Section 13.491 - Complaint Systems(a) Each HCC must implement and maintain a complaint system that complies with Insurance Code § 848.107 and this division that provides reasonable procedures for resolving an oral or written complaint initiated by a complainant concerning the HCC or health care services arranged by, or offered through, the HCC.(b) For purposes of this subchapter, a complaint is any oral or written expression of dissatisfaction by a complainant to an HCC regarding any aspect of the HCC's operation.(c) The HCC's complaint system must address a complaint initiated:(1) by or on behalf of a patient who sought or received health care services by a participant; or(d) The complaint system for complaints initiated by or on behalf of patients must include a process for the notice and appeal of a complaint.(e) The commissioner has discretion to examine a complaint system for compliance with Insurance Code § 848.107 and this subchapter and will require the HCC to make corrections that the commissioner considers necessary.28 Tex. Admin. Code § 13.491
The provisions of this §13.491 adopted to be effective March 31, 2013, 38 TexReg 2100