The board must accept and process complaints against certain health organizations and keep related investigative information confidential. It may also dispose of or resolve complaints in another chapter’s manner if the board decides that chapter can apply.
Sec. 162.004. PROCEDURES FOR AND DISPOSITION OF COMPLAINTS AGAINST CERTAIN HEALTH ORGANIZATIONS. (a) The board shall accept and process complaints against a health organization certified under Section 162.001(b) for alleged violations of this subchapter or any other provision of this subtitle applicable to a health organization in the same manner as provided under Subchapter B, Chapter 154, and the rules adopted under that subchapter, including the requirements to: (1) maintain a system to promptly and efficiently act on complaints filed with the board; (2) with respect to a health organization that is the subject of a complaint, notify the health organization that a complaint has been filed, disclose the nature of the complaint, and provide the health organization with an opportunity to respond to the complaint; (3) ensure that a complaint is not dismissed without appropriate consideration; and (4) establish methods by which physicians employed by a health organization are notified of the name, mailing address, and telephone number of the board for the purpose of directing complaints under this section to the board. (b) Each complaint, adverse report, investigation file, other investigation report, and other investigative information in the possession of or received or gathered by the board or the board's employees or agents relating to a health organization certified under Section 162.001(b) is privileged and confidential and is not subject to discovery, subpoena, or other means of legal compulsion for release to anyone other than the board or the board's employees or agents involved in the investigation or discipline of a health organization certified under Section 162.001(b). (c) The board may dispose of a complaint or resolve the investigation of a complaint under this section in a manner provided under Subchapter A, Chapter 164, to the extent the board determines the provisions of that subchapter can be made applicable to a health organization certified under Section 162.001. (d) This section does not require an individual to file or prohibit an individual from filing a complaint against a health organization certified under Section 162.001(b) directly with the health organization, alone or in connection with a complaint filed with the board under this section, relating to: (1) the care or services provided by, or the policies of, the health organization; or (2) an alleged violation by the health organization of this subchapter or any other provision of this subtitle applicable to the health organization. Added by Acts 2019, 86th Leg., R.S., Ch. 771 (H.B. 1532), Sec. 2, eff. September 1, 2019.