reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.9931. Ombudsman for Children and Youth in Foster Care

Sec. 531.9931.  OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE.  (a)  The commission shall establish an ombudsman program to provide support and information services to children and youth in foster care.
(b)  An ombudsman appointed under this section shall:
(1)  receive complaints from children and youth in the conservatorship of the department as provided under Section 531.993(b)(1)(A)(i);
(2)  inform children and youth in the conservatorship of the department who file a complaint under this subchapter about the result of an ombudsman's investigation of the complaint, including whether the ombudsman was able to substantiate the child's or youth's complaint; and
(3)  collaborate with the department to develop an outreach plan for children and youth in the conservatorship of the department to promote awareness of the ombudsman program.
Added by Acts 2017, 85th Leg., R.S., Ch. 906 (S.B. 213), Sec. 7, eff. September 1, 2017.
Reenacted and amended by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 9, eff. June 12, 2023.
Text of section as transferred, redesignated and amended by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 10
Without reference to the amendment of this section, this section was repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.9933. Ombudsman for Behavioral Health Access to Care

Sec. 531.9933.  OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE.  (a)  The commission shall establish an ombudsman program to provide support and information services to a consumer enrolled in or applying for a behavioral health program.
(b)   The commission may use an alternate title for the ombudsman in consumer-facing materials if the commission determines that an alternate title would be beneficial to consumer understanding or access.
(c)  An ombudsman serves as an impartial party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders.
(d)  An ombudsman shall:
(1)  interact with consumers and behavioral health care providers with concerns or complaints to help the consumers and providers resolve behavioral health care access issues;
(2)  identify, track, and help report potential violations of state or federal rules, regulations, or statutes concerning the availability of, and terms and conditions of, benefits for mental health conditions or substance use disorders, including potential violations related to quantitative and nonquantitative treatment limitations;
(3)  report concerns, complaints, and potential violations described by Subdivision (2) to the appropriate regulatory or oversight agency;
(4)  receive and report concerns and complaints relating to inappropriate care or mental health commitment;
(5)  provide appropriate information to help consumers obtain behavioral health care;
(6)  develop appropriate points of contact for referrals to other state and federal agencies; and
(7)  provide appropriate information to help consumers or providers file appeals or complaints with the appropriate entities, including insurers and other state and federal agencies.
(e)  The Texas Department of Insurance shall appoint a liaison to an ombudsman to receive reports of concerns, complaints, and potential violations described by Subsection (d)(2) from an ombudsman, consumers, or behavioral health care providers.
Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 1, eff. September 1, 2017.
Transferred, redesignated and amended from Government Code, Section 531.02251 by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 11, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.9934. Ombudsman for Individuals With an Intellectual or Developmental Disability

Sec. 531.9934.  OMBUDSMAN FOR INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY.  The executive commissioner shall appoint an ombudsman to assist a client, or a person acting on behalf of an individual with an intellectual or developmental disability or a group of individuals with an intellectual or developmental disability, with a complaint or grievance regarding the infringement of the rights of an individual with an intellectual or developmental disability or the delivery of intellectual disability services submitted under Section 592.039, Health and Safety Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 12, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.994. Investigation of Unreported Complaints

Sec. 531.994.  INVESTIGATION OF UNREPORTED COMPLAINTS.  If, during the investigation of a complaint, an ombudsman discovers unreported violations of the commission's or department's rules and policies, the ombudsman shall open a new investigation for each unreported violation.
Added by Acts 2015, 84th Leg., R.S., Ch. 1168 (S.B. 830), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 13, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.995. Access to Information

Sec. 531.995.  ACCESS TO INFORMATION.  The commission and department shall provide an ombudsman access to the records that relate to a complaint the ombudsman is reviewing or investigating.
Added by Acts 2015, 84th Leg., R.S., Ch. 1168 (S.B. 830), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 14, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.996. Communication and Confidentiality

Sec. 531.996.  COMMUNICATION AND CONFIDENTIALITY.  (a) A person may communicate with an ombudsman relating to a complaint by telephone, by mail, by electronic mail, or by any other means the ombudsman determines to be feasible, secure, and accessible.
(b)  A communication with an ombudsman is confidential during an investigation or review of a complaint and remains confidential after the complaint is resolved.
(c)  The records of an ombudsman are confidential and must be maintained in a manner that preserves the confidentiality of the records.
(d)  The disclosure of confidential information to an ombudsman under this subchapter does not constitute a waiver of confidentiality. Any information disclosed to the ombudsman under this subchapter remains confidential and privileged following disclosure.
(e)  An ombudsman is not prohibited from communicating with the commission or department regarding confidential information disclosed to the ombudsman.
(f)  An ombudsman may make reports relating to an investigation of a complaint public after the complaint is resolved. A report may not include information that identifies an individual complainant, client, parent, or employee or any other person involved in the complaint.
Added by Acts 2015, 84th Leg., R.S., Ch. 1168 (S.B. 830), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 14, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.997. Retaliation Prohibited

Sec. 531.997.  RETALIATION PROHIBITED.  The commission or department may not retaliate against an employee of the commission or department, as applicable, or any other person who in good faith makes a complaint to an ombudsman or against any person who cooperates with the ombudsman in an investigation.
Added by Acts 2015, 84th Leg., R.S., Ch. 1168 (S.B. 830), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 906 (S.B. 213), Sec. 9, eff. September 1, 2017.
Reenacted and amended by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 15, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter Y. Commission Ombudsman Programs › Section 531.998. Report

Sec. 531.998.  REPORT.  (a) Each ombudsman shall prepare an annual report that contains:
(1)  a description of the ombudsman's work;
(2)  any change made by the commission or department in response to a substantiated complaint;
(3)  a description of any trends in the nature of complaints received by the ombudsman or any systemic issues identified by the ombudsman in the investigation of individual complaints, any recommendations related to addressing those trends and issues, and an evaluation of the feasibility of the ombudsman's recommendations;
(4)  a glossary of terms used in the report;
(5)  a description of the methods used to promote awareness of the ombudsman under Section 531.993(b) and the ombudsman's promotion plan for the next year; and
(6)  any public feedback received by the ombudsman relating to the ombudsman's previous annual reports.
(b)  Each report must be submitted to the governor, the lieutenant governor, each standing committee of the legislature with jurisdiction over matters involving the commission, each member of the legislature, and the executive commissioner not later than December 1 of each year. On receipt of the report, the commission shall make the report publicly available on the commission's Internet website.
Added by Acts 2015, 84th Leg., R.S., Ch. 1168 (S.B. 830), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 906 (S.B. 213), Sec. 10, eff. September 1, 2017.
Reenacted and amended by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462), Sec. 15, eff. June 12, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 532 - Medicaid Administration and Operation in General › Subchapter A. General Provisions › Section 532.0001. Definition

Text of section effective on April 01, 2025
Sec. 532.0001.  DEFINITION.  In this chapter, "recipient" means a Medicaid recipient.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0051. Commission Administration of Medicaid

Text of section effective on April 01, 2025
Sec. 532.0051.  COMMISSION ADMINISTRATION OF MEDICAID.  (a)  The commission is the state agency designated to administer federal Medicaid funds.
(b)  The commission shall:
(1)  in each agency that operates a portion of Medicaid, plan and direct Medicaid, including the management of the Medicaid managed care system and the development, procurement, management, and monitoring of contracts necessary to implement that system; and
(2)  establish requirements for and define the scope of the ongoing evaluation of the Medicaid managed care system conducted in conjunction with the Department of State Health Services under Section 108.0065, Health and Safety 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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0052. Streamlining Administrative Processes

Text of section effective on April 01, 2025
Sec. 532.0052.  STREAMLINING ADMINISTRATIVE PROCESSES.  The commission shall make every effort:
(1)  using the commission's existing resources, to reduce the paperwork and other administrative burdens placed on recipients, Medicaid providers, and other Medicaid participants, and shall use technology and efficient business practices to reduce those burdens; and
(2)  to improve the business practices associated with Medicaid administration by any method the commission determines is cost-effective, including:
(A)  expanding electronic claims payment system use;
(B)  developing an Internet portal system for prior authorization requests;
(C)  encouraging Medicaid providers to submit program participation applications electronically;
(D)  ensuring that the Medicaid provider application is easy to locate on the Internet so that providers can conveniently apply to the program;
(E)  working with federal partners to take advantage of every opportunity to maximize additional federal funding for technology in Medicaid; and
(F)  encouraging providers' increased use of medical technology, including increasing providers' use of:
(i)  electronic communications between patients and their physicians or other health care providers;
(ii)  electronic prescribing tools that provide current payer formulary information at the time the physician or other health care provider writes a prescription and that support the electronic transmission of a prescription;
(iii)  ambulatory computerized order entry systems that facilitate at the point of care physician and other health care provider orders for medications and laboratory and radiological tests;
(iv)  inpatient computerized order entry systems to reduce errors, improve health care quality, and lower costs in a hospital setting;
(v)  regional data-sharing to coordinate patient care across a community for patients who are treated by multiple providers; and
(vi)  electronic intensive care unit technology to allow physicians to fully monitor hospital patients remotely.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0053. Grievances

Text of section effective on April 01, 2025
Sec. 532.0053.  GRIEVANCES.  (a)  The commission shall:
(1)  adopt a definition of "grievance" related to Medicaid and ensure the definition is consistent among divisions within the commission to ensure all grievances are managed consistently;
(2)  standardize Medicaid grievance data reporting and tracking among divisions within the commission;
(3)  implement a no-wrong-door system for Medicaid grievances reported to the commission; and
(4)  verify grievance data a Medicaid managed care organization reports.
(b)  The commission shall establish a procedure for expedited resolution of a grievance related to Medicaid that allows the commission to:
(1)  identify a grievance related to a Medicaid access-to-care issue that is urgent and requires an expedited resolution; and
(2)  resolve the grievance within a specified period.
(c)  The commission shall:
(1)  aggregate recipient and Medicaid provider grievance data to provide a comprehensive data set of grievances; and
(2)  make the aggregated data available to the legislature and the public in a manner that does not allow for the identification of a particular recipient or provider.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0054. Office of Community Access and Services

Text of section effective on April 01, 2025
Sec. 532.0054.  OFFICE OF COMMUNITY ACCESS AND SERVICES.  The executive commissioner shall establish within the commission an office of community access and services.  The office is responsible for:
(1)  collaborating with community, state, and federal stakeholders to improve the elements of the health care system that are involved in delivering Medicaid services; and
(2)  sharing with Medicaid providers, including hospitals, any best practices, resources, or other information regarding improvements to the health care 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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0055. Service Delivery Audit Mechanisms

Text of section effective on April 01, 2025
Sec. 532.0055.  SERVICE DELIVERY AUDIT MECHANISMS.  The commission shall make every effort to ensure the integrity of Medicaid.  To ensure that integrity, the commission shall:
(1)  perform risk assessments of every element of the program and audit the program elements determined to present the greatest risks;
(2)  ensure that sufficient oversight is in place for the Medicaid medical transportation program and that a quality review assessment of that program occurs; and
(3)  evaluate Medicaid with respect to use of the metrics developed through the Texas Health Steps performance improvement plan to guide changes and improvements to the program.
Added by Acts 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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0056. Federal Authorization for Reform

Text of section effective on April 01, 2025
Sec. 532.0056.  FEDERAL AUTHORIZATION FOR REFORM.  The executive commissioner shall seek a waiver under Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to the state Medicaid plan that is designed to achieve the following objectives regarding Medicaid and alternatives to Medicaid:
(1)  provide flexibility to determine Medicaid eligibility categories and income levels;
(2)  provide flexibility to design Medicaid benefits that meet the demographic, public health, clinical, and cultural needs of this state or regions within this state;
(3)  encourage use of the private health benefits coverage market rather than public benefits systems;
(4)  encourage individuals who have access to private employer-based health benefits to obtain or maintain those benefits;
(5)  create a culture of shared financial responsibility, accountability, and participation in Medicaid by:
(A)  establishing and enforcing copayment requirements similar to private sector principles for all eligibility groups;
(B)  promoting the use of health savings accounts to influence a culture of individual responsibility; and
(C)  promoting the use of vouchers for consumer-directed services in which consumers manage and pay for health-related services provided to them using program vouchers;
(6)  consolidate federal funding streams, including funds from the disproportionate share hospitals and upper payment limit supplemental payment programs and other federal Medicaid funds, to ensure the most effective and efficient use of those funding streams;
(7)  allow flexibility in the use of state funds used to obtain federal matching funds, including allowing the use of intergovernmental transfers, certified public expenditures, costs not otherwise matchable, or other funds and funding mechanisms to obtain federal matching funds;
(8)  empower individuals who are uninsured to acquire health benefits coverage through the promotion of cost-effective coverage models that provide access to affordable primary, preventive, and other health care on a sliding scale, with fees paid at the point of service; and
(9)  allow for the redesign of long-term care services and supports to increase access to patient-centered care in the most cost-effective manner.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0057. Fees, Charges, and Rates

Text of section effective on April 01, 2025
Sec. 532.0057.  FEES, CHARGES, AND RATES.  (a)  The executive commissioner shall adopt reasonable rules and standards governing the determination of fees, charges, and rates for Medicaid payments.
(b)  In adopting rules and standards required by Subsection (a), the executive commissioner:
(1)  may provide for payment of fees, charges, and rates in accordance with:
(A)  formulas, procedures, or methodologies commission rules prescribe;
(B)  state or federal law, policies, rules, regulations, or guidelines;
(C)  economic conditions that substantially and materially affect provider participation in Medicaid, as the executive commissioner determines; or
(D)  available levels of appropriated state and federal funds; and
(2)  shall include financial performance standards that, in the event of a proposed rate reduction, provide private ICF-IID facilities and home and community-based services providers with flexibility in determining how to use Medicaid payments to provide services in the most cost-effective manner while continuing to meet state and federal Medicaid requirements.
(c)  Notwithstanding any other provision of Chapter 32, Human Resources Code, Chapter 531 or revised provisions of Chapter 531, as that chapter existed on March 31, 2025, or Chapter 540 or 540A, the commission may adjust the fees, charges, and rates paid to Medicaid providers as necessary to achieve the objectives of Medicaid in a manner consistent with the considerations described by Subsection (b)(1).
(d)  In adopting rates for Medicaid payments under Subsection (a), the executive commissioner may adopt reimbursement rates for appropriate nursing services provided to recipients with certain health conditions if those services are determined to provide a cost-effective alternative to hospitalization.  A physician must certify that the nursing services are medically appropriate for the recipient for those services to qualify for reimbursement under this subsection.
(e)  In adopting rates for Medicaid payments under Subsection (a), the executive commissioner may adopt cost-effective reimbursement rates for group appointments with Medicaid providers for certain diseases and medical conditions commission rules specify.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0058. Acute Care Billing Coordination System; Penalties

Text of section effective on April 01, 2025
Sec. 532.0058.  ACUTE CARE BILLING COORDINATION SYSTEM; PENALTIES.  (a)  The acute care Medicaid billing coordination system for the fee-for-service and primary care case management delivery models for which the commission contracts must, on entry of a claim in the claims system:
(1)  identify within 24 hours whether another entity has primary responsibility for paying the claim; and
(2)  submit the claim to the entity the system determines is the primary payor.
(b)  The billing coordination system may not increase Medicaid claims payment error rates.
(c)  If cost-effective and feasible, the commission shall contract to expand the acute care Medicaid billing coordination system to process claims for all other Medicaid health care services in the manner the system processes claims for acute care services.  This subsection does not apply to claims for Medicaid health care services if, before September 1, 2009, those claims were being processed by an alternative billing coordination system.
(d)  If cost-effective, the executive commissioner shall adopt rules to enable the acute care Medicaid billing coordination system to identify an entity with primary responsibility for paying a claim that is processed by the system and establish reporting requirements for an entity that may have a contractual responsibility to pay for the types of services that are provided under Medicaid and the claims for which are processed by the system.
(e)  An entity that holds a permit, license, or certificate of authority issued by a regulatory agency of this state:
(1)  must allow a contractor under this section access to databases to allow the contractor to carry out the purposes of this section, subject to the contractor's contract with the commission and rules the executive commissioner adopts under this section; and
(2)  is subject to an administrative penalty or other sanction as provided by the law applicable to the permit, license, or certificate of authority for the entity's violation of a rule the executive commissioner adopts under this section.
(f)  Public funds may not be spent on an entity that is not in compliance with this section unless the executive commissioner and the entity enter into a memorandum of understanding.
(g)  Information obtained under this section is confidential.  The contractor may use the information only for the purposes authorized under this section.  A person commits an offense if the person knowingly uses information obtained under this section for any purpose not authorized under this section.  An offense under this subsection is a Class B misdemeanor and all other penalties may apply.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0059. Recovery of Certain Third-Party Reimbursements

Text of section effective on April 01, 2025
Sec. 532.0059.  RECOVERY OF CERTAIN THIRD-PARTY REIMBURSEMENTS.  The commission shall obtain Medicaid reimbursement from each fiscal intermediary who makes a payment to a service provider on behalf of the Medicare program, including a reimbursement for a payment made to a home health services provider or nursing facility for services provided to an individual who is eligible to receive health care benefits under both Medicaid and the Medicare 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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0060. Dental Director

Text of section effective on April 01, 2025
Sec. 532.0060.  DENTAL DIRECTOR.  The executive commissioner shall appoint a Medicaid dental director who is a licensed dentist under Subtitle D, Title 3, Occupations Code, and rules the State Board of Dental Examiners adopts under that subtitle.
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 532 - Medicaid Administration and Operation in General › Subchapter B. Administration › Section 532.0061. Alignment of Medicaid and Medicare Diabetic Equipment and Supplies Written Order Procedures

Text of section effective on April 01, 2025
Sec. 532.0061.  ALIGNMENT OF MEDICAID AND MEDICARE DIABETIC EQUIPMENT AND SUPPLIES WRITTEN ORDER PROCEDURES.  (a)  The commission shall review Medicaid forms and requirements regarding written orders for diabetic equipment and supplies to identify variations between permissible Medicaid ordering procedures and ordering procedures available to Medicare providers.
(b)  To the extent practicable and in conformity with Chapter 157, Occupations Code, and Chapter 483, Health and Safety Code, after the commission conducts a review under Subsection (a), the commission or executive commissioner, as appropriate, shall modify only Medicaid forms, rules, and procedures applicable to orders for diabetic equipment and supplies to provide for an ordering system that is comparable to the Medicare ordering system for diabetic equipment and supplies.  The ordering system must permit a diabetic equipment or supplies supplier to complete forms by hand or enter medical information or supply orders electronically into a form as necessary to provide the information required to dispense diabetic equipment or supplies.
(c)  A diabetic equipment and supplies provider may bill and collect payment for the provider's services if the provider has a copy of the form that meets the requirements of Subsection (b) and is signed by a medical provider licensed in this state to treat diabetic patients.  Additional documentation may not be required.
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 532 - Medicaid Administration and Operation in General › Subchapter C. Financing › Section 532.0101. Financing Optimization

Text of section effective on April 01, 2025
Sec. 532.0101.  FINANCING OPTIMIZATION.  The commission shall ensure that the Medicaid finance system is optimized to:
(1)  maximize this state's receipt of federal funds;
(2)  create incentives for providers to use preventive care;
(3)  increase and retain providers in the system to maintain an adequate provider network;
(4)  more accurately reflect the costs borne by providers; and
(5)  encourage improvement of the quality of care.
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 532 - Medicaid Administration and Operation in General › Subchapter C. Financing › Section 532.0102. Retention of Certain Money to Administer Certain Programs; Annual Report Required

Text of section effective on April 01, 2025
Sec. 532.0102.  RETENTION OF CERTAIN MONEY TO ADMINISTER CERTAIN PROGRAMS; ANNUAL REPORT REQUIRED.  (a)  In this section, "directed payment program" means a delivery system and provider patient initiative implemented by this state under 42 C.F.R. Section 438.6(c).
(b)  This section applies only to money the commission receives from a source other than the general revenue fund to operate a waiver program established under Section 1115 of the Social Security Act (42 U.S.C. Section 1315) or a directed payment program or successor program as the commission determines.
(c)  Subject to Subsection (d), the commission may retain from money to which this section applies an amount equal to the estimated costs necessary to administer the program for which the commission receives the money, but not to exceed $8 million for a state fiscal year.
(d)  If the commission determines that the commission needs additional money to administer a program described by Subsection (b), the commission may retain an additional amount with the governor's and the Legislative Budget Board's approval, but not to exceed a total retained amount equal to 0.25 percent of the total estimated amount the commission receives for the program.
(e)  The commission shall spend the retained money to assist in paying the costs necessary to administer the program for which the commission receives the money, except that the commission may not use the money to pay any type of administrative cost that, before June 1, 2019, was funded with general revenue.
(f)  The commission shall submit an annual report to the governor and the Legislative Budget Board that:
(1)  details the amount of money the commission retained and spent under this section during the preceding state fiscal year, including a separate detail of any increase in the amount of money the commission retained for a program under Subsection (d);
(2)  contains a transparent description of how the commission used the money described by Subdivision (1); and
(3)  assesses the extent to which the retained money covered the estimated costs to administer the applicable program and states whether, based on that assessment, the commission adjusted or considered adjustments to the amount retained.
(g)  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 532 - Medicaid Administration and Operation in General › Subchapter C. Financing › Section 532.0103. Biennial Financial Report

Text of section effective on April 01, 2025
Sec. 532.0103.  BIENNIAL FINANCIAL REPORT.  (a)  The commission shall prepare a biennial Medicaid financial report covering each state agency that operates a part of Medicaid and each component of Medicaid those agencies operate.
(b)  The report must include:
(1)  for each state agency that operates a part of Medicaid:
(A)  a description of each of the Medicaid components the agency operates; and
(B)  an accounting of all funds related to Medicaid the agency received and disbursed during the period the report covers, including:
(i)  the amount of any federal Medicaid funds allocated to the agency for the support of each of the Medicaid components the agency operates;
(ii)  the amount of any funds the legislature appropriated to the agency for each of those components; and
(iii)  the amount of Medicaid payments and related expenditures made by or in connection with each of those components; and
(2)  for each Medicaid component identified in the report:
(A)  the amount and source of funds or other revenue received by or made available to the agency for the component;
(B)  the amount spent on each type of service or benefit provided by or under the component;
(C)  the amount spent on component operations, including eligibility determination, claims processing, and case management; and
(D)  the amount spent on any other administrative costs.
(c)  The report must cover the three-year period ending on the last day of the previous fiscal year.
(d)  The commission may request from any appropriate state agency information necessary to complete the report.  Each agency shall cooperate with the commission in providing information for the report.
(e)  Not later than December 1 of each even-numbered year, the commission shall submit the report to the governor, the lieutenant governor, the speaker of the house of representatives, the presiding officer of each standing committee of the senate and house of representatives having jurisdiction over health and human services issues, and the state auditor.
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 532 - Medicaid Administration and Operation in General › Subchapter D. Providers › Section 532.0151. Streamlining Provider Enrollment and Credentialing Processes

Text of section effective on April 01, 2025
Sec. 532.0151.  STREAMLINING PROVIDER ENROLLMENT AND CREDENTIALING PROCESSES.  (a)  The commission shall streamline Medicaid provider enrollment and credentialing processes.
(b)  In streamlining the Medicaid provider enrollment process, the commission shall establish a centralized Internet portal through which providers may enroll in Medicaid.
(c)  In streamlining the Medicaid provider credentialing process, the commission may:
(1)  designate a centralized credentialing entity;
(2)  share information in the database established under Subchapter C, Chapter 32, Human Resources Code, with the centralized credentialing entity; and
(3)  require all Medicaid managed care organizations to use the centralized credentialing entity as a hub for collecting and sharing information.
(d)  The commission may:
(1)  use the Internet portal created under Subsection (b) to create a single, consolidated Medicaid provider enrollment and credentialing process; and
(2)  if cost-effective, contract with a third party to develop the single, consolidated process.
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 532 - Medicaid Administration and Operation in General › Subchapter D. Providers › Section 532.0152. Use of National Provider Identifier Number

Text of section effective on April 01, 2025
Sec. 532.0152.  USE OF NATIONAL PROVIDER IDENTIFIER NUMBER.  (a)  In this section, "national provider identifier number" means the national provider identifier number required under Section 1128J(e) of the Social Security Act (42 U.S.C. Section 1320a-7k(e)).
(b)  The commission shall transition from using a state-issued provider identifier number to using only a national provider identifier number in accordance with this section.
(c)  The commission shall implement a Medicaid provider management and enrollment system and, following that implementation, use only a national provider identifier number to enroll a provider in Medicaid.
(d)  The commission shall implement a modernized claims processing system and, following that implementation, use only a national provider identifier number to process claims for and authorize Medicaid 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 532 - Medicaid Administration and Operation in General › Subchapter D. Providers › Section 532.0153. Enrollment of Certain Eye Health Care Providers

Text of section effective on April 01, 2025
Sec. 532.0153.  ENROLLMENT OF CERTAIN EYE HEALTH CARE PROVIDERS.  (a)  This section applies only to:
(1)  an optometrist who is licensed by the Texas Optometry Board;
(2)  a therapeutic optometrist who is licensed by the Texas Optometry Board;
(3)  an ophthalmologist who is licensed by the Texas Medical Board; and
(4)  an institution of higher education that provides an accredited program for:
(A)  training as a doctor of optometry or an optometrist residency; or
(B)  training as an ophthalmologist or an ophthalmologist residency.
(b)  The commission may not prevent a provider to whom this section applies from enrolling as a Medicaid provider if the provider:
(1)  either:
(A)  joins an established practice of a health care provider or provider group that has a contract with a Medicaid managed care organization to provide health care services to recipients under Chapter 540 or 540A; or
(B)  is employed by or otherwise compensated for providing training at an institution of higher education described by Subsection (a)(4);
(2)  applies to be an enrolled Medicaid provider;
(3)  if applicable, complies with the requirements of the contract described by Subdivision (1)(A); and
(4)  complies with all other applicable requirements related to being a Medicaid provider.
(c)  The commission may not prevent an institution of higher education from enrolling as a Medicaid provider if the institution:
(1)  has a contract with a managed care organization to provide health care services to recipients under Chapter 540 or 540A;
(2)  applies to be an enrolled Medicaid provider;
(3)  complies with the requirements of the contract described by Subdivision (1); and
(4)  complies with all other applicable requirements related to being a Medicaid provider.
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 532 - Medicaid Administration and Operation in General › Subchapter D. Providers › Section 532.0154. Rural Health Clinic Reimbursement

Text of section effective on April 01, 2025
Sec. 532.0154.  RURAL HEALTH CLINIC REIMBURSEMENT.  The commission may not impose any condition on the reimbursement of a rural health clinic under Medicaid if the condition is more stringent than the conditions imposed by:
(1)  the Rural Health Clinic Services Act of 1977 (Pub. L. No. 95-210); or
(2)  the laws of this state regulating the practice of medicine, pharmacy, or professional nursing.
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 532 - Medicaid Administration and Operation in General › Subchapter D. Providers › Section 532.0156. Reimbursement System for Electronic Health Information Review and Transmission

Text of section effective on April 01, 2025
Sec. 532.0156.  REIMBURSEMENT SYSTEM FOR ELECTRONIC HEALTH INFORMATION REVIEW AND TRANSMISSION.  If feasible and cost-effective, the executive commissioner by rule may develop and the commission may implement a system to provide Medicaid reimbursement to a health care provider, including a physician, for reviewing and transmitting electronic health information.
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 532 - Medicaid Administration and Operation in General › Subchapter E. Data and Technology › Section 532.0201. Data Collection System

Text of section effective on April 01, 2025
Sec. 532.0201.  DATA COLLECTION SYSTEM.  (a)  The commission and each health and human services agency that administers a part of Medicaid shall jointly develop a system to coordinate and integrate state Medicaid databases to:
(1)  facilitate the comprehensive analysis of Medicaid data; and
(2)  detect fraud a program provider or recipient perpetrates.
(b)  To minimize cost and duplication of activities, the commission shall assist and coordinate:
(1)  the efforts of the agencies that are participating in developing the system; and
(2)  the efforts of those agencies with the efforts of other agencies involved in a statewide health care data collection system provided for by Section 108.006, Health and Safety Code, including avoiding duplication of expenditure of state funds for computer hardware, staff, or services.
(c)  On the executive commissioner's request, a state agency that administers any part of Medicaid shall assist the commission in developing the system.
(d)  The commission shall develop the system in a manner that will enable a complete analysis of the use of prescription medications, including information relating to:
(1)  recipients for whom more than three medications have been prescribed; and
(2)  the medical effect denial of Medicaid coverage for more than three medications has had on recipients.
(e)  The commission shall ensure that the system is used each month to match vital statistics unit death records with a list of individuals eligible for Medicaid, and that each individual who is deceased is promptly removed from the list of individuals eligible for Medicaid.
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 532 - Medicaid Administration and Operation in General › Subchapter E. Data and Technology › Section 532.0203. Public Access to Certain Data

Text of section effective on April 01, 2025
Sec. 532.0203.  PUBLIC ACCESS TO CERTAIN DATA.  (a)  To the extent permitted by federal law, the commission, in collaboration with the appropriate advisory committees related to Medicaid, shall make available to the public on the commission's Internet website in an easy-to-read format data relating to the quality of health care recipients received and the health outcomes of those recipients.  Data the commission makes available to the public must be made available in a manner that does not identify or allow for the identification of individual recipients.
(b)  In performing duties under this section, the commission may collaborate with an institution of higher education or another state agency with experience in analyzing and producing public use data.
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 532 - Medicaid Administration and Operation in General › Subchapter E. Data and Technology › Section 532.0204. Data Regarding Treatment for Prenatal Alcohol or Controlled Substance Exposure

Text of section effective on April 01, 2025
Sec. 532.0204.  DATA REGARDING TREATMENT FOR PRENATAL ALCOHOL OR CONTROLLED SUBSTANCE EXPOSURE.  (a)  The commission shall collect hospital discharge data for recipients regarding treatment of a newborn child for prenatal exposure to alcohol or a controlled substance.
(b)  The commission shall provide the collected data to the Department of Family and Protective 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 532 - Medicaid Administration and Operation in General › Subchapter E. Data and Technology › Section 532.0205. Medical Technology

Text of section effective on April 01, 2025
Sec. 532.0205.  MEDICAL TECHNOLOGY.  The commission shall explore and evaluate new developments in medical technology and propose implementing the technology in Medicaid, if appropriate and cost-effective.  Commission staff implementing this section must have skills and experience in research regarding health care technology.
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 532 - Medicaid Administration and Operation in General › Subchapter E. Data and Technology › Section 532.0206. Pilot Projects Relating to Technology Applications

Text of section effective on April 01, 2025
Sec. 532.0206.  PILOT PROJECTS RELATING TO TECHNOLOGY APPLICATIONS.  (a)  Notwithstanding any other law, the commission may establish one or more pilot projects through which Medicaid reimbursement is made to demonstrate the applications of technology in providing Medicaid services.
(b)  A pilot project under this section may relate to providing rehabilitation services, services for the aging or individuals with disabilities, or long-term care services, including community care services and supports.
(c)  Notwithstanding an eligibility requirement prescribed by any other law or rule, the commission may establish requirements for an individual to receive services provided through a pilot project under this section.
(d)  An individual's receipt of services provided through a pilot project under this section does not entitle the individual to other services under a government-funded health program.
(e)  The commission may set a maximum enrollment limit for a pilot project under this section.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.