reglab/housing_qa huggingface dataset:
TX Govt Code § 531.0225 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.0225. Mental Health and Substance Abuse Services

Sec. 531.0225.  MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES.  (a)  To ensure appropriate delivery of mental health and substance abuse services, the commission shall regularly evaluate program contractors and subcontractors that provide or arrange for the services for persons enrolled in:(1)  the Medicaid managed care program;  and(2)  the state child health plan program.(b)  The commission shall monitor:(1)  penetration rates, as they relate to mental health and substance abuse services provided by or through contractors and subcontractors;(2)  utilization rates, as they relate to mental health and substance abuse services provided by or through contractors and subcontractors;  and(3)  provider networks used by contractors and subcontractors to provide mental health or substance abuse services.|Added by Acts 2003, 78th Leg., ch. 358, Sec. 2, eff. June 18, 2003.Renumbered from Government Code, Section 531.0224 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(32), eff. September 1, 2005.|
TX Govt Code § 531.02251 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.02251. Ombudsman for Behavioral Health Access to Care

Sec. 531.02251.  OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE.  (a) In this section, "ombudsman" means the individual designated as the ombudsman for behavioral health access to care.(b)  The executive commissioner shall designate an ombudsman for behavioral health access to care.(c)  The ombudsman is administratively attached to the office of the ombudsman for the commission.(d)  The commission may use an alternate title for the ombudsman in consumer-facing materials if the commission determines that an alternate title would be beneficial to consumer understanding or access.(e)  The ombudsman serves as a neutral party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders.(f)  The ombudsman shall:(1)  interact with consumers and behavioral health care providers with concerns or complaints to help the consumers and providers resolve behavioral health care access issues;(2)  identify, track, and help report potential violations of state or federal rules, regulations, or statutes concerning the availability of, and terms and conditions of, benefits for mental health conditions or substance use disorders, including potential violations related to quantitative and nonquantitative treatment limitations;(3)  report concerns, complaints, and potential violations described by Subdivision (2) to the appropriate regulatory or oversight agency;(4)  receive and report concerns and complaints relating to inappropriate care or mental health commitment;(5)  provide appropriate information to help consumers obtain behavioral health care;(6)  develop appropriate points of contact for referrals to other state and federal agencies; and(7)  provide appropriate information to help consumers or providers file appeals or complaints with the appropriate entities, including insurers and other state and federal agencies.(g)  The ombudsman shall participate in the mental health condition and substance use disorder parity work group established under Section 531.02252 and provide summary reports of concerns, complaints, and potential violations described by Subsection (f)(2) to the work group.  This subsection expires September 1, 2021.(h)  The Texas Department of Insurance shall appoint a liaison to the ombudsman to receive reports of concerns, complaints, and potential violations described by Subsection (f)(2) from the ombudsman, consumers, or behavioral health care providers.|Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 1, eff. September 1, 2017.|For expiration of this section, see Subsection (h).
TX Govt Code § 531.02253 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.02253. Telehealth Treatment for Substance Use Disorders

Sec. 531.02253.  TELEHEALTH TREATMENT FOR SUBSTANCE USE DISORDERS.  The executive commissioner by rule shall establish a program to increase opportunities and expand access to telehealth treatment for substance use disorders in this state.|Added by Acts 2019, 86th Leg., R.S., Ch. 1167 (H.B. 3285), Sec. 3, eff. September 1, 2019.|
TX Govt Code § 531.0226 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.0226. Chronic Health Conditions Services Medicaid Waiver Program

Sec. 531.0226.  CHRONIC HEALTH CONDITIONS SERVICES MEDICAID WAIVER PROGRAM.  (a)  If feasible and cost-effective, the commission may apply for a waiver from the federal Centers for Medicare and Medicaid Services or another appropriate federal agency to more efficiently leverage the use of state and local funds in order to maximize the receipt of federal Medicaid matching funds by providing benefits under Medicaid to individuals who:(1)  meet established income and other eligibility criteria; and(2)  are eligible to receive services through the county for chronic health conditions.(b)  In establishing the waiver program under this section, the commission shall:(1)  ensure that the state is a prudent purchaser of the health care services that are needed for the individuals described by Subsection (a);(2)  solicit broad-based input from interested persons;(3)  ensure that the benefits received by an individual through the county are not reduced once the individual is enrolled in the waiver program; and(4)  employ the use of intergovernmental transfers and other procedures to maximize the receipt of federal Medicaid matching funds.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 4 (S.B. 1), Sec. 71.01, eff. September 28, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.044, eff. April 2, 2015.|
TX Govt Code § 531.0227 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.0227. Person First Respectful Language Promotion

Sec. 531.0227.  PERSON FIRST RESPECTFUL LANGUAGE PROMOTION.  The executive commissioner shall ensure that the commission and each health and human services agency use the terms and phrases listed as preferred under the person first respectful language initiative in Chapter 392 when proposing, adopting, or amending the commission's or agency's rules, reference materials, publications, and electronic media.|Added by Acts 2011, 82nd Leg., R.S., Ch. 272 (H.B. 1481), Sec. 3, eff. September 1, 2011.|
TX Govt Code § 531.023 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.023. Submission of Plans and Updates by Agencies

Sec. 531.023.  SUBMISSION OF PLANS AND UPDATES BY AGENCIES.  (a)  All health and human services agencies shall submit to the commission strategic plans and biennial updates on a date to be determined by commission rule.  The commission shall review and comment on the strategic plans and biennial updates.(b)  Not later than January 1 of each even-numbered year, the commission shall begin formal discussions with each health and human services agency regarding that agency's strategic plan or biennial update.|Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept. 1, 1995.  Amended by Acts 1997, 75th Leg., ch. 165, Sec. 14.05(a), eff. Sept. 1, 1997.|
TX Govt Code § 531.0241 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.0241. Streamlining Delivery of Services

Sec. 531.0241.  STREAMLINING DELIVERY OF SERVICES.  To integrate and streamline service delivery and facilitate access to services, the executive commissioner may request a health and human services agency to take a specific action and may recommend the manner in which the streamlining is to be accomplished, including requesting each health and human services agency to:(1)  simplify agency procedures;(2)  automate agency procedures;(3)  coordinate service planning and management tasks between and among health and human services agencies;(4)  reallocate staff resources;(5)  waive existing rules; or(6)  take other necessary actions.|Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.07(a), eff. Sept. 1, 1997.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.047, eff. April 2, 2015.|
TX Govt Code § 531.02411 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.02411. Streamlining Administrative Processes

Sec. 531.02411.  STREAMLINING ADMINISTRATIVE PROCESSES.  The commission shall make every effort using the commission's existing resources to reduce the paperwork and other administrative burdens placed on Medicaid recipients and providers and other participants in Medicaid and shall use technology and efficient business practices to decrease those burdens.  In addition, the commission shall make every effort to improve the business practices associated with the administration of Medicaid by any method the commission determines is cost-effective, including:(1)  expanding the utilization of the electronic claims payment system;(2)  developing an Internet portal system for prior authorization requests;(3)  encouraging Medicaid providers to submit their program participation applications electronically;(4)  ensuring that the Medicaid provider application is easy to locate on the Internet so that providers may conveniently apply to the program;(5)  working with federal partners to take advantage of every opportunity to maximize additional federal funding for technology in Medicaid; and(6)  encouraging the increased use of medical technology by providers, including increasing their use of:(A)  electronic communications between patients and their physicians or other health care providers;(B)  electronic prescribing tools that provide up-to-date payer formulary information at the time a physician or other health care practitioner writes a prescription and that support the electronic transmission of a prescription;(C)  ambulatory computerized order entry systems that facilitate physician and other health care practitioner orders at the point of care for medications and laboratory and radiological tests;(D)  inpatient computerized order entry systems to reduce errors, improve health care quality, and lower costs in a hospital setting;(E)  regional data-sharing to coordinate patient care across a community for patients who are treated by multiple providers; and(F)  electronic intensive care unit technology to allow physicians to fully monitor hospital patients remotely.|Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 4(a), eff. September 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.048, eff. April 2, 2015.|
TX Govt Code § 531.024115 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024115. Service Delivery Area Alignment

Sec. 531.024115.  SERVICE DELIVERY AREA ALIGNMENT.  Notwithstanding Section 533.0025(e) or any other law, to the extent possible, the commission shall align service delivery areas under Medicaid and the child health plan program.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 6.03, eff. September 1, 2013.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.049, eff. April 2, 2015.|
TX Govt Code § 531.02412 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.02412. Service Delivery Audit Mechanisms

Sec. 531.02412.  SERVICE DELIVERY AUDIT MECHANISMS.  (a)  The commission shall make every effort to ensure the integrity of Medicaid.  To ensure that integrity, the commission shall:(1)  perform risk assessments of every element of the program and audit those elements of the program that are determined to present the greatest risks;(2)  ensure that sufficient oversight is in place for the Medicaid medical transportation program;(3)  ensure that a quality review assessment of the Medicaid medical transportation program occurs; and(4)  evaluate Medicaid with respect to use of the metrics developed through the Texas Health Steps performance improvement plan to guide changes and improvements to the program.|Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 4(a), eff. September 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 32(f), eff. September 1, 2008.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.050, eff. April 2, 2015.|
TX Govt Code § 531.024131 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024131. Expansion of Billing Coordination and Information Collection Activities

Sec. 531.024131.  EXPANSION OF BILLING COORDINATION AND INFORMATION COLLECTION ACTIVITIES.  (a)  If cost-effective, the commission may:(1)  contract to expand all or part of the billing coordination system established under Section 531.02413 to process claims for services provided through other benefits programs administered by the commission or a health and human services agency;(2)  expand any other billing coordination tools and resources used to process claims for health care services provided through Medicaid to process claims for services provided through other benefits programs administered by the commission or a health and human services agency; and(3)  expand the scope of persons about whom information is collected under Section 32.042, Human Resources Code, to include recipients of services provided through other benefits programs administered by the commission or a health and human services agency.(b)  Notwithstanding any other state law, each health and human services agency shall provide the commission with any information necessary to allow the commission or the commission's designee to perform the billing coordination and information collection activities authorized by this section.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.10, eff. September 28, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.052, eff. April 2, 2015.|
TX Govt Code § 531.024161 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024161. Reimbursement Claims for Certain Medicaid or Child Health Plan Services Involving Supervised Providers

Sec. 531.024161.  REIMBURSEMENT CLAIMS FOR CERTAIN MEDICAID OR CHILD HEALTH PLAN SERVICES INVOLVING SUPERVISED PROVIDERS.  (a)  If a provider, including a nurse practitioner or physician assistant, under Medicaid or the child health plan program provides a referral for or orders health care services for a recipient or enrollee, as applicable, at the direction or under the supervision of another provider, and the referral or order is based on the supervised provider's evaluation of the recipient or enrollee, the names and associated national provider identifier numbers of the supervised provider and the supervising provider must be included on any claim for reimbursement submitted by a provider based on the referral or order.  For purposes of this section, "national provider identifier" means the national provider identifier required under Section 1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)).(b)  The executive commissioner shall adopt rules necessary to implement this section.|Added by Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 2, eff. September 1, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.054, eff. April 2, 2015.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.055, eff. April 2, 2015.|
TX Govt Code § 531.024162 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024162. Notice Requirements Regarding Medicaid Coverage or Prior Authorization Denial and Incomplete Requests

Sec. 531.024162.  NOTICE REQUIREMENTS REGARDING MEDICAID COVERAGE OR PRIOR AUTHORIZATION DENIAL AND INCOMPLETE REQUESTS.  (a)  The commission shall ensure that notice sent by the commission or a Medicaid managed care organization to a Medicaid recipient or provider regarding the denial, partial denial, reduction, or termination of coverage or denial of prior authorization for a service includes:(1)  information required by federal and state law and applicable regulations;(2)  for the recipient:(A)  a clear and easy-to-understand explanation of the reason for the decision, including a clear explanation of the medical basis, applying the policy or accepted standard of medical practice to the recipient's particular medical circumstances;(B)  a copy of the information sent to the provider; and(C)  an educational component that includes a description of the recipient's rights, an explanation of the process related to appeals and Medicaid fair hearings, and a description of the role of an external medical review; and(3)  for the provider, a thorough and detailed clinical explanation of the reason for the decision, including, as applicable, information required under Subsection (b).(b)  The commission or a Medicaid managed care organization that receives from a provider a coverage or prior authorization request that contains insufficient or inadequate documentation to approve the request shall issue a notice to the provider and the Medicaid recipient on whose behalf the request was submitted.  The notice issued under this subsection must:(1)  include a section specifically for the provider that contains:(A)  a clear and specific list and description of the documentation necessary for the commission or organization to make a final determination on the request;(B)  the applicable timeline, based on the requested service, for the provider to submit the documentation and a description of the reconsideration process described by Section 533.00284, if applicable; and(C)  information on the manner through which a provider may contact a Medicaid managed care organization or other entity as required by Section 531.024163; and(2)  be sent:(A)  to the provider:(i)  using the provider's preferred method of communication, to the extent practicable using existing resources; and(ii)  as applicable, through an electronic notification on an Internet portal; and(B)  to the recipient using the recipient's preferred method of communication, to the extent practicable using existing resources.|Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.|
TX Govt Code § 531.024163 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024163. Accessibility of Information Regarding Medicaid Prior Authorization Requirements

Sec. 531.024163.  ACCESSIBILITY OF INFORMATION REGARDING MEDICAID PRIOR AUTHORIZATION REQUIREMENTS.  (a)  The executive commissioner by rule shall require each Medicaid managed care organization or other entity responsible for authorizing coverage for health care services under Medicaid to ensure that the organization or entity maintains on the organization's or entity's Internet website in an easily searchable and accessible format:(1)  the applicable timelines for prior authorization requirements, including:(A)  the time within which the organization or entity must make a determination on a prior authorization request;(B)  a description of the notice the organization or entity provides to a provider and Medicaid recipient on whose behalf the request was submitted regarding the documentation required to complete a determination on a prior authorization request; and(C)  the deadline by which the organization or entity is required to submit the notice described by Paragraph (B); and(2)  an accurate and up-to-date catalogue of coverage criteria and prior authorization requirements, including:(A)  for a prior authorization requirement first imposed on or after September 1, 2019, the effective date of the requirement;(B)  a list or description of any supporting or other documentation necessary to obtain prior authorization for a specified service; and(C)  the date and results of each review of the prior authorization requirement conducted under Section 533.00283, if applicable.(b)  The executive commissioner by rule shall require each Medicaid managed care organization or other entity responsible for authorizing coverage for health care services under Medicaid to:(1)  adopt and maintain a process for a provider or Medicaid recipient to contact the organization or entity to clarify prior authorization requirements or to assist the provider in submitting a prior authorization request; and(2)  ensure that the process described by Subdivision (1) is not arduous or overly burdensome to a provider or recipient.|Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.|
TX Govt Code § 531.024165 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 531 - Health and Human Services Commission|Subchapter B. Powers and Duties|Section 531.024165. Medical Review of Medicaid Service Denials for Foster Care Youth

Sec. 531.024165.  MEDICAL REVIEW OF MEDICAID SERVICE DENIALS FOR FOSTER CARE YOUTH.  (a)  Using existing resources, the commission shall coordinate with the Department of Family and Protective Services to develop and implement a process to review a denial of services under the Medicaid managed care program on the basis of medical necessity for foster care youth.(b)  Not later than December 31, 2022, the commission and the Department of Family and Protective Services shall submit a report to the legislature that includes a summary of the process developed and implemented under Subsection (a).(c)  This section expires September 1, 2023.|Added by Acts 2021, 87th Leg., R.S., Ch. 954 (S.B. 1648), Sec. 1, eff. September 1, 2021.|