reglab/housing_qa huggingface dataset:
TX Hum Res Code § 32.047 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.047. Prohibition of Certain Health Care Service Providers

Sec. 32.047.  PROHIBITION OF CERTAIN HEALTH CARE SERVICE PROVIDERS.  (a)  A person is permanently prohibited from providing or arranging to provide health care services under the medical assistance program if:(1)  the person is convicted of an offense arising from a fraudulent act under the program; and(2)  the person's fraudulent act results in injury to an elderly person, as defined by Section 48.002(a)(1), a person with a disability, as defined by Section 48.002(a)(8)(A), or a person younger than 18 years of age.(b)  The executive commissioner shall adopt rules for prohibiting a person from participating in the medical assistance program as a health care provider for a reasonable period, as determined by the executive commissioner, if the person:(1)  fails to repay overpayments under the program; or(2)  owns, controls, manages, or is otherwise affiliated with and has financial, managerial, or administrative influence over a provider who has been suspended or prohibited from participating in the program.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 3.03, eff. Sept. 1, 1997.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 30, eff. September 1, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.|
TX Hum Res Code § 32.048 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.048. Managed Care Information and Training Plan

Sec. 32.048.  MANAGED CARE INFORMATION AND TRAINING PLAN.  (a)  Subject to the availability of funds, the commission shall develop a comprehensive plan to provide information and training about the requirements of a managed care plan to recipients of medical assistance, providers of medical assistance, local health and human services agencies, and other interested parties in each service area in which the commission provides medical assistance through a managed care plan.(b)  The commission shall include in the comprehensive plan:(1)  information and training at regular intervals determined by the commission; and(2)  performance measures to evaluate the effectiveness of the information and training.(c)  In developing the comprehensive plan, the commission shall consult with the Medicaid medical care advisory committee.|Added by Acts 1997, 75th Leg., ch. 618, Sec. 1, eff. June 11, 1997.  Renumbered from Sec. 32.043 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(74), eff. Sept. 1, 1999.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1050 (S.B. 71), Sec. 23(6), eff. September 1, 2011.Acts 2011, 82nd Leg., R.S., Ch. 1083 (S.B. 1179), Sec. 25(108), eff. June 17, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.|
TX Hum Res Code § 32.050 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.050. Dual Medicaid and Medicare Coverage

Sec. 32.050.  DUAL MEDICAID AND MEDICARE COVERAGE.  (a)  At least annually the commission shall identify each individual receiving medical assistance under the medical assistance program who is eligible to receive similar assistance under the Medicare program.(b)  The commission shall analyze claims submitted for payment for a service provided under the medical assistance program to an individual identified under Subsection (a) to ensure that payment is sought first under the Medicare program to the extent allowed by law.(c)  For an ambulance service provided to an individual who is eligible under the medical assistance program and Medicare, the medical assistance program shall pay the Medicare deductibles and coinsurance.(d)  Except as provided by Subsection (e), a nursing facility, a home health services provider, or any other similar long-term care services provider that is Medicare-certified and provides care to individuals who are eligible for Medicare must:(1)  seek reimbursement from Medicare before billing the medical assistance program for services provided to an individual identified under Subsection (a); and(2)  as directed by the commission, appeal Medicare claim denials for payment services provided to an individual identified under Subsection (a).(e)  A home health services provider is not required to seek reimbursement from Medicare before billing the medical assistance program for services provided to a person who is eligible for Medicare and who:(1)  has been determined as not being homebound; or(2)  meets other criteria determined by the executive commissioner.(f)  Repealed by Acts 2005, 79th Leg., Ch. 1067, Sec. 1, eff. June 18, 2005.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.03(a), eff. June 20, 1997.  Amended by Acts 1999, 76th Leg., ch. 710, Sec. 1.  Renumbered from Sec. 32.043 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(76), eff. Sept. 1, 1999;  Acts 2003, 78th Leg., ch. 198, Sec. 2.108, eff. Sept. 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 1067 (H.B. 1502), Sec. 1, eff. June 18, 2005.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.125, eff. April 2, 2015.|
TX Hum Res Code § 32.051 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.051. Misdirected Billing

Sec. 32.051.  MISDIRECTED BILLING.  To the extent authorized by federal law, the commission shall develop a procedure for the state to:(1)  match claims for payment for medical assistance provided under the medical assistance program against data available from other entities, including the United States Department of Veterans Affairs and nursing facilities, to determine alternative responsibility for payment of the claims; and(2)  ensure that the appropriate entity bears the cost of a claim.|Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.03(a), eff. June 20, 1997.  Renumbered from Sec. 32.044 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(77), eff. Sept. 1, 1999.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.126, eff. April 2, 2015.|
TX Hum Res Code § 32.0531 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0531. Pace Program Team

Sec. 32.0531.  PACE PROGRAM TEAM.  (a)  The Department of Aging and Disability Services shall establish a PACE program team composed of experienced personnel.  The team is responsible for:(1)  increasing public attention and awareness of the availability of PACE program sites;(2)  increasing the number of PACE program sites operating in this state; and(3)  serving as a liaison with the state and federal agencies responsible for administering the PACE program, participants in the program, and PACE program sites.(b)  Expired.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1168 (H.B. 2903), Sec. 2, eff. September 1, 2011.|
TX Hum Res Code § 32.0532 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0532. Pace Program Reimbursement Methodology

Sec. 32.0532.  PACE PROGRAM REIMBURSEMENT METHODOLOGY.  (a)  In this section and Sections 32.0533 and 32.0534, "PACE program" means the program of all-inclusive care for the elderly (PACE) established under Section 32.053.(b)  In setting the reimbursement rates under the PACE program, the executive commissioner shall ensure that:(1)  reimbursement rates for providers under the program are adequate to sustain the program; and(2)  the program is cost-neutral or costs less when compared to the cost to serve a population in the STAR + PLUS Medicaid managed care program that is comparable in:(A)  age;(B)  eligibility factors, including:(i)  income level;(ii)  health status; and(iii)  impairment level;(C)  geographic location;(D)  living environment; and(E)  other factors determined to be necessary.(c)  For purposes of Subsection (b)(2), the commission shall consider data on the cost of services provided to comparable recipients enrolled in the STAR + PLUS Medicaid managed care program to calculate the upper payment limit component of the PACE program reimbursement rates.  The cost of those services includes the Medicaid capitation payment per recipient and Medicaid payments made on a fee-for-service basis for services not covered by the capitation payment.|Added by Acts 2015, 84th Leg., R.S., Ch. 823 (H.B. 3823), Sec. 1, eff. June 17, 2015.|
TX Hum Res Code § 32.0533 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0533. Data Collection: Pace and Star + Plus Medicaid Managed Care Programs

Sec. 32.0533.  DATA COLLECTION: PACE AND STAR + PLUS MEDICAID MANAGED CARE PROGRAMS.  The commission, in collaboration with the Department of Aging and Disability Services and appropriate stakeholder groups, shall modify the methods by which the commission and the department collect data for evaluation of the PACE and STAR + PLUS Medicaid managed care programs to allow comparison of recipient outcomes between the programs.  The modification to data collection methods must include changes to:(1)  survey instruments that measure recipient experience;(2)  compilation of the same or similar complaint, disenrollment, and appeals data; and(3)  compilation of the same or similar hospital admissions and readmissions data. |Added by Acts 2015, 84th Leg., R.S., Ch. 823 (H.B. 3823), Sec. 1, eff. June 17, 2015.|
TX Hum Res Code § 32.055 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.055. Catastrophic Case Management

Sec. 32.055.  CATASTROPHIC CASE MANAGEMENT.  (a)  The commission shall develop and implement a catastrophic case management system to be used in providing medical assistance to persons with catastrophic health problems.(b)  The system must provide for the assignment of a case manager to a recipient of medical assistance with catastrophic health problems that are likely to:(1)  require the services of multiple, specialized health care providers;  and(2)  result in major medical costs.(c)  The commission shall identify the services to be provided by a case manager assigned under the system.  The services must include assessment of the recipient's needs and coordination of all available medical services and payment options.  The services may include other support services such as:(1)  assistance with making arrangements to receive care from medical facilities;(2)  assistance with travel and lodging in connection with receipt of medical care;(3)  education of the recipient and the recipient's family members regarding the nature of the recipient's health problems;(4)  referral to appropriate support groups; and(5)  any other service likely to result in better care provided in a cost-effective manner.(d)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1083, Sec. 25(109), eff. June 17, 2011.|Added by Acts 2001, 77th Leg., ch. 408, Sec. 1, eff. Sept. 1, 2001.  Renumbered from Human Resources Code Sec. 32.053 by Acts 2003, 78th Leg., ch. 1275, Sec. 2(99), eff. Sept. 1, 2003.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1050 (S.B. 71), Sec. 23(7), eff. September 1, 2011.Acts 2011, 82nd Leg., R.S., Ch. 1083 (S.B. 1179), Sec. 25(109), eff. June 17, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.130, eff. April 2, 2015.|
TX Hum Res Code § 32.0551 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0551. Optimization of Case Management Systems

Sec. 32.0551.  OPTIMIZATION OF CASE MANAGEMENT SYSTEMS.  The commission shall:(1)  create and coordinate staffing and other administrative efficiencies for case management initiatives across the commission and health and human services agencies; and(2)  optimize federal funding revenue sources and maximize the use of state funding resources for case management initiatives across the commission and health and human services agencies.|Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 8(a), eff. September 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.131, eff. April 2, 2015.|
TX Hum Res Code § 32.056 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.056. Compliance With Texas Health Steps Comprehensive Care Program

Sec. 32.056.  COMPLIANCE WITH TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM.  The executive commissioner by rule shall develop procedures to ensure that recipients of medical assistance who are eligible for Texas Health Steps Comprehensive Care Program comply with the regimen of care prescribed by the program.|Added by Acts 2001, 77th Leg., ch. 584, Sec. 5, eff. Jan. 1, 2002.  Renumbered from Human Resources Code Sec. 32.053 by Acts 2003, 78th Leg., ch. 1275, Sec. 2(100), eff. Sept. 1, 2003.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.131, eff. April 2, 2015.|
TX Hum Res Code § 32.0561 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0561. Maternal Depression Screening

Sec. 32.0561.  MATERNAL DEPRESSION SCREENING.  (a)  In this section, "maternal depression" means depression of any severity with postpartum onset.(b)  The commission shall provide medical assistance reimbursement for a maternal depression screening for a recipient's mother, regardless of whether the mother is also a recipient, that is performed during a covered examination for the recipient under the Texas Health Steps Comprehensive Care Program that occurs before the recipient's first birthday.(c)  The executive commissioner shall adopt rules necessary to implement this section.  The rules must be based on:(1)  clinical and empirical evidence concerning maternal depression; and(2)  information provided by relevant physicians and behavioral health organizations.(d)  The commission shall seek, accept, and spend any federal funds that are available for the purposes of this section, including priority funding authorized by Section 317L-1 of the Public Health Service Act (42 U.S.C. Section 201 et seq.), as added by the 21st Century Cures Act (Pub. L. No. 114-255).|Added by Acts 2017, 85th Leg., R.S., Ch. 852 (H.B. 2466), Sec. 3, eff. September 1, 2017.|
TX Hum Res Code § 32.059 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.059. Use of Respiratory Therapists for Respiratory Therapy Services

Sec. 32.059.  USE OF RESPIRATORY THERAPISTS FOR RESPIRATORY THERAPY SERVICES.  The executive commissioner by rule shall require that respiratory therapy services for ventilator-dependent persons furnished as part of a plan of care under this chapter be provided by a respiratory care practitioner authorized to practice respiratory care under Chapter 604, Occupations Code, when:(1)  respiratory therapy is determined by the recipient's treating physician to be the most effective method of treatment; and(2)  the use of a respiratory care practitioner is practicable and cost-neutral or cost-effective.|Acts 2003, 78th Leg., ch. 1167, Sec. 1, eff. Sept. 1, 2003.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.134, eff. April 2, 2015.|
TX Hum Res Code § 32.061 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.061. Community Attendant Services Program

Sec. 32.061.  COMMUNITY ATTENDANT SERVICES PROGRAM.  (a)  Any home and community-based services that the commission provides under Section 1929, Social Security Act (42 U.S.C. Section 1396t) and its subsequent amendments to functionally disabled individuals who have income that exceeds the limit established by federal law for Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.) and its subsequent amendments shall be provided through the community attendant services program.(b)  In determining an applicant's eligibility for home and community-based services described by Subsection (a), the commission shall exclude $20 of unearned or earned income from the applicant's monthly income.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.110, eff. Sept. 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 1(a), eff. September 1, 2007.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.135, eff. April 2, 2015.|
TX Hum Res Code § 32.062 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.062. Admissibility of Certain Evidence Relating to Nursing Institutions

Sec. 32.062.  ADMISSIBILITY OF CERTAIN EVIDENCE RELATING TO NURSING INSTITUTIONS.(a)  The following are not admissible as evidence in a civil action:(1)  any finding by the Department of Aging and Disability Services that an institution licensed under Chapter 242, Health and Safety Code, has violated a standard for participation in the medical assistance program under this chapter; or(2)  the fact of the assessment of a monetary penalty against an institution under Section 32.021 or the payment of the penalty by an institution.(b)  This section does not apply in an enforcement action in which the state or an agency or political subdivision of the state is a party.(c)  Notwithstanding any other provision of this section, evidence described by Subsection (a) is admissible as evidence in a civil action only if:(1)  the evidence relates to a material violation of this chapter or a rule adopted under this chapter or assessment of a monetary penalty with respect to:(A)  the particular incident and the particular individual whose personal injury is the basis of the claim being brought in the civil action; or(B)  a finding by the Department of Aging and Disability Services that directly involves substantially similar conduct that occurred at the institution within a period of one year before the particular incident that is the basis of the claim being brought in the civil action;(2)  the evidence of a material violation has been affirmed by the entry of a final adjudicated and unappealable order of the Department of Aging and Disability Services after formal appeal; and(3)  the record is otherwise admissible under the Texas Rules of Evidence.|Added by Acts 2003, 78th Leg., ch. 204, Sec. 16.01, eff. Sept. 1, 2003.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1120 (H.B. 1218), Sec. 3, eff. September 1, 2009.Redesignated from Human Resources Code, Section 32.060 by Acts 2011, 82nd Leg., R.S., Ch. 91 (S.B. 1303), Sec. 27.001(33), eff. September 1, 2011.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.136, eff. April 2, 2015.|
TX Hum Res Code § 32.0641 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.0641. Recipient Accountability Provisions; Cost-Sharing Requirement to Improve Appropriate Utilization of Services

Sec. 32.0641.  RECIPIENT ACCOUNTABILITY PROVISIONS; COST-SHARING REQUIREMENT TO IMPROVE APPROPRIATE UTILIZATION OF SERVICES.  (a)  To the extent permitted under and in a manner that is consistent with Title XIX, Social Security Act (42 U.S.C. Section 1396 et seq.) and any other applicable law or regulation or under a federal waiver or other authorization, the executive commissioner shall adopt cost-sharing provisions that encourage personal accountability and appropriate utilization of health care services, including a cost-sharing provision applicable to a recipient who chooses to receive a nonemergency medical service through a hospital emergency room.(b)  The commission may not seek a federal waiver or other authorization under this section that would:(1)  prevent a Medicaid recipient who has a condition requiring emergency medical services from receiving care through a hospital emergency room; or(2)  waive any provision under Section 1867, Social Security Act (42 U.S.C. Section 1395dd).|Added by Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 20, eff. September 1, 2007.Amended by: Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.09(b), eff. September 28, 2011.Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.139, eff. April 2, 2015.Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.37, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.34, eff. January 1, 2016.|
TX Hum Res Code § 32.067 (2021)
2021 Texas Statutes|Human Resources Code|Title 2 - Human Services and Protective Services in General|Subtitle C - Assistance Programs|Chapter 32 - Medical Assistance Program|Subchapter B. Administrative Provisions|Section 32.067. Delivery of Comprehensive Care Services to Certain Recipients of Medical Assistance

Sec. 32.067.  DELIVERY OF COMPREHENSIVE CARE SERVICES TO CERTAIN RECIPIENTS OF MEDICAL ASSISTANCE.  (a)  In this section, "certified agency" and "home health service" have the meanings assigned by Section 142.001, Health and Safety Code.(b)  The commission shall assure that any agency licensed to provide home health services under Chapter 142, Health and Safety Code, and not only a certified agency licensed under that chapter, may provide home health services to individuals enrolled in the Texas Health Steps Comprehensive Care Program.|Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.204, eff. Sept. 1, 2003.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.140, eff. April 2, 2015.|