Texas § IN.843.261 - SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS
Full text of Texas The Texas Constitution § IN.843.261 — SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS, with citation guidance and answers to common questions.
§ IN.843.261. SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS
SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS. (a) A health maintenance organization shall implement and maintain an internal appeal system that: (1) provides reasonable procedures for the resolution of an oral or written appeal concerning dissatisfaction or disagreement with an adverse determination; and (2) includes procedures for notification, review, and appeal of an adverse determination in accordance with Chapter 4201 . (b) An appeal must be initiated by an enrollee, a person acting on behalf of an enrollee, or an enrollee's provider of record. (c) When an enrollee, a person acting on behalf of an enrollee, or an enrollee's provider of record expresses orally or in writing any dissatisfaction or disagreement with an adverse determination, the health maintenance organization or utilization review agent shall: (1) consider the expression of dissatisfaction or disagreement as an appeal of the adverse determination; and (2) review and resolve the appeal in accordance with Chapter 4201 . (d) A health maintenance organization may integrate its appeal procedures related to adverse determinations with the complaint and appeal procedures established by the health maintenance organization under Section 843.251 and otherwise governed by this subchapter only if the procedures related to adverse determinations comply with this section and Chapter 4201 . Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636 ), Sec. 2E.046, eff. April 1, 2009.
Source: official Texas text · Last verified 2026-08-27
Frequently Asked Questions About Texas § IN.843.261
What does The Texas Constitution § IN.843.261 cover?
Section IN.843.261 ("SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS") 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.843.261?
A common citation format is "The Texas Constitution § IN.843.261" (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.843.261 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.