reglab/housing_qa huggingface dataset:
TX Ins Code § 4201.555 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter L. Confidentiality of Information; Access to Other Information|Section 4201.555. Access to Recorded Personal Information

Sec. 4201.555.  ACCESS TO RECORDED PERSONAL INFORMATION.  (a)  If an individual submits a written request to a utilization review agent for access to recorded personal information concerning the individual, the agent shall, within 10 business days from the date the agent receives the request:(1)  inform the requesting individual in writing of the nature and substance of the recorded personal information; and(2)  allow the individual, at the individual's discretion, to:(A)  view and copy, in person, the recorded personal information concerning the individual; or(B)  obtain a copy of the information by mail.(b)  If the information requested under this section is in coded form, the utilization review agent shall provide in writing an accurate translation of the information in plain language.(c)  A utilization review agent's charges for providing a copy of information requested under this section shall be reasonable, as determined by rule adopted by the commissioner.  The charges may not include any costs otherwise recouped as part of the charges for utilization review.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.556 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter L. Confidentiality of Information; Access to Other Information|Section 4201.556. Publishing Information Identifiable to Health Care Provider

Sec. 4201.556.  PUBLISHING INFORMATION IDENTIFIABLE TO HEALTH CARE PROVIDER.  (a)  A utilization review agent may not publish data that identifies a particular physician or other health care provider, including data in a quality review study or performance tracking data, without providing prior written notice to the physician or other provider.(b)  The prohibition under this section does not apply to internal systems or reports used by the utilization review agent.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.557 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter L. Confidentiality of Information; Access to Other Information|Section 4201.557. Requirement to Maintain Data in Confidential Manner

Sec. 4201.557.  REQUIREMENT TO MAINTAIN DATA IN CONFIDENTIAL MANNER.  A utilization review agent shall maintain all data concerning a patient or physician or other health care provider in a confidential manner that prevents unauthorized disclosure to a third party.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.558 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter L. Confidentiality of Information; Access to Other Information|Section 4201.558. Destruction of Certain Confidential Documents

Sec. 4201.558.  DESTRUCTION OF CERTAIN CONFIDENTIAL DOCUMENTS.  When a utilization review agent determines a document in the custody of the agent that contains confidential patient information or confidential physician or other health care provider financial data is no longer needed, the document shall be destroyed by a method that ensures the complete destruction of the information.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.601 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter M. Enforcement|Section 4201.601. Notice of Suspected Violation; Compelling Production of Information

Sec. 4201.601.  NOTICE OF SUSPECTED VIOLATION; COMPELLING PRODUCTION OF INFORMATION.  If the commissioner believes that a person or entity conducting utilization review is in violation of this chapter or applicable rules, the commissioner:(1)  shall notify the utilization review agent, health maintenance organization, or insurer of the alleged violation; and(2)  may compel the production of documents or other information as necessary to determine whether a violation has occurred.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.602 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter M. Enforcement|Section 4201.602. Enforcement Proceeding

Sec. 4201.602.  ENFORCEMENT PROCEEDING.  (a)  The commissioner may initiate a proceeding under this subchapter.(b)  A proceeding under this chapter is a contested case for purposes of Chapter 2001, Government Code.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.603 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter M. Enforcement|Section 4201.603. Remedies and Penalties for Violation

Sec. 4201.603.  REMEDIES AND PENALTIES FOR VIOLATION.  If the commissioner determines that a utilization review agent, health maintenance organization, insurer, or other person or entity conducting utilization review has violated or is violating this chapter, the commissioner may:(1)  impose a sanction under Chapter 82;(2)  issue a cease and desist order under Chapter 83;  or(3)  assess an administrative penalty under Chapter 84.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.651 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.651. Definitions

Sec. 4201.651.  DEFINITIONS.  (a)  In this subchapter, "preauthorization" means a determination by a health maintenance organization, insurer, or person contracting with a health maintenance organization or insurer that health care services proposed to be provided to a patient are medically necessary and appropriate.(b)  In this subchapter, terms defined by Section 843.002, including "health care services," "physician," and "provider," have the meanings assigned by that section.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.652 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.652. Applicability of Subchapter

Sec. 4201.652.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to:(1)  a health benefit plan offered by a health maintenance organization operating under Chapter 843, except that this subchapter does not apply to:(A)  the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; or(B)  the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;(2)  a preferred provider benefit plan or exclusive provider benefit plan offered by an insurer under Chapter 1301; and(3)  a person who contracts with a health maintenance organization or insurer to issue preauthorization determinations or perform the functions described in this subchapter for a health benefit plan to which this subchapter applies.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.653 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.653. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services

Sec. 4201.653.  EXEMPTION FROM PREAUTHORIZATION REQUIREMENTS FOR PHYSICIANS AND PROVIDERS PROVIDING CERTAIN HEALTH CARE SERVICES.  (a)  A health maintenance organization or an insurer that uses a preauthorization process for health care services may not require a physician or provider to obtain preauthorization for a particular health care service if, in the most recent six-month evaluation period, as described by Subsection (b), the health maintenance organization or insurer has approved or would have approved not less than 90 percent of the preauthorization requests submitted by the physician or provider for the particular health care service.(b)  Except as provided by Subsection (c), a health maintenance organization or insurer shall evaluate whether a physician or provider qualifies for an exemption from preauthorization requirements under Subsection (a) once every six months.(c)  A health maintenance organization or insurer may continue an exemption under Subsection (a) without evaluating whether the physician or provider qualifies for the exemption under Subsection (a) for a particular evaluation period.(d)  A physician or provider is not required to request an exemption under Subsection (a) to qualify for the exemption.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.654 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.654. Duration of Preauthorization Exemption

Sec. 4201.654.  DURATION OF PREAUTHORIZATION EXEMPTION.  (a)  A physician's or provider's exemption from preauthorization requirements under Section 4201.653 remains in effect until:(1)  the 30th day after the date the health maintenance organization or insurer notifies the physician or provider of the health maintenance organization's or insurer's determination to rescind the exemption under Section 4201.655, if the physician or provider does not appeal the health maintenance organization's or insurer's determination; or(2)  if the physician or provider appeals the determination, the fifth  day after the date the independent review organization affirms the health maintenance organization's or insurer's determination to rescind the exemption.(b)  If a health maintenance organization or insurer does not finalize a rescission determination as specified in Subsection (a), then the physician or provider is considered to have met the criteria under Section 4201.653 to continue to qualify for the exemption.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.655 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.655. Denial or Rescission of Preauthorization Exemption

Sec. 4201.655.  DENIAL OR RESCISSION OF PREAUTHORIZATION EXEMPTION.  (a)  A health maintenance organization or insurer may rescind an exemption from preauthorization requirements under Section 4201.653 only:(1)  during January or June of each  year;(2)  if the health maintenance organization or insurer makes a determination, on the basis of a retrospective review of a random sample of not fewer than five and no more than 20 claims submitted by the physician or provider during the most recent evaluation period described by Section 4201.653(b), that less than 90 percent of the claims for the particular health care service met the medical necessity criteria that would have been used by the health maintenance organization or insurer when conducting preauthorization review for the particular health care service during the relevant evaluation period; and(3)  if the health maintenance organization or insurer complies with other applicable requirements specified in this section, including:(A)  notifying the physician or provider not less than 25 days before the proposed rescission is to take effect; and(B)  providing with the notice under Paragraph (A):(i)  the sample information used to make the determination under Subdivision (2); and(ii)  a plain language explanation of how the physician or provider may appeal and seek an independent review of the determination.(b)  A determination made under Subsection (a)(2) must be made by an individual licensed to practice medicine in this state.  For a determination made under Subsection (a)(2) with respect to a physician, the determination must be made by an individual licensed to practice medicine in this state who has the same or similar specialty as that physician.(c)  A health maintenance organization or insurer may deny an exemption from preauthorization requirements under Section 4201.653 only if:(1)  the physician or provider does not have the exemption at the time of the relevant evaluation period; and(2)  the health maintenance organization or insurer provides the physician or provider with actual statistics and data for the relevant preauthorization request evaluation period and detailed information sufficient to demonstrate that the physician or provider does not meet the criteria for an exemption from preauthorization requirements for the particular health care service under Section 4201.653.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.656 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.656. Independent Review of Exemption Determination

Sec. 4201.656.  INDEPENDENT REVIEW OF EXEMPTION DETERMINATION.  (a)  A physician or provider has a right to a review of an adverse determination regarding a preauthorization exemption be conducted by an independent review organization. A health maintenance organization or insurer may not require a physician or provider to engage in an internal appeal process before requesting a review by an independent review organization under this section.(b)  A health maintenance organization or insurer shall pay:(1)  for any appeal or independent review of an adverse determination regarding a preauthorization exemption requested under this section; and(2)  a reasonable fee determined by the Texas Medical Board for any copies of medical records or other documents requested from a physician or provider during an exemption rescission review requested under this section.(c)  An independent review organization must complete an expedited review of an adverse determination regarding a preauthorization exemption not later than the 30th day after the date a physician or provider files the request for a review under this section.(d)  A physician or provider may request that the independent review organization consider another random sample of not less than five and no more than 20 claims submitted to the health maintenance organization or insurer by the physician or provider during the relevant evaluation period for the relevant health care service as part of its review.  If the physician or provider makes a request under this subsection, the independent review organization shall base its determination on the medical necessity of claims reviewed by the health maintenance organization or insurer under Section 4201.655 and reviewed under this subsection.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.657 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.657. Effect of Appeal or Independent Review Determination

Sec. 4201.657.  EFFECT OF APPEAL OR INDEPENDENT REVIEW DETERMINATION.  (a)  A health maintenance organization or insurer is bound by an appeal or independent review determination that does not affirm the determination made by the health maintenance organization or insurer to rescind a preauthorization exemption.(b)  A health maintenance organization or insurer may not retroactively deny a health care service on the basis of a rescission of an exemption, even if the health maintenance organization's or insurer's determination to rescind the preauthorization exemption is affirmed by an independent review organization.(c)  If a determination of a preauthorization exemption made by the health maintenance organization or insurer is overturned on review by an independent review organization, the health maintenance organization or insurer:(1)  may not attempt to rescind the exemption before the end of the next evaluation period that occurs; and(2)  may only rescind the exemption after if the health maintenance organization or insurer complies with Sections 4201.655 and 4201.656.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 4201.658 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter N. Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services|Section 4201.658. Eligibility for Preauthorization Exemption Following Finalized Exemption Rescission or Denial

Sec. 4201.658.  ELIGIBILITY FOR PREAUTHORIZATION EXEMPTION FOLLOWING FINALIZED EXEMPTION RESCISSION OR DENIAL.  After a final determination or review affirming the rescission or denial of an exemption for a specific health care service under Section 4201.653, a physician or provider is eligible for consideration of an exemption for the same health care service after the six-month evaluation period that follows the evaluation period which formed the basis of the rescission or denial of an exemption.|Added by Acts 2021, 87th Leg., R.S., Ch. 1018 (H.B. 3459), Sec. 5, eff. September 1, 2021.|
TX Ins Code § 6001.001 (2021)
2021 Texas Statutes|Insurance Code|Title 20 - Regulation of Other Occupations|Chapter 6001 - Fire Extinguisher Service and Installation|Subchapter A. General Provisions|Section 6001.001. Purpose

Sec. 6001.001.  PURPOSE.  The purpose of this chapter is to safeguard lives and property by:(1)  regulating:(A)  the leasing, selling, installing, and servicing of portable fire extinguishers; and(B)  the planning, certifying, installing, and servicing of fixed fire extinguisher systems; and(2)  prohibiting portable fire extinguishers, fixed fire extinguisher systems, or extinguisher equipment that is not listed by a testing laboratory approved by the department.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1J.001, eff. April 1, 2009.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 1004 (H.B. 2447), Sec. 2, eff. September 1, 2013.|
TX Ins Code § 6001.002 (2021)
2021 Texas Statutes|Insurance Code|Title 20 - Regulation of Other Occupations|Chapter 6001 - Fire Extinguisher Service and Installation|Subchapter A. General Provisions|Section 6001.002. Definitions

Sec. 6001.002.  DEFINITIONS.  In this chapter:(1)  "Firm" means an individual, partnership, corporation, or association.(2)  "Fixed fire extinguisher system" means an assembly of piping, conduits, or containers that convey liquid, powder, or gases to dispersal openings or devices protecting one or more hazards by suppressing or extinguishing fires.(3)  "Hydrostatic testing" means pressure testing by hydrostatic methods.(4)  "Insurance agent" means:(A)  an individual, firm, or corporation licensed under:(i)  Subchapter E, Chapter 981; or(ii)  Subchapter A, B, C, D, E, or G, Chapter 4051; or(B)  an individual authorized to represent an insurance fund or pool created by a municipality, county, or other political subdivision of this state under Chapter 791, Government Code.(5)  "Portable fire extinguisher" means any device that contains liquid, powder, or gases for suppressing or extinguishing fires.(5-a)  "Portable fire extinguisher inspection" means a monthly inspection to ensure that a portable fire extinguisher:(A)  is in the extinguisher's designated location;(B)  has not been actuated or subject to tampering; and(C)  does not have any obvious physical damage or another condition that may prevent proper operation of the extinguisher.(6)  "Registered firm" means a firm that holds a registration certificate.(7)  "Service" and "servicing" mean servicing a portable fire extinguisher or a fixed fire extinguisher system by charging, filling, maintaining, recharging, refilling, repairing, or testing.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1J.001, eff. April 1, 2009.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 450 (S.B. 1598), Sec. 1, eff. September 1, 2011.|
TX Ins Code § 6001.051 (2021)
2021 Texas Statutes|Insurance Code|Title 20 - Regulation of Other Occupations|Chapter 6001 - Fire Extinguisher Service and Installation|Subchapter B. Powers and Duties of Commissioner,|Section 6001.051. Administration of Chapter

Sec. 6001.051.  ADMINISTRATION OF CHAPTER.  (a)  The department shall administer this chapter.(b)  The commissioner may issue rules the commissioner considers necessary to administer this chapter through the state fire marshal.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1J.001, eff. April 1, 2009.|
TX Ins Code § 6001.052 (2021)
2021 Texas Statutes|Insurance Code|Title 20 - Regulation of Other Occupations|Chapter 6001 - Fire Extinguisher Service and Installation|Subchapter B. Powers and Duties of Commissioner,|Section 6001.052. Adoption of Rules

Sec. 6001.052.  ADOPTION OF RULES.  (a)  In adopting necessary rules, the commissioner may use recognized standards, including standards:(1)  published by the National Fire Protection Association;(2)  recognized by federal law or regulation;(3)  published by any nationally recognized standards-making organization; or(4)  contained in the manufacturer's installation manuals.(b)  The commissioner shall adopt and administer rules determined essentially necessary for the protection and preservation of life and property regarding:(1)  registration of firms engaged in the business of:(A)  installing or servicing portable fire extinguishers or planning, certifying, installing, or servicing fixed fire extinguisher systems; or(B)  hydrostatic testing of fire extinguisher cylinders;(2)  the examination and licensing of individuals to:(A)  install or service portable fire extinguishers; and(B)  plan, certify, install, or service fixed fire extinguisher systems; and(3)  requirements for:(A)  installing or servicing portable fire extinguishers; and(B)  planning, certifying, installing, or servicing fixed fire extinguisher systems.(c)  The commissioner by rule shall prescribe requirements for applications and qualifications for licenses, permits, and certificates issued under this chapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1J.001, eff. April 1, 2009.|