Texas § IN.4201.303 - ADVERSE DETERMINATION
Full text of Texas The Texas Constitution § IN.4201.303 — ADVERSE DETERMINATION, with citation guidance and answers to common questions.
§ IN.4201.303. ADVERSE DETERMINATION
ADVERSE DETERMINATION: CONTENTS OF NOTICE. (a) Notice of an adverse determination must include: (1) the principal reasons for the adverse determination; (2) the clinical basis for the adverse determination; (3) a description of and the source of the screening criteria and review procedures used as guidelines in making the adverse determination; and (4) a description of the procedure for the complaint and appeal process, including notice to the enrollee of the enrollee's right to appeal an adverse determination to an independent review organization and of the procedures to obtain that review. (b) For an enrollee who has a life-threatening condition, the notice required by Subsection (a)(4) must include a description of the enrollee's right to an immediate review by an independent review organization and of the procedures to obtain that review. (c) For an enrollee who is denied the provision of prescription drugs or intravenous infusions for which the patient is receiving benefits under the health insurance policy, the notice required by Subsection (a)(4) must include a description of the enrollee's right to an immediate review by an independent review organization and of the procedures to obtain that review. Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017 ), Sec. 4, eff. April 1, 2007. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1037 (H.B. 1621 ), Sec. 3, eff. September 1, 2015. Acts 2025, 89th Leg., R.S., Ch. 989 (S.B. 815 ), Sec. 3, eff. September 1, 2025.
Frequently Asked Questions About Texas § IN.4201.303
What does The Texas Constitution § IN.4201.303 cover?
Section IN.4201.303 ("ADVERSE DETERMINATION") is part of the The Texas Constitution, the codified statutory law of Texas. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Texas § IN.4201.303?
A common citation format is "The Texas Constitution § IN.4201.303" (Texas). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Texas law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Texas official source linked on this page or consult a licensed Texas attorney.
How does Texas § IN.4201.303 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Texas can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Texas.