Tex. Ins. Code § 843.306 · Subchapter I. RELATIONS WITH PHYSICIANS AND PROVIDERS
TERMINATION OF PARTICIPATION; ADVISORY REVIEW PANEL.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) Before terminating a contract with a physician or provider, a health maintenance organization shall provide to the physician or provider a written explanation of the reasons for termination.
(b) On request, before the effective date of the termination and within a period not to exceed 60 days, a physician or provider is entitled to a review by an advisory review panel of the health maintenance organization's proposed termination, except in a case involving:
(1) imminent harm to patient health;
(2) an action by a state medical or dental board, another medical or dental licensing board, or another licensing board or government agency that effectively impairs the physician's or provider's ability to practice medicine, dentistry, or another profession; or
(3) fraud or malfeasance.
(c) An advisory review panel must:
(1) be composed of physicians and providers who are appointed to serve on the standing quality assurance committee or utilization review committee of the health maintenance organization; and
(2) include, if available, at least one representative of the physician's or provider's specialty or a similar specialty.
(d) The health maintenance organization must consider, but is not bound by, the recommendation of the advisory review panel.
(e) The health maintenance organization on request shall provide to the affected physician or provider a copy of the recommendation of the advisory review panel and the health maintenance organization's determination.
(f) A health maintenance organization may not terminate participation of a physician or provider solely because the physician or provider informs an enrollee of the full range of physicians and providers available to the enrollee, including out-of-network providers.
Notes and commentary — not statutory text
History
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 275 (H.B. 574), Sec. 2, eff. September 1, 2015.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm
- Text hash
- sha256 531002afe2de6ae8c8cd3b289c11d9b93ed3460df5de1d0a4e865c0b1663df72
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 1 provision
Provisions in this library whose text cites Tex. Ins. Code § 843.306. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.