commissioner by rule may establish minimum standards and requirements for the quality assurance programs, including standards for ensuring availability, accessibility, quality, and continuity of care.
(d)A health maintenance organization shall record formal proceedings of quality assurance program activities and maintain documentation in a confidential manner. The health maintenance organization shall make the quality assurance program minutes available to the commissioner.
(e)A health maintenance organization shall establish and maintain a physician review panel to assist in:
(1)reviewing medical guidelines or criteria; and
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Legislative history
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.