§ 1355.2571 — PARITY COMPLAINT PORTAL.

Texas § 1355.2571

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 1355.2571. PARITY COMPLAINT PORTAL. (a) The commissioner shall develop and maintain a parity complaint portal that is an integrated system that allows for the enrollee of a health benefit plan to submit complaints of suspected violations of the provisions of this subchapter. The parity complaint portal must:
(1) allow for an enrollee to submit a complaint through multiple ways;
(2) provide updates on the status of an enrollee's complaint;
(3) ensure timely, effective, and equitable resolution for submitted complaints;
(4) include educational materials regarding:
(A) benefits for mental health conditions and substance use disorders required under this subchapter;
(B) an enrollee's rights and responsibilities under a health benefit plan concerning coverage under this subchapter;
(C) circumstances under which a claim may be denied; and
(D) the processes for reviewing a complaint submitted through the portal;
(5) adhere to national best practices as determined by the commissioner; and
(6) include the findings of the report required by Section 1355.2572 (b).
(b) In developing the parity complaint portal under Subsection (a), the commissioner:
(1) shall conduct an assessment of complaint portals and similar systems used by other relevant public or private entities;
(2) shall develop best practice standards for complaint submissions and tracking consistent with the findings of the assessment conducted under Subdivision (1); and
(3) may develop a new complaint portal or modify an existing complaint portal.
(c) The Health and Human Services Commission shall appoint a liaison to the department to receive reports of concerns, complaints, and potential violations submitted through the parity complaint portal established under Subsection (a).

Legislative History

Added by Acts 2021, 87th Leg., R.S., Ch. 703 (H.B. 2595 ), Sec. 2, eff. September 1, 2021.