| (2) Not later than the 60th day after HHSC receives
a provider complaint, HHSC notifies the provider who initiated the
complaint of the conclusions of HHSC's investigation into the complaint.
The notification to the complaining provider will include a description
of the corrective action plan, if required, that HHSC has initiated
under subsection (g) of this section.
(3) Provider complaints regarding reimbursement rates
should be submitted to the Texas Department of Insurance.
(g) Corrective action plan.
(1) HHSC initiates a corrective action plan with an
MCO if HHSC determines through investigation that:
(A) the MCO did not comply with the out-of-network
utilization standards for health care services and dental services
described in subsection (d) of this section; and
(B) HHSC has not granted a special consideration under
subsection (d)(3).
(2) HHSC may impose other contractual remedies as appropriate.
(h) Application to Pharmacy Providers. The requirements
of this section do not apply to providers of outpatient pharmacy benefits.
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