reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter H. Managed Care Organization Prevention and Investigation of Fraud and Abuse › Section 544.0355. Rules

Text of section effective on April 01, 2025
Sec. 544.0355.  RULES.  (a)  The executive commissioner, in consultation with the office of inspector general, shall adopt rules as necessary to accomplish the purposes of this subchapter, including rules defining the investigative role of the office with respect to the investigative role of special investigative units established by managed care organizations under Section 544.0352(a)(1) and entities with which managed care organizations contract under Section 544.0352(a)(2).
(b)  The rules must specify the office of inspector general's role in:
(1)  reviewing the findings of special investigative units and contracted entities;
(2)  investigating cases in which the overpayment amount sought to be recovered exceeds $100,000; and
(3)  investigating providers who are enrolled in more than one managed care organization.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0401. Definition

Text of section effective on April 01, 2025
Sec. 544.0401.  DEFINITION.  In this subchapter, "financial assistance" means assistance provided under the financial assistance program under Chapter 31, Human Resources Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0402. False or Misleading Information Related to Financial Assistance Eligibility

Text of section effective on April 01, 2025
Sec. 544.0402.  FALSE OR MISLEADING INFORMATION RELATED TO FINANCIAL ASSISTANCE ELIGIBILITY.  To establish or maintain the eligibility of an individual and the individual's family for financial assistance or to increase or prevent a reduction in the amount of that assistance, an individual may not intentionally:
(1)  make a statement that the individual knows is false or misleading;
(2)  misrepresent, conceal, or withhold a fact; or
(3)  knowingly misrepresent a statement as being true.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0403. Commission Action Following Determination of Violation

Text of section effective on April 01, 2025
Sec. 544.0403.  COMMISSION ACTION FOLLOWING DETERMINATION OF VIOLATION.  If after an investigation the commission determines that an individual violated Section 544.0402, the commission shall:
(1)  notify the individual of the alleged violation not later than the 30th day after the date the commission completes the investigation and provide the individual with an opportunity for a hearing on the matter; or
(2)  refer the matter to the appropriate prosecuting attorney for prosecution.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0404. Ineligibility for Financial Assistance Following Violation; Right to Appeal

Text of section effective on April 01, 2025
Sec. 544.0404.  INELIGIBILITY FOR FINANCIAL ASSISTANCE FOLLOWING VIOLATION; RIGHT TO APPEAL.  (a)  An individual is not eligible to receive financial assistance as provided by Subsection (b) if the individual waives the right to a hearing or a hearing officer at an administrative hearing held under this subchapter determines that the individual violated Section 544.0402.  An individual who a hearing officer determines violated Section 544.0402 may appeal that determination by filing a petition in the district court in the county in which the violation occurred not later than the 30th day after the date the hearing officer makes the determination.
(b)  An individual determined under Subsection (a) to have violated Section 544.0402 is not eligible for financial assistance:
(1)  before the first anniversary of the date of that determination if the individual has no previous violations; and
(2)  permanently if the individual was previously determined to have committed a violation.
(c)  An individual who is convicted of a state or federal offense for conduct described by Section 544.0402 or who is granted deferred adjudication or placed on community supervision for that conduct is permanently disqualified from receiving financial assistance.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0405. Household Eligibility for Financial Assistance Not Affected

Text of section effective on April 01, 2025
Sec. 544.0405.  HOUSEHOLD ELIGIBILITY FOR FINANCIAL ASSISTANCE NOT AFFECTED.  This subchapter does not affect the eligibility for financial assistance of any other member of the household of an individual who is ineligible as a result of Section 544.0404(b) or (c).
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter I. Financial Assistance Fraud › Section 544.0406. Rules

Text of section effective on April 01, 2025
Sec. 544.0406.  RULES.  The executive commissioner shall adopt rules as necessary to implement this subchapter.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0451. Learning, Neural Network, or Other Technology Relating to Medicaid

Text of section effective on April 01, 2025
Sec. 544.0451.  LEARNING, NEURAL NETWORK, OR OTHER TECHNOLOGY RELATING TO MEDICAID.  (a)  The commission shall:
(1)  use learning, neural network, or other technology to identify and deter Medicaid fraud throughout this state; and
(2)  require each health and human services agency that performs any part of Medicaid to participate in implementing and using the technology.
(b)  The commission shall contract with a private or public entity to develop and implement the technology.  The commission may require the contracted entity to install and operate the technology at locations the commission specifies, including commission offices.
(c)  The commission shall maintain all information necessary to apply the technology to claims data covering a period of at least two years.  The data used for data processing shall be maintained as an independent subset for security purposes.
(d)  The commission shall refer cases the technology identifies to the office of inspector general or the office of the attorney general, as appropriate.
(e)  Each month, the technology must match vital statistics unit death records with Medicaid claims filed by a provider.  If the commission determines that a provider filed a claim for services provided to an individual after the individual's date of death, as determined by the vital statistics unit death records, the commission shall refer the case to the office of inspector general for investigation.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0452. Medicaid Fraud Investigation Tracking System

Text of section effective on April 01, 2025
Sec. 544.0452.  MEDICAID FRAUD INVESTIGATION TRACKING SYSTEM.  (a)  The commission shall use an automated fraud investigation tracking system through the office of inspector general to monitor the progress of an investigation of suspected fraud, abuse, or insufficient quality of care in Medicaid.
(b)  For each case of suspected fraud, abuse, or insufficient quality of care the technology required under Section 544.0451 identifies, the automated fraud investigation tracking system must:
(1)  receive from the technology electronically transferred records relating to the case;
(2)  record the details and monitor the status of an investigation of the case, including maintaining a record of the beginning and completion dates for each phase of the case investigation;
(3)  generate documents and reports related to the status of the case investigation; and
(4)  generate standard letters to a provider regarding the status or outcome of an investigation.
(c)  The commission shall require each health and human services agency that performs any part of Medicaid to participate in implementing and using the automated fraud investigation tracking system.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0453. Medicaid Fraud Detection Technology

Text of section effective on April 01, 2025
Sec. 544.0453.  MEDICAID FRAUD DETECTION TECHNOLOGY.  The commission may contract with a contractor who specializes in developing technology capable of identifying fraud patterns exhibited by Medicaid recipients to:
(1)  develop and implement the fraud detection technology; and
(2)  determine whether a fraud pattern by Medicaid recipients is present in the recipients' eligibility files the commission maintains.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0454. Data Matching Against Federal Felon List

Text of section effective on April 01, 2025
Sec. 544.0454.  DATA MATCHING AGAINST FEDERAL FELON LIST.  The commission shall develop and implement a system to cross-reference the list of fugitive felons the federal government maintains with data collected for the following programs:
(1)  the child health plan program;
(2)  the financial assistance program under Chapter 31, Human Resources Code;
(3)  Medicaid;
(4)  nutritional assistance programs under Chapter 33, Human Resources Code;
(5)  long-term care services, as defined by Section 22.0011, Human Resources Code;
(6)  community-based support services identified or provided in accordance with Subchapter D, Chapter 546; and
(7)  other health and human services programs, as appropriate.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0455. Electronic Data Matching

Text of section effective on April 01, 2025
Sec. 544.0455.  ELECTRONIC DATA MATCHING.  (a)  In this section, "public assistance program" includes:
(1)  Medicaid;
(2)  the financial assistance program under Chapter 31, Human Resources Code; and
(3)  a nutritional assistance program under Chapter 33, Human Resources Code, including the supplemental nutrition assistance program under that chapter.
(b)  At least quarterly, the commission shall conduct electronic data matches for a recipient of public assistance program benefits to verify the identity, income, employment status, and other factors that affect the recipient's eligibility.  To verify a recipient's eligibility, the electronic data matching must match information the recipient provided with information contained in databases appropriate federal and state agencies maintain.
(c)  Health and human services agencies shall cooperate with the commission by providing data or any other assistance necessary to conduct the electronic data matches required by this section.
(d)  The commission shall enter into a memorandum of understanding with each state agency from which data is required to conduct electronic data matches under this section and Section 544.0456.
(e)  The commission may contract with a public or private entity to conduct the electronic data matches required by this section.
(f)  The executive commissioner shall establish procedures by which the commission or a health and human services agency the commission designates verifies the electronic data matches the commission conducts under this section.  Not later than the 20th day after the date an electronic data match is verified, the commission shall remove from eligibility a recipient who is determined to be ineligible for a public assistance program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter J. Use of Technology to Detect, Investigate, and Prevent Fraud, Abuse, and Overcharges › Section 544.0456. Methods to Reduce Fraud, Waste, and Abuse in Certain Public Assistance Programs

Text of section effective on April 01, 2025
Sec. 544.0456.  METHODS TO REDUCE FRAUD, WASTE, AND ABUSE IN CERTAIN PUBLIC ASSISTANCE PROGRAMS.  (a)  In this section:
(1)  "Financial assistance benefits" means monetary payments under:
(A)  the federal Temporary Assistance for Needy Families program operated under Chapter 31, Human Resources Code; or
(B)  this state's temporary assistance and support services program operated under Chapter 34, Human Resources Code.
(2)  "Supplemental nutrition assistance benefits" means monetary payments under the supplemental nutrition assistance program operated under Chapter 33, Human Resources Code.
(b)  To the extent not otherwise provided by this subtitle or Title 2, Human Resources Code, and in accordance with this section, the commission shall develop and implement methods for reducing  fraud, waste, and abuse in public assistance programs.
(c)  On a monthly basis, the commission shall:
(1)  conduct electronic data matches with the Texas Lottery Commission to determine whether a recipient of supplemental nutrition assistance benefits or a recipient's household member received reportable lottery winnings;
(2)  use the database system developed under Section 532.0201 to:
(A)  match vital statistics unit death records with a list of individuals eligible for financial assistance or supplemental nutrition assistance benefits; and
(B)  ensure that any individual receiving assistance under either program who is discovered to be deceased has the individual's eligibility for assistance promptly terminated; and
(3)  review the out-of-state electronic benefit transfer card transactions a recipient of supplemental nutrition assistance benefits made to determine whether those transactions indicate a possible change in the recipient's residence.
(d)  The commission shall immediately review a recipient's eligibility for public assistance benefits if the commission discovers information under this section that affects the recipient's eligibility.
(e)  A recipient presumptively commits a program violation if the recipient fails to disclose lottery winnings that are required to be reported to the commission under a public assistance program.
(f)  The executive commissioner shall adopt rules necessary to implement this section.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0501. Recovery Monitoring System

Text of section effective on April 01, 2025
Sec. 544.0501.  RECOVERY MONITORING SYSTEM.  (a)  The commission shall use an automated recovery monitoring system to monitor the collections process for a settled case of fraud, abuse, or insufficient quality of care in Medicaid.
(b)  The recovery monitoring system must:
(1)  monitor the collection of funds resulting from settled cases, including by recording:
(A)  monetary payments received from a provider who agreed to a monetary payment plan; and
(B)  deductions taken through the recoupment program from subsequent Medicaid claims the provider filed; and
(2)  provide immediate notice of a provider who:
(A)  agreed to a monetary payment plan or to deductions through the recoupment program from subsequent Medicaid claims; and
(B)  fails to comply with the settlement agreement, including by providing notice of a provider who:
(i)  does not make a scheduled payment; or
(ii)  pays less than a scheduled amount.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0503. Process for Managed Care Organizations to Recoup Overpayments Related to Electronic Visit Verification Transactions

Text of section effective on April 01, 2025
Sec. 544.0503.  PROCESS FOR MANAGED CARE ORGANIZATIONS TO RECOUP OVERPAYMENTS RELATED TO ELECTRONIC VISIT VERIFICATION TRANSACTIONS.  (a)  The executive commissioner shall adopt rules that standardize the process by which a managed care organization collects alleged overpayments that are made to a health care provider and discovered through an audit or investigation the organization conducts secondary to missing electronic visit verification information.  The rules must require that the organization:
(1)  provide written notice to a provider:
(A)  of the organization's intent to recoup overpayments not later than the 30th day after the date an audit is complete;
(B)  of the specific claims and electronic visit verification transactions that are the basis of the overpayment;
(C)  of the process the provider should use to communicate with the organization to provide information about the electronic visit verification transactions;
(D)  of the provider's option to seek an informal resolution of the alleged overpayment;
(E)  of the process to appeal the determination that an overpayment was made; and
(F)  if the provider intends to respond to the notice, that the provider must respond not later than the 30th day after the date the provider receives the notice; and
(2)  limit the duration of audits to 24 months.
(b)  Notwithstanding any other law, a managed care organization may not attempt to recover an overpayment described by Subsection (a) until the provider exhausts all rights to an appeal.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0504. Recovery Audit Contractors

Text of section effective on April 01, 2025
Sec. 544.0504.  RECOVERY AUDIT CONTRACTORS.  To the extent required under Section 1902(a)(42), Social Security Act (42 U.S.C. Section 1396a(a)(42)), the commission shall establish a program under which the commission contracts with one or more recovery audit contractors to identify Medicaid underpayments and overpayments and recover the overpayments.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0505. Annual Report on Certain Fraud and Abuse Recoveries

Text of section effective on April 01, 2025
Sec. 544.0505.  ANNUAL REPORT ON CERTAIN FRAUD AND ABUSE RECOVERIES.  Not later than December 1 of each year, the commission shall prepare and submit to the legislature a report on the amount of money recovered during the preceding 12-month period as a result of investigations and recovery efforts made under Subchapter H and Section 544.0502 by special investigative units or entities with which a managed care organization contracts under Section 544.0352(a)(2).  The report must specify the amount of money each managed care organization retained under Section 544.0502(d).
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0506. Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt

Text of section effective on April 01, 2025
Sec. 544.0506.  NOTICE AND INFORMAL RESOLUTION OF PROPOSED RECOUPMENT OF OVERPAYMENT OR DEBT.  (a)  The commission or the office of inspector general shall provide a provider with written notice of any proposed recoupment of an overpayment or debt and any damages or penalties relating to a proposed recoupment of an overpayment or debt arising out of a fraud or abuse investigation.  The notice must include:
(1)  the specific basis for the overpayment or debt;
(2)  a description of facts and supporting evidence;
(3)  a representative sample of any documents that form the basis for the overpayment or debt;
(4)  the extrapolation methodology;
(5)  information relating to the extrapolation methodology used as part of the investigation and the methods used to determine the overpayment or debt in sufficient detail so that the extrapolation results may be demonstrated to be statistically valid and are fully reproducible;
(6)  the calculation of the overpayment or debt amount;
(7)  the amount of damages and penalties, if applicable; and
(8)  a description of administrative and judicial due process remedies, including the provider's option to seek informal resolution, the provider's right to seek a formal administrative appeal hearing, or that the provider may seek both.
(b)  A provider may request an informal resolution meeting.  On receipt of the request, the office of inspector general shall schedule the meeting and give notice to the provider of the time and place of the meeting.  The informal resolution process shall run concurrently with the administrative hearing process, and the administrative hearing process may not be delayed on account of the informal resolution process.
(c)  The commission shall provide the notice required by Subsection (a) to a provider that is a hospital not later than the 90th day before the date the overpayment or debt that is the subject of the notice must be paid.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 544 - Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services › Subchapter K. Recovery and Recoupment in Cases of Fraud, Abuse, and Overcharges › Section 544.0507. Appeal of Determination to Recoup Overpayment or Debt

Text of section effective on April 01, 2025
Sec. 544.0507.  APPEAL OF DETERMINATION TO RECOUP OVERPAYMENT OR DEBT.  (a)  A provider must request an appeal under this section not later than the 30th day after the date the provider is notified that the commission or the office of inspector general will seek to recover an overpayment or debt from the provider.
(b)  On receipt of a timely written request by a provider who is the subject of a recoupment of overpayment or debt arising out of a fraud or abuse investigation, the office of inspector general shall file a docketing request with the State Office of Administrative Hearings or the commission's appeals division, as the provider requests, for an administrative hearing regarding the proposed recoupment amount and any associated damages or penalties.  The office of inspector general shall file the docketing request not later than the 60th day after the date of the provider's request or not later than the 60th day after completing the informal resolution process, if applicable.
(c)  The office of inspector general is responsible for the costs of an administrative hearing, but a provider is responsible for the provider's own costs incurred in preparing for the hearing.
(d)  A provider who is the subject of a recoupment of overpayment or debt arising out of a fraud or abuse investigation may appeal a final administrative order issued after an administrative hearing by filing a petition for judicial review in a district court in Travis County.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0001. Definitions

Text of section effective on April 01, 2025
Sec. 545.0001.  DEFINITIONS.  In this subchapter:
(1)  "Integrated system" means the integrated eligibility determination and service delivery system that is implemented under the integration plan.
(2)  "Integration plan" means the plan to integrate services and functions relating to eligibility determination and service delivery required by Section 545.0002.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0002. Development and Implementation of Integration Plan

Text of section effective on April 01, 2025
Sec. 545.0002.  DEVELOPMENT AND IMPLEMENTATION OF INTEGRATION PLAN.  (a)  The commission, subject to the approval of the governor and the Legislative Budget Board, shall develop and implement a plan to integrate services and functions relating to eligibility determination and service delivery by health and human services agencies, the Texas Workforce Commission, and other agencies. The integration plan must include:
(1)  a reengineering of eligibility determination business processes;
(2)  streamlined service delivery;
(3)  a unified and integrated process for the transition from welfare to work; and
(4)  improved access to benefits and services for clients.
(b)  In developing and implementing the integration plan, the commission:
(1)  shall give priority to the design and development of computer hardware and software for and provide technical support relating to the integrated eligibility determination system;
(2)  shall consult with agencies whose programs are included in the plan, including the Department of State Health Services and the Texas Workforce Commission; and
(3)  may contract for appropriate professional and technical assistance.
(c)  The commission shall develop and implement the integrated system to achieve:
(1)  increased quality of and client access to services; and
(2)  savings in the cost of providing administrative and other services and staff as a result of streamlining and eliminating duplication of services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0003. Methods to Address Fraud and Eligibility Error Rate

Text of section effective on April 01, 2025
Sec. 545.0003.  METHODS TO ADDRESS FRAUD AND ELIGIBILITY ERROR RATE.  The commission shall examine cost-effective methods to address:
(1)  fraud in assistance programs; and
(2)  the error rate in eligibility determination.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0004. Contract for Integration Plan Implementation

Text of section effective on April 01, 2025
Sec. 545.0004.  CONTRACT FOR INTEGRATION PLAN IMPLEMENTATION.  (a)  On receipt by this state of any necessary federal approval and subject to the approval of the governor and the Legislative Budget Board, the commission may contract to implement all or part of the integration plan if the commission determines that contracting:
(1)  may advance the objectives of Sections 545.0002 and 545.0006(b); and
(2)  meets the criteria set out in the cost-benefit analysis described by this section.
(b)  Before awarding a contract, the commission shall provide to the governor and the Legislative Budget Board a detailed cost-benefit analysis that demonstrates:
(1)  the integration plan's cost-effectiveness;
(2)  mechanisms for monitoring performance under the plan; and
(3)  specific improvements the plan makes to the service delivery system and client access.
(c)  The commission shall make the cost-benefit analysis described by Subsection (b) available to the public.
(d)  On or before the 10th day after releasing a request for bids, proposals, offers, or other applicable expressions of interest relating to developing or implementing the integration plan, the commission shall hold a public hearing and receive public comment on the request.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0005. Use of Other Agencies' Staff and Resources

Text of section effective on April 01, 2025
Sec. 545.0005.  USE OF OTHER AGENCIES' STAFF AND RESOURCES.  (a)  The commission, in developing and implementing the integration plan, may use the staff and resources of agencies whose programs are included in the plan.
(b)  The agencies whose programs are included in the integration plan shall cooperate with a commission request to provide available staff and resources that will be subject to the commission's direction.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter A. Public Assistance Benefits Program Eligibility Determination and Service Delivery Integration › Section 545.0006. Funding

Text of section effective on April 01, 2025
Sec. 545.0006.  FUNDING.  (a)  The design, development, and operation of an automated data processing system to support the integration plan may be financed through the issuance of bonds or other obligations under Chapter 1232.
(b)  The commission, subject to any spending limitation prescribed in the General Appropriations Act, may use savings described by Section 545.0002(c)(2) to further develop the integrated system and provide other health and human services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0051. Consolidated Recipient Identification and Benefits Issuance Method

Text of section effective on April 01, 2025
Sec. 545.0051.  CONSOLIDATED RECIPIENT IDENTIFICATION AND BENEFITS ISSUANCE METHOD.  (a)  If the commission determines that the implementation would be feasible and cost-effective, the commission may develop and implement a method to consolidate, to the extent possible, recipient identification and benefits issuance for the commission and health and human services agencies.
(b)  The method may:
(1)  provide for the use of a single integrated benefits issuance card or multiple cards capable of integrating benefits issuance or other program functions;
(2)  incorporate a fingerprint image identifier to enable personal identity verification at a point of service and reduce fraud;
(3)  enable immediate electronic verification of recipient eligibility; and
(4)  replace multiple forms, cards, or other methods used for fraud reduction or provision of health and human services benefits, including:
(A)  electronic benefits transfer cards; and
(B)  smart cards used in Medicaid.
(c)  In developing and implementing the method, the commission shall:
(1)  to the extent possible, use industry-standard communication, messaging, and electronic benefits transfer protocols;
(2)  ensure that all identifying and descriptive information of recipients of each health and human services program included in the method can be accessed only by a provider or other entity participating in the particular program;
(3)  ensure that a provider or other entity participating in a health and human services program included in the method cannot identify whether a program recipient is receiving benefits under another program included in the method; and
(4)  ensure that the storage and communication of all identifying and descriptive information included in the method comply with existing federal and state privacy laws governing individually identifiable information for recipients of public benefits programs.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0052. Expansion of Billing Coordination and Information Collection Activities

Text of section effective on April 01, 2025
Sec. 545.0052.  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 532.0058 to process claims for services provided through other benefits programs the commission or a health and human services agency administers;
(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 the commission or a health and human services agency administers; and
(3)  expand the scope of individuals about whom information is collected under Section 32.042, Human Resources Code, to include recipients of services provided through other benefits programs the commission or a health and human services agency administers.
(b)  Notwithstanding any other state law, each health and human services agency shall provide the commission with 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 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0053. Service Delivery Area Alignment

Text of section effective on April 01, 2025
Sec. 545.0053.  SERVICE DELIVERY AREA ALIGNMENT.  Notwithstanding Section 540.0701(d) or any other law and to the extent possible, the commission shall align Medicaid and the child health plan program service delivery areas.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0054. Program to Improve and Monitor Certain Outcomes of Medicaid Recipients and Child Health Plan Program Enrollees

Text of section effective on April 01, 2025
Sec. 545.0054.  PROGRAM TO IMPROVE AND MONITOR CERTAIN OUTCOMES OF MEDICAID RECIPIENTS AND CHILD HEALTH PLAN PROGRAM ENROLLEES.  The commission may design and implement a program to improve and monitor clinical and functional outcomes of a Medicaid recipient or child health plan program enrollee. The program may use financial, clinical, and other criteria based on pharmacy, medical services, and other claims data related to Medicaid or the child health plan program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0055. Minimum Collection Goal for Recovery of Certain Benefits

Text of section effective on April 01, 2025
Sec. 545.0055.  MINIMUM COLLECTION GOAL FOR RECOVERY OF CERTAIN BENEFITS.  (a)  Not later than August 30 of each year, the executive commissioner by rule shall set a minimum goal for the commission specifying the percentage of the amount of benefits the commission granted in error under the supplemental nutrition assistance program under Chapter 33, Human Resources Code, or the financial assistance program under Chapter 31, Human Resources Code, that the commission should recover. The executive commissioner shall set the percentage based on:
(1)  comparable recovery rates other states reported; or
(2)  other appropriate factors the executive commissioner identifies.
(b)  If the commission fails to meet the goal set under Subsection (a) for the fiscal year, the executive commissioner shall notify the comptroller, and the comptroller shall reduce the commission's general revenue appropriation by an amount equal to the difference between the amount of state funds the commission would have collected had the commission met the goal and the amount of state funds the commission actually collected.
(c)  The executive commissioner, the governor, and the Legislative Budget Board shall monitor the commission's performance in meeting the goal set under Subsection (a).  The commission shall cooperate by providing to the governor and the Legislative Budget Board, on request, information concerning the commission's collection efforts.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0056. Distribution of Earned Income Tax Credit Information

Text of section effective on April 01, 2025
Sec. 545.0056.  DISTRIBUTION OF EARNED INCOME TAX CREDIT INFORMATION.  (a)  The commission shall ensure that educational materials relating to the federal earned income tax credit are provided in accordance with this section to each individual receiving assistance or benefits under:
(1)  the child health plan program;
(2)  the financial assistance program under Chapter 31, Human Resources Code;
(3)  Medicaid;
(4)  the supplemental nutrition assistance program under Chapter 33, Human Resources Code; or
(5)  another appropriate health and human services program.
(b)  In accordance with Section 526.0002, the commission shall, by mail or through the Internet, provide an individual described by Subsection (a) with access to:
(1)  Internal Revenue Service publications relating to the federal earned income tax credit or information the comptroller prepares under Section 403.025 relating to that credit;
(2)  federal income tax forms necessary to claim the federal earned income tax credit; and
(3)  where feasible, the location of at least one program that:
(A)  is in close geographic proximity to the individual; and
(B)  provides free federal income tax preparation services to low-income and other eligible persons.
(c)  In January of each year, the commission or a commission representative shall mail to each individual described by Subsection (a) information about the federal earned income tax credit that provides the individual with referrals to the resources described by Subsection (b).
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter B. Administration of Certain Public Assistance Benefits Programs › Section 545.0057. Application Assistance for Financial Assistance Recipients Eligible for Federal Programs

Text of section effective on April 01, 2025
Sec. 545.0057.  APPLICATION ASSISTANCE FOR FINANCIAL ASSISTANCE RECIPIENTS ELIGIBLE FOR FEDERAL PROGRAMS.  The commission shall assist recipients of financial assistance under Chapter 31, Human Resources Code, who are eligible for assistance under federal programs to apply for benefits under those federal programs.  The commission may delegate this responsibility to a health and human services agency, contract with a unit of local government, or use any other cost-effective method to assist financial assistance recipients who are eligible for federal programs.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter C. Certain Public Assistance Benefits Program Eligibility › Section 545.0101. Memorandum of Understanding Regarding Medicaid and Child Health Plan Program Eligibility Determinations for Certain Children

Text of section effective on April 01, 2025
Sec. 545.0101.  MEMORANDUM OF UNDERSTANDING REGARDING MEDICAID AND CHILD HEALTH PLAN PROGRAM ELIGIBILITY DETERMINATIONS FOR CERTAIN CHILDREN.  (a)  The commission shall enter into a memorandum of understanding with the Texas Juvenile Justice Department to ensure that the commission assesses each individual who is committed, placed, or detained under Title 3, Family Code, for Medicaid and child health plan program eligibility before that individual's release from commitment, placement, or detention.  A local juvenile probation department is subject to the requirements of the memorandum.
(b)  The memorandum of understanding must specify:
(1)  the information that must be provided to the commission;
(2)  the process by which and time frame within which the information must be provided; and
(3)  the roles and responsibilities of all parties to the memorandum, including a requirement that the commission pursue the actions necessary to complete eligibility applications.
(c)  The memorandum of understanding must be tailored to:
(1)  achieve the goal of ensuring that an individual described by Subsection (a) who the commission determines is eligible for Medicaid or the child health plan program:
(A)  is enrolled in the program for which the individual is eligible; and
(B)  may begin receiving services through the program as soon as possible after the eligibility determination is made; and
(2)  if possible, achieve the goal of ensuring that the individual may begin receiving services through the program on the date of the individual's release from commitment, placement, or detention.
(d)  The executive commissioner may adopt rules as necessary to implement this section.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 545 - Certain Public Assistance Benefits › Subchapter C. Certain Public Assistance Benefits Program Eligibility › Section 545.0102. Verification of Immigration Status of Certain Applicants for Public Assistance Benefits

Text of section effective on April 01, 2025
Sec. 545.0102.  VERIFICATION OF IMMIGRATION STATUS OF CERTAIN APPLICANTS FOR PUBLIC ASSISTANCE BENEFITS.  (a)  This section applies only with respect to the following benefits programs:
(1)  the child health plan program under Chapter 62, Health and Safety Code;
(2)  the financial assistance program under Chapter 31, Human Resources Code;
(3)  Medicaid; and
(4)  the supplemental nutrition assistance program under Chapter 33, Human Resources Code.
(b)  If an individual states at the time of application for benefits under a program to which this section applies that the individual is a qualified alien, as that term is defined by 8 U.S.C. Section 1641(b), the commission shall, to the extent allowed by federal law, verify information regarding the individual's immigration status using an automated system where available.
(c)  The executive commissioner shall adopt rules necessary to implement this section.
(d)  Nothing in this section adds to or changes the eligibility requirements for a benefits program to which this section applies.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.