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 B. Powers and Duties › Section 531.0602. Medically Dependent Children (Mdcp) Waiver Program Assessments and Reassessments

Text of section effective until April 01, 2025
Sec. 531.0602.  MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER PROGRAM ASSESSMENTS AND REASSESSMENTS.  (a)  The commission shall ensure that the care coordinator for a Medicaid managed care organization under the STAR Kids managed care program provides the results of the initial assessment or annual reassessment of medical necessity to the parent or legally authorized representative of a recipient receiving benefits under the medically dependent children (MDCP) waiver program for review.  The commission shall ensure the provision of the results does not delay the determination of the services to be provided to the recipient or the ability to authorize and initiate services.
(b)  The commission shall require the parent's or representative's signature to verify the parent or representative received the results of the initial assessment or reassessment from the care coordinator under Subsection (a).  A Medicaid managed care organization may not delay the delivery of care pending the signature.
(c)  The commission shall provide a parent or representative who disagrees with the results of the initial assessment or reassessment an opportunity to request to dispute the results with the Medicaid managed care organization through a peer-to-peer review with the treating physician of choice.
(d)  This section does not affect any rights of a recipient to appeal an initial assessment or reassessment determination through the Medicaid managed care organization's internal appeal process, the Medicaid fair hearing process, or the external medical review process.
Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff.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 B. Powers and Duties › Section 531.0603. Eligibility of Certain Children for Medically Dependent Children (Mdcp) or Deaf-Blind With Multiple Disabilities (Dbmd) Waiver Program

Text of section effective until April 01, 2025
Sec. 531.0603.  ELIGIBILITY OF CERTAIN CHILDREN FOR MEDICALLY DEPENDENT CHILDREN (MDCP) OR DEAF-BLIND WITH MULTIPLE DISABILITIES (DBMD) WAIVER PROGRAM.  (a)  Notwithstanding any other law and to the extent allowed by federal law, in determining eligibility of a child for the medically dependent children (MDCP) waiver program, the deaf-blind with multiple disabilities (DBMD) waiver program, or a "Money Follows the Person" demonstration project, the commission shall consider whether the child:
(1)  is diagnosed as having a condition included in the list of compassionate allowances conditions published by the United States Social Security Administration; or
(2)  receives Medicaid hospice or palliative care services.
(b)  If the commission determines a child is eligible for a waiver program under Subsection (a), the child's enrollment in the applicable program is contingent on the availability of a slot in the program.  If a slot is not immediately available, the commission shall place the child in the first position on the interest list for the medically dependent children (MDCP) waiver program or deaf-blind with multiple disabilities (DBMD) waiver program, as applicable.
Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.
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 B. Powers and Duties › Section 531.0604. Medically Dependent Children Program Eligibility Requirements; Nursing Facility Level of Care

Text of section effective until April 01, 2025
Sec. 531.0604.  MEDICALLY DEPENDENT CHILDREN PROGRAM ELIGIBILITY REQUIREMENTS; NURSING FACILITY LEVEL OF CARE.  To the extent allowed by federal law, the commission may not require that a child reside in a nursing facility for an extended period of time to meet the nursing facility level of care required for the child to be determined eligible for the medically dependent children (MDCP) waiver program.
Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
For expiration of this section, see Subsection (d).
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0605. Advancing Care for Exceptional Kids Pilot Program

Text of section effective until April 01, 2025
Sec. 531.0605.  ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT PROGRAM.  (a)  The commission shall collaborate with the STAR Kids Managed Care Advisory Committee, Medicaid recipients, family members of children with complex medical conditions, children's health care advocates, Medicaid managed care organizations, and other stakeholders to develop and implement a pilot program that is substantially similar to the program described by Section 3, Medicaid Services Investment and Accountability Act of 2019 (Pub. L. No. 116-16), to provide coordinated care through a health home to children with complex medical conditions.
(b)  The commission shall seek guidance from the Centers for Medicare and Medicaid Services and the United States Department of Health and Human Services regarding the design of the program and, based on the guidance, may actively seek and apply for federal funding to implement the program.
(c)  Not later than December 31, 2024, the commission shall prepare and submit a report to the legislature that includes:
(1)  a summary of the commission's implementation of the pilot program; and
(2)  if the pilot program has been operating for a period sufficient to obtain necessary data, a summary of the commission's evaluation of the effect of the pilot program on the coordination of care for children with complex medical conditions and a recommendation as to whether the pilot program should be continued, expanded, or terminated.
(d)  The pilot program terminates and this section expires September 1, 2025.
Added by Acts 2021, 87th Leg., R.S., Ch. 954 (S.B. 1648), Sec. 3, eff. September 1, 2021.
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 B. Powers and Duties › Section 531.061. Participation by Fathers

Text of section effective until April 01, 2025
Sec. 531.061.  PARTICIPATION BY FATHERS.  (a)  The commission and each health and human services agency shall periodically examine commission or agency policies and procedures to determine if the policies and procedures deter or encourage participation of fathers in commission or agency programs and services relating to children.
(b)  Based on the examination required under Subsection (a), the commission and each health and human services agency shall modify policies and procedures as necessary to permit full participation of fathers in commission or agency programs and services relating to children in all appropriate circumstances.
Added by Acts 2001, 77th Leg., ch. 256, Sec. 2, eff. Sept. 1, 2001.  Renumbered from Government Code Sec. 531.055 by Acts 2003, 78th Leg., ch. 1275, Sec. 2(70), eff. Sept. 1, 2003.
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 B. Powers and Duties › Section 531.062. Pilot Projects Relating to Technology Applications

Text of section effective until April 01, 2025
Sec. 531.062.  PILOT PROJECTS RELATING TO TECHNOLOGY APPLICATIONS.  (a)  Notwithstanding any other law, the commission may establish one or more pilot projects through which reimbursement under Medicaid is made to demonstrate the applications of technology in providing services under that program.
(b)  A pilot project established under this section may relate to providing rehabilitation services, services for the aging or persons with disabilities, or long-term care services, including community care services and support.
(c)  Notwithstanding an eligibility requirement prescribed by any other law or rule, the commission may establish requirements for a person to receive services provided through a pilot project under this section.
(d)  Receipt of services provided through a pilot project under this section does not entitle the recipient to other services under a government-funded health program.
(e)  The commission may set a maximum enrollment limit for a pilot project established under this section.
Added by Acts 2001, 77th Leg., ch. 959, Sec. 1, eff. June 14, 2001.  Renumbered from Government Code Sec. 531.055 by Acts 2003, 78th Leg., ch. 1275, Sec. 2(71), eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.099, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.064. Vaccines for Children Program Provider Enrollment and Reimbursement

Text of section effective until April 01, 2025
Sec. 531.064.  VACCINES FOR CHILDREN PROGRAM PROVIDER ENROLLMENT AND REIMBURSEMENT.  (a)  In this section, "vaccines for children program" means the program operated by the Department of State Health Services under authority of 42 U.S.C. Section 1396s, as amended.
(b)  The commission shall ensure that a provider can enroll in the vaccines for children program on the same form the provider completes to apply as a Medicaid health care provider.
(c)  The commission shall allow providers to report vaccines administered under the vaccines for children program to the immunization registry established under Section 161.007, Health and Safety Code, and to use the immunization registry, including individually identifiable information in accordance with state and federal law, to determine whether a child has received an immunization.
Added by Acts 2003, 78th Leg., ch. 613, Sec. 2, eff. Sept. 1, 2003.
Renumbered from Government Code, Section 531.063 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(33), eff. September 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.101, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.066. Participation of Diagnostic Laboratory Service Providers in Certain Programs

Text of section effective until April 01, 2025
Sec. 531.066.  PARTICIPATION OF DIAGNOSTIC LABORATORY SERVICE PROVIDERS IN CERTAIN PROGRAMS.  Notwithstanding any other law, a diagnostic laboratory may participate as an in-state provider under any program administered by a health and human services agency or the commission that involves diagnostic laboratory services, regardless of the location where any specific service is performed or where the laboratory's facilities are located if:
(1)  the laboratory or an entity that is a parent, subsidiary, or other affiliate of the laboratory maintains diagnostic laboratory operations in this state;
(2)  the laboratory and each entity that is a parent, subsidiary, or other affiliate of the laboratory, individually or collectively, employ at least 1,000 persons at places of employment located in this state; and
(3)  the laboratory is otherwise qualified to provide the services under the program and is not prohibited from participating as a provider under any benefits programs administered by a health and human services agency or the commission based on conduct that constitutes fraud, waste, or abuse.
Added by Acts 2013, 83rd Leg., R.S., Ch. 789 (S.B. 1401), Sec. 1, eff. June 14, 2013.
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 B. Powers and Duties › Section 531.067. Program to Improve and Monitor Certain Outcomes of Recipients Under Child Health Plan Program and Medicaid

Text of section effective until April 01, 2025
Sec. 531.067.  PROGRAM TO IMPROVE AND MONITOR CERTAIN OUTCOMES OF RECIPIENTS UNDER CHILD HEALTH PLAN PROGRAM AND MEDICAID.  The commission may design and implement a program to improve and monitor clinical and functional outcomes of a recipient of services under Medicaid or the state child health plan program.  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 2003, 78th Leg., ch. 198, Sec. 2.08, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.102, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.07, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.07, eff. January 1, 2016.
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 B. Powers and Duties › Section 531.069. Periodic Review of Vendor Drug Program

Text of section effective until April 01, 2025
Sec. 531.069.  PERIODIC REVIEW OF VENDOR DRUG PROGRAM.  (a)  The commission shall periodically review all purchases made under the vendor drug program to determine the cost-effectiveness of including a component for prescription drug benefits in any capitation rate paid by the state under a Medicaid managed care program or the child health plan program.
(b)  In making the determination required by Subsection (a), the commission shall consider the value of any prescription drug rebates received by the state.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.10, eff. Sept. 1, 2003.
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 B. Powers and Duties › Section 531.0691. Vendor Drug Program Inclusion

Sec. 531.0691.  VENDOR DRUG PROGRAM INCLUSION.  (a)  The commission shall ensure that the vendor drug program includes all drugs and national drug codes made available under the federal Medicaid Drug Rebate Program if a certificate of information form to request the drug's inclusion in the vendor drug program has been submitted to the commission and:
(1)  approved by the commission; or
(2)  subject to Subsection (b), is pending review by the commission.
(b)  On receipt of a certificate of information form to request the addition to the Texas Drug Code Index of a drug that is available under the federal Medicaid Drug Rebate Program, the commission shall, if the commission determines that the drug is appropriate for dispensing through an outpatient pharmacy, provisionally make the drug available under the vendor drug program for a period that expires on the earlier of:
(1)  the 90th day after the date the form was submitted; or
(2)  the date the commission makes a determination regarding whether to approve or deny the drug's inclusion on the vendor drug program formulary.
(c)  The commission shall:
(1)  denote the provisional availability of a drug under this section; and
(2)  remove a drug made provisionally available under the vendor drug program:
(A)  on the expiration of the 90-day period prescribed by Subsection (b)(1); or
(B)  if applicable, on the date the commission  denies the drug's inclusion on the vendor drug program formulary.
Added by Acts 2023, 88th Leg., R.S., Ch. 739 (H.B. 3286), Sec. 1, eff. September 1, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0693. Prescription Drug Use and Expenditure Patterns

Text of section effective until April 01, 2025
Sec. 531.0693.  PRESCRIPTION DRUG USE AND EXPENDITURE PATTERNS.  (a)  The commission shall monitor and analyze prescription drug use and expenditure patterns in Medicaid.  The commission shall identify the therapeutic prescription drug classes and individual prescription drugs that are most often prescribed to patients or that represent the greatest expenditures.
(b)  The commission shall post the data determined by the commission under Subsection (a) on the commission's website and update the information on a quarterly basis.
Added by Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 1, eff. September 1, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.105, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.0694. Period of Validity for Prescription

Text of section effective until April 01, 2025
Sec. 531.0694.  PERIOD OF VALIDITY FOR PRESCRIPTION.  In the rules and standards governing the vendor drug program, the executive commissioner, to the extent allowed by federal law and laws regulating the writing and dispensing of prescription medications, shall ensure that a prescription written by an authorized health care provider under Medicaid is valid for the lesser of the period for which the prescription is written or one year.  This section does not apply to a prescription for a controlled substance, as defined by Chapter 481, Health and Safety Code.
Added by Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 1, eff. September 1, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.106, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.0696. Considerations in Awarding Certain Contracts

Text of section effective until April 01, 2025
Sec. 531.0696.  CONSIDERATIONS IN AWARDING CERTAIN CONTRACTS.  The commission may not contract with a managed care organization, including a health maintenance organization, or a pharmacy benefit manager if, in the preceding three years, the organization or pharmacy benefit manager, in connection with a bid, proposal, or contract with the commission, was subject to a final judgment by a court of competent jurisdiction resulting in a conviction for a criminal offense under state or federal law:
(1)  related to the delivery of an item or service;
(2)  related to neglect or abuse of patients in connection with the delivery of an item or service;
(3)  consisting of a felony related to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct; or
(4)  resulting in a penalty or fine in the amount of $500,000 or more in a state or federal administrative proceeding.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.15, eff. September 28, 2011.
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 B. Powers and Duties › Section 531.0697. Prior Approval and Provider Access to Certain Communications With Certain Recipients

Text of section effective until April 01, 2025
Sec. 531.0697.  PRIOR APPROVAL AND PROVIDER ACCESS TO CERTAIN COMMUNICATIONS WITH CERTAIN RECIPIENTS.  (a)  This section applies to:
(1)  the vendor drug program for Medicaid and the child health plan program;
(2)  the kidney health care program;
(3)  the children with special health care needs program; and
(4)  any other state program administered by the commission that provides prescription drug benefits.
(b)  A managed care organization, including a health maintenance organization, or a pharmacy benefit manager, that administers claims for prescription drug benefits under a program to which this section applies shall, at least 10 days before the date the organization or pharmacy benefit manager intends to deliver a communication to recipients collectively under a program:
(1)  submit a copy of the communication to the commission for approval; and
(2)  if applicable, allow the pharmacy providers of recipients who are to receive the communication access to the communication.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.15, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.107, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.0701. Value-Based Arrangements

Text of section effective until April 01, 2025
Sec. 531.0701.  VALUE-BASED ARRANGEMENTS.  (a)  In this section, "manufacturer" has the meaning assigned by Section 531.070.
(b)  Subject to Section 531.071, the commission may enter into a value-based arrangement for the Medicaid vendor drug program by written agreement with a manufacturer based on outcome data or other metrics to which this state and the manufacturer agree in writing.  The value-based arrangement may include a rebate, a discount, a price reduction, a contribution, risk sharing, a reimbursement, payment deferral or installment payments, a guarantee, patient care, shared savings payments, withholds, a bonus, or any other thing of value.
Added by Acts 2019, 86th Leg., R.S., Ch. 272 (S.B. 1780), Sec. 1, eff. September 1, 2019.
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 B. Powers and Duties › Section 531.071. Confidentiality of Information Regarding Drug Rebates, Pricing, and Negotiations

Text of section effective until April 01, 2025
Sec. 531.071.  CONFIDENTIALITY OF INFORMATION REGARDING DRUG REBATES, PRICING, AND NEGOTIATIONS.  (a)  Notwithstanding any other state law, information obtained or maintained by the commission regarding prescription drug rebate negotiations or a supplemental Medicaid or other rebate agreement, including trade secrets, rebate amount, rebate percentage, and manufacturer or labeler pricing, is confidential and not subject to disclosure under Chapter 552.
(b)  Information that is confidential under Subsection (a) includes information described by Subsection (a) that is obtained or maintained by the commission in connection with the Medicaid vendor drug program, the child health plan program, the kidney health care program, the children with special health care needs program, or another state program administered by the commission or a health and human services agency.
(c)  General information about the aggregate costs of different classes of drugs is not confidential under Subsection (a), except that a drug name or information that could reveal a drug name is confidential.
(d)  Information about whether the commission and a manufacturer or labeler reached or did not reach a supplemental rebate agreement under Section 531.070 for a particular drug is not confidential under Subsection (a).
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.12, eff. Sept. 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 2, eff. September 1, 2009.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.109, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
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(1), 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 B. Powers and Duties › Section 531.072. Preferred Drug Lists

Text of section effective on April 01, 2025
Sec. 531.072.  PREFERRED DRUG LISTS.
(b-3)  Notwithstanding Subsection (b), the preferred drug lists must contain all therapeutic equivalents for a generic drug on the preferred drug list.
(g)  The commission shall develop an expedited review process to consider requests from managed care organizations and providers to add drugs to the preferred drug list.
(h)  The commission shall grant temporary non-preferred status to new drugs that are available but have not yet been reviewed by the drug utilization review board and establish criteria for authorizing drugs with temporary non-preferred status.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.13(a), eff. Sept. 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 3, eff. September 1, 2009.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.08(d), eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.08(d), eff. January 1, 2016.
Acts 2023, 88th Leg., R.S., Ch. 739 (H.B. 3286), Sec. 3, eff. September 1, 2023.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(1), 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 B. Powers and Duties › Section 531.0737. Drug Utilization Review Board: Conflicts of Interest

Text of section effective until April 01, 2025
Sec. 531.0737.  DRUG UTILIZATION REVIEW BOARD:  CONFLICTS OF INTEREST.  (a)  A voting member of the Drug Utilization Review Board may not have a contractual relationship, ownership interest, or other conflict of interest with a pharmaceutical manufacturer or labeler or with an entity engaged by the commission to assist in the development of the preferred drug lists or in the administration of the Medicaid Drug Utilization Review Program.
(b)  The executive commissioner may implement this section by adopting rules that identify prohibited relationships and conflicts or requiring the board to develop a conflict-of-interest policy that applies to the board.
Added by Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 1, eff. September 1, 2009.
Redesignated and amended from Government Code, Section 531.0692 by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.08(c), and Ch. 946 (S.B. 277), Sec. 2.08(c), eff. January 1, 2016.
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 B. Powers and Duties › Section 531.0741. Publication of Information Regarding Commission Decisions on Preferred Drug List Placement

Text of section effective until April 01, 2025
Sec. 531.0741.  PUBLICATION OF INFORMATION REGARDING COMMISSION DECISIONS ON PREFERRED DRUG LIST PLACEMENT.  The commission shall publish on the commission's Internet website any decisions on preferred drug list placement, including:
(1)  a list of drugs reviewed and the commission's decision for or against placement on a preferred drug list of each drug reviewed;
(2)  for each recommendation, whether a supplemental rebate agreement or a program benefit agreement was reached under Section 531.070; and
(3)  the rationale for any departure from a recommendation of the Drug Utilization Review Board under Section 531.0736.
Added by Acts 2009, 81st Leg., R.S., Ch. 1286 (H.B. 2030), Sec. 6, eff. September 1, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.08(f), eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.08(f), eff. January 1, 2016.
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 B. Powers and Duties › Section 531.075. Prior Authorization for High-Cost Medical Services

Text of section effective until April 01, 2025
Sec. 531.075.  PRIOR AUTHORIZATION FOR HIGH-COST MEDICAL SERVICES.  The commission may evaluate and implement, as appropriate, procedures, policies, and methodologies to require prior authorization for high-cost medical services and procedures and may contract with qualified service providers or organizations to perform those functions.  Any such program shall recognize any prohibitions in state or federal law on limits in the amount, duration, or scope of medically necessary services for children on Medicaid.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.16, eff. Sept. 1, 2003.
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 B. Powers and Duties › Section 531.076. Review of Prior Authorization and Utilization Review Processes

Text of section effective until April 01, 2025
Sec. 531.076.  REVIEW OF PRIOR AUTHORIZATION AND UTILIZATION REVIEW PROCESSES.  (a)  The commission shall periodically review in accordance with an established schedule the prior authorization and utilization review processes within the Medicaid fee-for-service delivery model to determine if those processes need modification to reduce authorizations of unnecessary services and inappropriate use of services.  The commission shall also monitor the processes described in this subsection for anomalies and, on identification of an anomaly in a process, shall review the process for modification earlier than scheduled.
(b)  The commission shall monitor Medicaid managed care organizations to ensure that the organizations are using prior authorization and utilization review processes to reduce authorizations of unnecessary services and inappropriate use of services.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1311 (S.B. 8), Sec. 4, eff. September 1, 2013.
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 B. Powers and Duties › Section 531.077. Recovery of Certain Assistance

Text of section effective until April 01, 2025
Sec. 531.077.  RECOVERY OF CERTAIN ASSISTANCE.  (a)  The executive commissioner shall ensure that Medicaid implements 42 U.S.C. Section 1396p(b)(1).
(b)  The Medicaid account is an account in the general revenue fund.  Any funds recovered by implementing 42 U.S.C. Section 1396p(b)(1) shall be deposited in the Medicaid account.  Money in the account may be appropriated only to fund long-term care, including community-based care and facility-based care.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.17, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.112, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.113, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.078. Quality Assurance Fees on Certain Waiver Program Services

Text of section effective until April 01, 2025
Sec. 531.078.  QUALITY ASSURANCE FEES ON CERTAIN WAIVER PROGRAM SERVICES.  (a)  In this section, "gross receipts" means money received as compensation for services under an intermediate care facility for individuals with an intellectual disability waiver program such as a home and community services waiver or a community living assistance and support services waiver.  The term does not include a charitable contribution, revenues received for services or goods other than waivers, or any money received from consumers or their families as reimbursement for services or goods not normally covered by the waivers.
(b)  The executive commissioner by rule shall modify the quality assurance fee program under Subchapter H, Chapter 252, Health and Safety Code, by providing for a quality assurance fee program that imposes a quality assurance fee on persons providing services under a home and community services waiver or a community living assistance and support services waiver.
(c)  The executive commissioner shall establish the fee at an amount that will produce annual revenues of not more than six percent of the total annual gross receipts in this state.
(d)  The executive commissioner shall adopt rules governing:
(1)  the reporting required to compute and collect the fee and the manner and times of collecting the fee; and
(2)  the administration of the fee, including the imposition of penalties for a violation of the rules.
(e)  Fees collected under this section shall be deposited in the waiver program quality assurance fee account.
Added by Acts 2005, 79th Leg., Ch. 896 (S.B. 1830), Sec. 1, eff. June 17, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.114, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.079. Waiver Program Quality Assurance Fee Account

Text of section effective until April 01, 2025
Sec. 531.079.  WAIVER PROGRAM QUALITY ASSURANCE FEE ACCOUNT.  (a)  The waiver program quality assurance fee account is a dedicated account in the general revenue fund.  The account is exempt from the application of Section 403.095.
(b)  The account consists of fees collected under Section 531.078.
(c)  Subject to legislative appropriation and state and federal law, money in the account may be appropriated only to the Department of Aging and Disability Services to increase reimbursement rates paid under the home and community services waiver program or the community living assistance and support services waiver program or to offset allowable expenses under Medicaid.
Added by Acts 2005, 79th Leg., Ch. 896 (S.B. 1830), Sec. 1, eff. June 17, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.115, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.080. Reimbursement of Waiver Programs

Text of section effective until April 01, 2025
Sec. 531.080.  REIMBURSEMENT OF WAIVER PROGRAMS.  Subject to legislative appropriation and state and federal law, the Department of Aging and Disability Services shall use money from the waiver program quality assurance fee account, together with any federal money available to match money from the account, to increase reimbursement rates paid under the home and community services waiver program or the community living assistance and support services waiver program.
Added by Acts 2005, 79th Leg., Ch. 896 (S.B. 1830), Sec. 1, eff. June 17, 2005.
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 B. Powers and Duties › Section 531.081. Invalidity; Federal Funds

Text of section effective until April 01, 2025
Sec. 531.081.  INVALIDITY; FEDERAL FUNDS.  If any portion of Sections 531.078-531.080 is held invalid by a final order of a court that is not subject to appeal, or if the commission determines that the imposition of the quality assurance fee and the expenditure of the money collected as provided by those sections will not entitle this state to receive additional federal money under Medicaid, the commission shall:
(1)  stop collection of the quality assurance fee; and
(2)  not later than the 30th day after the date the collection of the quality assurance fee is stopped, return any money collected under Section 531.078, but not spent under Section 531.080, to the persons who paid the fees in proportion to the total amount paid by those persons.
Added by Acts 2005, 79th Leg., Ch. 896 (S.B. 1830), Sec. 1, eff. June 17, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.116, eff. April 2, 2015.
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 B. Powers and Duties › Section 531.082. Expiration of Quality Assurance Fee on Waiver Programs

Text of section effective until April 01, 2025
Sec. 531.082.  EXPIRATION OF QUALITY ASSURANCE FEE ON WAIVER PROGRAMS.  If Subchapter H, Chapter 252, Health and Safety Code, expires, this section and Sections 531.078-531.081 expire on the same date.
Added by Acts 2005, 79th Leg., Ch. 896 (S.B. 1830), Sec. 1, eff. June 17, 2005.
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 B. Powers and Duties › Section 531.083. Medicaid Long-Term Care System

Text of section effective until April 01, 2025
Sec. 531.083.  MEDICAID LONG-TERM CARE SYSTEM.  The commission shall ensure that the Medicaid long-term care system provides the broadest array of choices possible for recipients while ensuring that the services are delivered in a manner that is cost-effective and makes the best use of available funds.  The commission shall also make every effort to improve the quality of care for recipients of Medicaid long-term care services by:
(1)  evaluating the need for expanding the provider base for consumer-directed services and, if the commission identifies a demand for that expansion, encouraging area agencies on aging, independent living centers, and other potential long-term care providers to become providers through contracts with the Department of Aging and Disability Services;
(2)  ensuring that all recipients who reside in a nursing facility are provided information about end-of-life care options and the importance of planning for end-of-life care; and
(3)  developing policies to encourage a recipient who resides in a nursing facility to receive treatment at that facility whenever possible, while ensuring that the recipient receives an appropriate continuum of care.
Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 5(a), eff. September 1, 2005.
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 B. Powers and Duties › Section 531.084. Medicaid Long-Term Care Cost Containment Strategies

Sec. 531.084.  MEDICAID LONG-TERM CARE COST CONTAINMENT STRATEGIES.  (a)  The commission shall make every effort to achieve cost efficiencies within the Medicaid long-term care program.  To achieve those efficiencies, the commission shall:
(1)  establish a fee schedule for reimbursable incurred medical expenses for dental services controlled in long-term care facilities;
(2)  implement a fee schedule for reimbursable incurred medical expenses for durable medical equipment in nursing facilities and ICF-IID facilities;
(3)  implement a durable medical equipment fee schedule action plan;
(4)  establish a system for private contractors to secure and coordinate the collection of Medicare funds for recipients who are dually eligible for Medicare and Medicaid;
(5)  create additional partnerships with pharmaceutical companies to obtain discounted prescription drugs for Medicaid recipients; and
(6)  develop and implement a system for auditing the Medicaid hospice care system that provides services in long-term care facilities to ensure correct billing for pharmaceuticals.
(b)  The executive commissioner and the commissioner of aging and disability services shall jointly appoint persons to serve on a work group to assist the commission in developing the fee schedule required by Subsection (a)(1).  The work group must consist of providers of long-term care services, including dentists and long-term care advocates.
(c)  In developing the fee schedule required by Subsection (a)(1), the commission shall consider:
(1)  the need to ensure access to dental services for residents of long-term care facilities who are unable to travel to a dental office to obtain care;
(2)  the most recent Comprehensive Fee Report published by the National Dental Advisory Service;
(3)  the difficulty of providing dental services in long-term care facilities;
(4)  the complexity of treating medically compromised patients; and
(5)  time-related and travel-related costs incurred by dentists providing dental services in long-term care facilities.
(d)  The commission shall annually update the fee schedule required by Subsection (a)(1).
Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 5(a), eff. September 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.117, eff. April 2, 2015.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0841. Long-Term Care Insurance Awareness and Education Campaign

Text of section effective until April 01, 2025
Sec. 531.0841.  LONG-TERM CARE INSURANCE AWARENESS AND EDUCATION CAMPAIGN.  (a)  The commission, in consultation with the Department of Aging and Disability Services and the Texas Department of Insurance, shall develop and implement a public awareness and education campaign designed to:
(1)  educate the public on the cost of long-term care, including the limits of Medicaid eligibility and the limits of Medicare benefits;
(2)  educate the public on the value and availability of long-term care insurance; and
(3)  encourage individuals to obtain long-term care insurance.
(b)  The Department of Aging and Disability Services and the Texas Department of Insurance shall cooperate with and assist the commission in implementing the campaign under this section.
(c)  The commission may coordinate the implementation of the campaign under this section with any other state outreach campaign or activity relating to long-term care issues.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 4, eff. March 1, 2008.
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 B. Powers and Duties › Section 531.0843. Durable Medical Equipment Reuse Program

Text of section effective until April 01, 2025
Sec. 531.0843.  DURABLE MEDICAL EQUIPMENT REUSE PROGRAM.  (a)  In this section:
(1)  "Complex rehabilitation technology equipment" means equipment that is classified as durable medical equipment under the Medicare program on January 1, 2013, configured specifically for an individual to meet the individual's unique medical, physical, and functional needs and capabilities for basic and instrumental daily living activities, and medically necessary to prevent the individual's hospitalization or institutionalization.  The term includes a complex rehabilitation power wheelchair, highly configurable manual wheelchair, adaptive seating and positioning system, standing frame, and gait trainer.
(2)  "Durable medical equipment" means equipment, including repair and replacement parts for the equipment, but excluding complex rehabilitation technology equipment, that:
(A)  can withstand repeated use;
(B)  is primarily and customarily used to serve a medical purpose;
(C)  generally is not useful to a person in the absence of illness or injury; and
(D)  is appropriate and safe for use in the home.
(b)  If the commission determines that it is cost-effective, the executive commissioner by rule shall establish a program to facilitate the reuse of durable medical equipment provided to recipients under the Medicaid program.
(c)  The program must include provisions for ensuring that:
(1)  reused equipment meets applicable standards of functionality and sanitation; and
(2)  a Medicaid recipient's participation in the reuse program is voluntary.
(d)  The program does not:
(1)  waive any immunity from liability of the commission or an employee of the commission; or
(2)  create a cause of action against the commission or an employee of the commission arising from the provision of reused durable medical equipment under the program.
(e)  In accordance with Chapter 551 or 2001, as applicable, the executive commissioner shall provide notice of each proposed rule, adopted rule, and hearing that relates to establishing the program under this section.
Added by Acts 2013, 83rd Leg., R.S., Ch. 609 (S.B. 1175), Sec. 1, eff. June 14, 2013.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.