reglab/housing_qa huggingface dataset:
TX Govt Code § 533.0029 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0029. Promotion and Principles of Patient-Centered Medical Homes for Recipients

Sec. 533.0029.  PROMOTION AND PRINCIPLES OF PATIENT-CENTERED MEDICAL HOMES FOR RECIPIENTS.  (a)  For purposes of this section, a "patient-centered medical home" means a medical relationship:(1)  between a primary care physician and a child or adult patient in which the physician:(A)  provides comprehensive primary care to the patient; and(B)  facilitates partnerships between the physician, the patient, acute care and other care providers, and, when appropriate, the patient's family; and(2)  that encompasses the following primary principles:(A)  the patient has an ongoing relationship with the physician, who is trained to be the first contact for the patient and to provide continuous and comprehensive care to the patient;(B)  the physician leads a team of individuals at the practice level who are collectively responsible for the ongoing care of the patient;(C)  the physician is responsible for providing all of the care the patient needs or for coordinating with other qualified providers to provide care to the patient throughout the patient's life, including preventive care, acute care, chronic care, and end-of-life care;(D)  the patient's care is coordinated across health care facilities and the patient's community and is facilitated by registries, information technology, and health information exchange systems to ensure that the patient receives care when and where the patient wants and needs the care and in a culturally and linguistically appropriate manner; and(E)  quality and safe care is provided.(b)  The commission shall, to the extent possible, work to ensure that managed care organizations:(1)  promote the development of patient-centered medical homes for recipients; and(2)  provide payment incentives for providers that meet the requirements of a patient-centered medical home.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.02(b), eff. September 28, 2011.|
TX Govt Code § 533.003 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.003. Considerations in Awarding Contracts

Sec. 533.003.  CONSIDERATIONS IN AWARDING CONTRACTS.  (a)  In awarding contracts to managed care organizations, the commission shall:(1)  give preference to organizations that have significant participation in the organization's provider network from each health care provider in the region who has traditionally provided care to Medicaid and charity care patients;(2)  give extra consideration to organizations that agree to assure continuity of care for at least three months beyond the period of Medicaid eligibility for recipients;(3)  consider the need to use different managed care plans to meet the needs of different populations;(4)  consider the ability of organizations to process Medicaid claims electronically; and(5)  in the initial implementation of managed care in the South Texas service region, give extra consideration to an organization that either:(A)  is locally owned, managed, and operated, if one exists; or(B)  is in compliance with the requirements of Section 533.004.(b)  The commission, in considering approval of a subcontract between a managed care organization and a pharmacy benefit manager for the provision of prescription drug benefits under Medicaid, shall review and consider whether the pharmacy benefit manager has been in the preceding three years:(1)  convicted of an offense involving a material misrepresentation or an act of fraud or of another violation of state or federal criminal law;(2)  adjudicated to have committed a breach of contract; or(3)  assessed a penalty or fine in the amount of $500,000 or more in a state or federal administrative proceeding.|Added by Acts 1997, 75th Leg., ch. 1262, Sec. 2, eff. June 20, 1997.  Amended by Acts 1999, 76th Leg., ch. 1447, Sec. 2, eff. June 19, 1999;  Acts 1999, 76th Leg., ch. 1460, Sec. 9.02, eff. Sept. 1, 1999.Amended by: Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.02(c), eff. September 28, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.221, eff. April 2, 2015.|
TX Govt Code § 533.0031 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0031. Medicaid Managed Care Plan Accreditation

Sec. 533.0031.  MEDICAID MANAGED CARE PLAN ACCREDITATION.  (a)  A managed care plan offered by a Medicaid managed care organization must be accredited by a nationally recognized accreditation organization.  The commission may choose whether to require all managed care plans offered by Medicaid managed care organizations to be accredited by the same organization or to allow for accreditation by different organizations.(b)  The commission may use the data, scoring, and other information provided to or received from an accreditation organization in the commission's contract oversight processes.|Added by Acts 2019, 86th Leg., R.S., Ch. 680 (S.B. 2138), Sec. 3, eff. June 10, 2019.Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 5, eff. September 1, 2019.|
TX Govt Code § 533.0035 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0035. Certification by Commission

Sec. 533.0035.  CERTIFICATION BY COMMISSION.  (a)  Before the commission may award a contract under this chapter to a managed care organization, the commission shall evaluate and certify that the organization is reasonably able to fulfill the terms of the contract, including all requirements of applicable federal and state law.(b)  Notwithstanding any other law, the commission may not award a contract under this chapter to a managed care organization that does not receive the certification required under this section.(c)  A managed care organization may appeal a denial of certification by the commission under this section.|Added by Acts 2021, 87th Leg., R.S., Ch. 609 (S.B. 1244), Sec. 1, eff. September 1, 2021.|
TX Govt Code § 533.00511 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.00511. Quality-Based Enrollment Incentive Program for Managed Care Organizations

Sec. 533.00511.  QUALITY-BASED ENROLLMENT INCENTIVE PROGRAM FOR MANAGED CARE ORGANIZATIONS.  (a)  In this section, "potentially preventable event" has the meaning assigned by Section 536.001.(b)  The commission shall create an incentive program that automatically enrolls a greater percentage of recipients who did not actively choose their managed care plan in a managed care plan, based on:(1)  the quality of care provided through the managed care organization offering that managed care plan;(2)  the organization's ability to efficiently and effectively provide services, taking into consideration the acuity of populations primarily served by the organization; and(3)  the organization's performance with respect to exceeding, or failing to achieve, appropriate outcome and process measures developed by the commission, including measures based on potentially preventable events.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 4.03, eff. September 1, 2013.|
TX Govt Code § 533.00515 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.00515. Medication Therapy Management

Sec. 533.00515.  MEDICATION THERAPY MANAGEMENT.  The executive commissioner shall collaborate with Medicaid managed care organizations to implement medication therapy management services to lower costs and improve quality outcomes for recipients by reducing adverse drug events.|Added by Acts 2021, 87th Leg., R.S., Ch. 820 (H.B. 2658), Sec. 4, eff. September 1, 2021.|
TX Govt Code § 533.0052 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0052. Star Health Program: Trauma-Informed Care Training

Sec. 533.0052.  STAR HEALTH PROGRAM:  TRAUMA-INFORMED CARE TRAINING.  (a)  A contract between a managed care organization and the commission for the organization to provide health care services to recipients under the STAR Health program must include a requirement that trauma-informed care training be offered to each contracted physician or provider.(b)  The commission shall encourage each managed care organization providing health care services to recipients under the STAR Health program to make training in post-traumatic stress disorder and attention-deficit/hyperactivity disorder available to a contracted physician or provider within a reasonable time after the date the physician or provider begins providing services under the managed care plan.|Added by Acts 2011, 82nd Leg., R.S., Ch. 371 (S.B. 219), Sec. 3, eff. September 1, 2011.|
TX Govt Code § 533.00521 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.00521. Star Health Program: Health Care for Foster Children

Sec. 533.00521.  STAR HEALTH PROGRAM:  HEALTH CARE FOR FOSTER CHILDREN.  (a)  The commission shall annually evaluate the use of benefits under the Medicaid program in the STAR Health program offered to children in foster care and provide recommendations to the Department of Family and Protective Services and each single source continuum contractor in this state to better coordinate the provision of health care and use of those benefits for children in foster care.(b)  In conducting the evaluation required under Subsection (a), the commission shall:(1)  collaborate with residential child-care providers regarding any unmet needs of children in foster care and the development of capacity for providing quality medical, behavioral health, and other services for children in foster care; and(2)  identify options to obtain federal matching funds under the Medical Assistance Program to pay for a safe home-like or community-based residential setting for a child in the conservatorship of the Department of Family and Protective Services: (A)  who is identified or diagnosed as having a serious behavioral or mental health condition that requires intensive treatment;(B)  who is identified as a victim of serious abuse or serious neglect; (C)  for whom a traditional substitute care placement contracted for or purchased by the department is not available or would further denigrate the child's behavioral or mental health condition; or(D)  for whom the department determines a safe home-like or community-based residential placement could stabilize the child's behavioral or mental health condition in order to return the child to a traditional substitute care placement.(c)  The commission shall report its findings to the standing committees of the senate and house of representatives having jurisdiction over the Department of Family and Protective Services.|Added by Acts 2021, 87th Leg., R.S., Ch. 621 (S.B. 1896), Sec. 13(a), eff. June 14, 2021.|
TX Govt Code § 533.00522 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.00522. Star Health Program: Mental Health Providers

Sec. 533.00522.  STAR HEALTH PROGRAM:  MENTAL HEALTH PROVIDERS.  A contract between a Medicaid managed care organization and the commission for the organization to provide health care services to recipients under the STAR Health program must require the organization to ensure the organization maintains a network of mental and behavioral health providers, including child psychiatrists and other appropriate providers, in all Department of Family and Protective Services regions in this state, regardless of whether community-based care has been implemented in any region.|Added by Acts 2021, 87th Leg., R.S., Ch. 621 (S.B. 1896), Sec. 13(b), eff. June 14, 2021.|
TX Govt Code § 533.0053 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0053. Compliance With Texas Health Steps

Sec. 533.0053.  COMPLIANCE WITH TEXAS HEALTH STEPS.  The commission shall encourage each managed care organization providing health care services to a recipient under the STAR Health program to ensure that the organization's network providers comply with the regimen of care prescribed by the Texas Health Steps program under Section 32.056, Human Resources Code, if applicable, including the requirement to provide a mental health screening during each of the recipient's Texas Health Steps medical exams conducted by a network provider.|Added by Acts 2011, 82nd Leg., R.S., Ch. 371 (S.B. 219), Sec. 3, eff. September 1, 2011.|
TX Govt Code § 533.00531 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.00531. Medicaid Benefits for Certain Children Formerly in Foster Care

Sec. 533.00531.  MEDICAID BENEFITS FOR CERTAIN CHILDREN FORMERLY IN FOSTER CARE.  (a)  This section applies only with respect to a child who:(1)  resides in this state; and(2)  is eligible for assistance or services under:(A)  Subchapter D, Chapter 162, Family Code; or(B)  Subchapter K, Chapter 264, Family Code.(b)  Except as provided by Subsection (c), the commission shall ensure that each child described by Subsection (a) remains or is enrolled in the STAR Health program unless or until the child is enrolled in another Medicaid managed care program.(c)  If a child described by Subsection (a) received Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.) or was receiving Supplemental Security Income before becoming eligible for assistance or services under  Subchapter D, Chapter 162, Family Code, or Subchapter K, Chapter 264, Family Code, as applicable, the child may receive Medicaid benefits in accordance with the program established under this subsection.  To the extent permitted by federal law, the commission, in consultation with the Department of Family and Protective Services, shall develop and implement a program that allows the adoptive parent or permanent managing conservator of a child described by this subsection to elect on behalf of the child to receive or, if applicable, continue receiving Medicaid benefits under the:(1)  STAR Health program; or(2)  STAR Kids managed care program.(d)  The commission shall protect the continuity of care for each child described under this section and, if applicable, ensure coordination between the STAR Health program and any other Medicaid managed care program for each child who is transitioning between Medicaid managed care programs.(e)  The executive commissioner shall adopt rules necessary to implement this section.|Added by Acts 2019, 86th Leg., R.S., Ch. 1022 (H.B. 72), Sec. 2, eff. September 1, 2019.|
TX Govt Code § 533.0054 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0054. Health Screening Requirements for Enrollee Under Star Health Program

Sec. 533.0054.  HEALTH SCREENING REQUIREMENTS FOR ENROLLEE UNDER STAR HEALTH PROGRAM.  (a)  A managed care organization that contracts with the commission to provide health care services to recipients under the STAR Health program must ensure that enrollees receive a complete early and periodic screening, diagnosis, and treatment checkup in accordance with the requirements specified in the contract between the managed care organization and the commission.(b)  The commission shall include a provision in a contract with a managed care organization to provide health care services to recipients under the STAR Health program specifying progressive monetary penalties for the organization's failure to comply with Subsection (a).|Added by Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 24(a), eff. September 1, 2017.|
TX Govt Code § 533.0056 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0056. Star Health Program: Notification of Placement Change

Sec. 533.0056.  STAR HEALTH PROGRAM:  NOTIFICATION OF PLACEMENT CHANGE.  A contract between a managed care organization and the commission for the organization to provide health care services to recipients under the STAR Health program must require the organization to ensure continuity of care for a child whose placement has changed by:(1)  notifying each specialist treating the child of the placement change; and(2)  coordinating the transition of care from the child's previous treating primary care physician and treating specialists to the child's new treating primary care physician and treating specialists, if any.|Added by Acts 2017, 85th Leg., R.S., Ch. 317 (H.B. 7), Sec. 40(a), eff. September 1, 2017.Added by Acts 2017, 85th Leg., R.S., Ch. 319 (S.B. 11), Sec. 25(a), eff. September 1, 2017.|
TX Govt Code § 533.006 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.006. Provider Networks

Sec. 533.006.  PROVIDER NETWORKS.  (a)  The commission shall require that each managed care organization that contracts with the commission to provide health care services to recipients in a region:(1)  seek participation in the organization's provider network from:(A)  each health care provider in the region who has traditionally provided care to recipients;(B)  each hospital in the region that has been designated as a disproportionate share hospital under Medicaid; and(C)  each specialized pediatric laboratory in the region, including those laboratories located in children's hospitals; and(2)  include in its provider network for not less than three years:(A)  each health care provider in the region who:(i)  previously provided care to Medicaid and charity care recipients at a significant level as prescribed by the commission;(ii)  agrees to accept the prevailing provider contract rate of the managed care organization; and(iii)  has the credentials required by the managed care organization, provided that lack of board certification or accreditation by The Joint Commission may not be the sole ground for exclusion from the provider network;(B)  each accredited primary care residency program in the region; and(C)  each disproportionate share hospital designated by the commission as a statewide significant traditional provider.(b)  A contract between a managed care organization and the commission for the organization to provide health care services to recipients in a health care service region that includes a rural area must require that the organization include in its provider network rural hospitals, physicians, home and community support services agencies, and other rural health care providers who:(1)  are sole community providers;(2)  provide care to Medicaid and charity care recipients at a significant level as prescribed by the commission;(3)  agree to accept the prevailing provider contract rate of the managed care organization; and(4)  have the credentials required by the managed care organization, provided that lack of board certification or accreditation by The Joint Commission may not be the sole ground for exclusion from the provider network.|Added by Acts 1997, 75th Leg., ch. 1262, Sec. 2, eff. June 20, 1997.  Amended by Acts 1999, 76th Leg., ch. 1447, Sec. 5, eff. June 19, 1999;  Acts 1999, 76th Leg., ch. 1460, Sec. 9.05, eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.225, eff. April 2, 2015.|
TX Govt Code § 533.0061 (2021)
2021 Texas Statutes|Government Code|Title 4 - Executive Branch|Subtitle I - Health and Human Services|Chapter 533 - Medicaid Managed Care Program|Subchapter A. General Provisions|Section 533.0061. Provider Access Standards; Report

Sec. 533.0061.  PROVIDER ACCESS STANDARDS; REPORT.  (a)  The commission shall establish minimum provider access standards for the provider network of a managed care organization that contracts with the commission to provide health care services to recipients.  The access standards must ensure that a managed care organization provides recipients sufficient access to:(1)  preventive care;(2)  primary care;(3)  specialty care;(4)  after-hours urgent care;(5)  chronic care;(6)  long-term services and supports;(7)  nursing services;(8)  therapy services, including services provided in a clinical setting or in a home or community-based setting; and(9)  any other services identified by the commission.(b)  To the extent it is feasible, the provider access standards established under this section must:(1)  distinguish between access to providers in urban and rural settings;(2)  consider the number and geographic distribution of Medicaid-enrolled providers in a particular service delivery area; and(3)  subject to Section 531.0216(c) and consistent with Section 111.007, Occupations Code, consider and include the availability of telehealth services and telemedicine medical services within the provider network of a Medicaid managed care organization.(c)  The commission shall biennially submit to the legislature and make available to the public a report containing information and statistics about recipient access to providers through the provider networks of the managed care organizations and managed care organization compliance with contractual obligations related to provider access standards established under this section.  The report must contain:(1)  a compilation and analysis of information submitted to the commission under Section 533.005(a)(20)(D);(2)  for both primary care providers and specialty providers, information on provider-to-recipient ratios in an organization's provider network, as well as benchmark ratios to indicate whether deficiencies exist in a given network; and(3)  a description of, and analysis of the results from, the commission's monitoring process established under Section 533.007(l).|Added by Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 5, eff. September 1, 2015.Amended by: Acts 2021, 87th Leg., R.S., Ch. 624 (H.B. 4), Sec. 4, eff. June 15, 2021.|