| (a) Each HCC must implement and maintain a complaint
system that complies with Insurance Code §848.107 and this division
that provides reasonable procedures for resolving an oral or written
complaint initiated by a complainant concerning the HCC or health
care services arranged by, or offered through, the HCC.
(b) For purposes of this subchapter, a complaint is
any oral or written expression of dissatisfaction by a complainant
to an HCC regarding any aspect of the HCC's operation.
(c) The HCC's complaint system must address a complaint
initiated:
(1) by or on behalf of a patient who sought or received
health care services by a participant; or
(2) by a participant.
(d) The complaint system for complaints initiated by
or on behalf of patients must include a process for the notice and
appeal of a complaint.
(e) The commissioner has discretion to examine a complaint
system for compliance with Insurance Code §848.107 and this subchapter
and will require the HCC to make corrections that the commissioner
considers necessary.
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