Texas law on any date › Insurance Code
Insurance Code §843.306
In force on Sep 01, 2015 · this text took effect Sep 01, 2015 · same as today's text
TERMINATION OF PARTICIPATION; ADVISORY REVIEW PANEL
(a) Before terminating a contract with a physician or provider, a health maintenance organization shall provide to the physician or provider a written explanation of the reasons for termination.
(b) On request, before the effective date of the termination and within a period not to exceed 60 days, a physician or provider is entitled to a review by an advisory review panel of the health maintenance organization's proposed termination, except in a case involving:
(1) imminent harm to patient health;
(2) an action by a state medical or dental board, another medical or dental licensing board, or another licensing board or government agency that effectively impairs the physician's or provider's ability to practice medicine, dentistry, or another profession; or
(3) fraud or malfeasance.
(c) An advisory review panel must:
(1) be composed of physicians and providers who are appointed to serve on the standing quality assurance committee or utilization review committee of the health maintenance organization; and
(2) include, if available, at least one representative of the physician's or provider's specialty or a similar specialty.
(d) The health maintenance organization must consider, but is not bound by, the recommendation of the advisory review panel.
(e) The health maintenance organization on request shall provide to the affected physician or provider a copy of the recommendation of the advisory review panel and the health maintenance organization's determination.
(f) A health maintenance organization may not terminate participation of a physician or provider solely because the physician or provider informs an enrollee of the full range of physicians and providers available to the enrollee, including out-of-network providers.
History: Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003. Amended by: Acts 2015, 84th Leg., R.S., Ch. 275 (H.B. 574 ), Sec. 2, eff. September 1, 2015.
Source: the Legislature's file server, seen Nov 08, 2026.
Every version on file
- Effective Sep 01, 2015 · seen Nov 2026–Nov 2026
Attorney General opinions that cite it
- KP-0036 (May 01, 2015): Whether sections 843.306 and 1301.057 of the Insurance Code apply to a pharmacy benefit manager acting on behalf of a health maintenance organization or a preferred provider organization
A research copy. The official text is the Legislature's (statutes), the Secretary of State's (Texas Administrative Code) or eCFR's (federal rules). Not legal advice.