reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.055. Agreed-Upon Procedures Engagements and Corrective Action Plans

Text of section effective until April 01, 2025
Sec. 533.055.  AGREED-UPON PROCEDURES ENGAGEMENTS AND CORRECTIVE ACTION PLANS.  To enhance the commission's use of agreed-upon procedures engagements to identify managed care organizations' performance and compliance issues, the commission shall:
(1)  ensure that financial risks identified in agreed-upon procedures engagements are adequately and consistently addressed; and
(2)  establish policies and procedures to determine under what circumstances the commission must issue a corrective action plan based on an agreed-upon procedures engagement.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.056. Audits of Pharmacy Benefit Managers

Text of section effective until April 01, 2025
Sec. 533.056.  AUDITS OF PHARMACY BENEFIT MANAGERS.  To obtain greater assurance about the effectiveness of pharmacy benefit managers' internal controls and compliance with state requirements, the commission shall:
(1)  periodically audit each pharmacy benefit manager that contracts with a managed care organization; and
(2)  develop, document, and implement a monitoring process to ensure that managed care organizations correct and resolve negative findings reported in performance audits or agreed-upon procedures engagements of pharmacy benefit managers.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.057. Collection of Costs for Audit-Related Services

Text of section effective until April 01, 2025
Sec. 533.057.  COLLECTION OF COSTS FOR AUDIT-RELATED SERVICES.  The commission shall develop, document, and implement billing processes in the Medicaid and CHIP services department of the commission to ensure that managed care organizations reimburse the commission for audit-related services as required by contract.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.058. Collection Activities Related to Profit Sharing

Text of section effective until April 01, 2025
Sec. 533.058.  COLLECTION ACTIVITIES RELATED TO PROFIT SHARING.  To strengthen the commission's process for collecting shared profits from managed care organizations, the commission shall develop, document, and implement monitoring processes in the Medicaid and CHIP services department of the commission to ensure that the commission:
(1)  identifies experience rebates deposited in the commission's suspense account and timely transfers those rebates to the appropriate accounts; and
(2)  timely follows up on and resolves disputes over experience rebates claimed by managed care organizations.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.059. Use of Information From External Quality Reviews

Text of section effective until April 01, 2025
Sec. 533.059.  USE OF INFORMATION FROM EXTERNAL QUALITY REVIEWS.  (a)  To enhance the commission's monitoring of managed care organizations, the commission shall use the information provided by the external quality review organization, including:
(1)  detailed data from results of surveys of Medicaid recipients and, if applicable, child health plan program enrollees, caregivers of those recipients and enrollees, and Medicaid and, as applicable, child health plan program providers; and
(2)  the validation results of matching paid claims data with medical records.
(b)  The commission shall document how the commission uses the information described by Subsection (a) to monitor managed care organizations.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter B. Strategy for Managing Audit Resources › Section 533.060. Security and Processing Controls Over Information Technology Systems

Text of section effective until April 01, 2025
Sec. 533.060.  SECURITY AND PROCESSING CONTROLS OVER INFORMATION TECHNOLOGY SYSTEMS.  The commission shall:
(1)  strengthen user access controls for the commission's accounts receivable tracking system and network folders that the commission uses to manage the collection of experience rebates;
(2)  document daily reconciliations of deposits recorded in the accounts receivable tracking system to the transactions processed in:
(A)  the commission's cost accounting system for all health and human services agencies; and
(B)  the uniform statewide accounting system; and
(3)  develop, document, and implement a process to ensure that the commission formally documents:
(A)  all programming changes made to the accounts receivable tracking system; and
(B)  the authorization and testing of the changes described by Paragraph (A).
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
Without reference to the addition of this subchapter, this chapter 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 533 - Medicaid Managed Care Program › Subchapter C. Prescription Drug Benefits Under Certain Outpatient Pharmacy Benefit Plans › Section 533.071. Preferred Drug List Exceptions

Sec. 533.071.  PREFERRED DRUG LIST EXCEPTIONS.  (a)  The commission shall adopt rules allowing exceptions to the preferred drug list if:
(1)  the drug required under the preferred drug list:
(A)  is contraindicated;
(B)  will likely cause an adverse reaction in or physical or mental harm to the recipient; or
(C)  is expected to be ineffective based on the known clinical characteristics of the recipient and the known characteristics of the prescription drug regimen;
(2)  the recipient previously discontinued taking the preferred drug at any point in the recipient's clinical history and for any length of time because the drug:
(A)  was not effective;
(B)  had a diminished effect; or
(C)  resulted in an adverse event;
(3)  the recipient was prescribed and is taking a nonpreferred drug in the antidepressant or antipsychotic drug class and the recipient:
(A)  was prescribed the nonpreferred drug before being discharged from an inpatient facility;
(B)  is stable on the nonpreferred drug; and
(C)  is at risk of experiencing complications from switching from the nonpreferred drug to another drug; or
(4)  the preferred drug is not available for reasons outside of the Medicaid managed care organization's control, including because:
(A)  the drug is in short supply according to the Food and Drug Administration Drug Shortages Database; or
(B)  the drug's manufacturer has placed the drug on backorder or allocation.
(b)  An exception provided under this section does not subject the Medicaid managed care plan to liquidated damages for failing to comply with the preferred drug list.
Added by Acts 2023, 88th Leg., R.S., Ch. 739 (H.B. 3286), Sec. 2, eff. September 1, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 533 - Medicaid Managed Care Program › Subchapter E. Pilot Program to Increase Incentive-Based Provider Payments › Section 533.083. Assessment and Implementation of Pilot Program Findings

Text of section effective until April 01, 2025
Sec. 533.083.  ASSESSMENT AND IMPLEMENTATION OF PILOT PROGRAM FINDINGS.  Not later than September 1, 2018, and notwithstanding any other law, the commission shall:
(1)  based on the results of the pilot program, identify which types of incentive-based provider payment goals and outcome measures are most appropriate for statewide implementation and the services that can be provided using those goals and outcome measures; and
(2)  require that a managed care organization that has contracted with the commission to provide health care services to recipients implement the payment goals and outcome measures identified under Subdivision (1).
Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.25(a), eff. September 1, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter A. General Provisions › Section 534.002. Conflict With Other Law

Text of section effective until April 01, 2025
Sec. 534.002.  CONFLICT WITH OTHER LAW.  To the extent of a conflict between a provision of this chapter and another state law, the provision of this chapter controls.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter B. Acute Care Services and Long-Term Services and Supports System › Section 534.051. Acute Care Services and Long-Term Services and Supports System for Individuals With an Intellectual or Developmental Disability

Text of section effective until April 01, 2025
Sec. 534.051.  ACUTE CARE SERVICES AND LONG-TERM SERVICES AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY.  In accordance with this chapter, the commission shall design and implement an acute care services and long-term services and supports system for individuals with an intellectual or developmental disability that supports the following goals:
(1)  provide Medicaid services to more individuals in a cost-efficient manner by providing the type and amount of services most appropriate to the individuals' needs and preferences in the most integrated and least restrictive setting;
(2)  improve individuals' access to services and supports by ensuring that the individuals receive information about all available programs and services, including employment and least restrictive housing assistance, and how to apply for the programs and services;
(3)  improve the assessment of individuals' needs and available supports, including the assessment of individuals' functional needs;
(4)  promote person-centered planning, self-direction, self-determination, community inclusion, and customized, integrated, competitive employment;
(5)  promote individualized budgeting based on an assessment of an individual's needs and person-centered planning;
(6)  promote integrated service coordination of acute care services and long-term services and supports;
(7)  improve acute care and long-term services and supports outcomes, including reducing unnecessary institutionalization and potentially preventable events;
(8)  promote high-quality care;
(9)  provide fair hearing and appeals processes in accordance with applicable federal law;
(10)  ensure the availability of a local safety net provider and local safety net services;
(11)  promote independent service coordination and independent ombudsmen services; and
(12)  ensure that individuals with the most significant needs are appropriately served in the community and that processes are in place to prevent inappropriate institutionalization of individuals.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.242, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 7, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter B. Acute Care Services and Long-Term Services and Supports System › Section 534.052. Implementation of System Redesign

Text of section effective until April 01, 2025
Sec. 534.052.  IMPLEMENTATION OF SYSTEM REDESIGN.  The commission shall, in consultation and collaboration with the advisory committee, implement the acute care services and long-term services and supports system for individuals with an intellectual or developmental disability in the manner and in the stages described in this chapter.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.243, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 7, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter B. Acute Care Services and Long-Term Services and Supports System › Section 534.054. Annual Report on Implementation

Text of section effective until April 01, 2025
Sec. 534.054.  ANNUAL REPORT ON IMPLEMENTATION.  (a)  Not later than September 30 of each year, the commission, in consultation and collaboration with the advisory committee, shall prepare and submit a report to the legislature that must include:
(1)  an assessment of the implementation of the system required by this chapter, including appropriate information regarding the provision of acute care services and long-term services and supports to individuals with an intellectual or developmental disability under Medicaid as described by this chapter;
(2)  recommendations regarding implementation of and improvements to the system redesign, including recommendations regarding appropriate statutory changes to facilitate the implementation; and
(3)  an assessment of the effect of the system on the following:
(A)  access to long-term services and supports;
(B)  the quality of acute care services and long-term services and supports;
(C)  meaningful outcomes for Medicaid recipients using person-centered planning, individualized budgeting, and self-determination, including a person's inclusion in the community;
(D)  the integration of service coordination of acute care services and long-term services and supports;
(E)  the efficiency and use of funding;
(F)  the placement of individuals in housing that is the least restrictive setting appropriate to an individual's needs;
(G)  employment assistance and customized, integrated, competitive employment options; and
(H)  the number and types of fair hearing and appeals processes in accordance with applicable federal law.
(b)  This section expires on the second anniversary of the date the commission completes implementation of the transition required under Section 534.202.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.245, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1117 (H.B. 3523), Sec. 4, eff. June 19, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 10, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.101. Definitions

Text of section effective until April 01, 2025
Sec. 534.101.  DEFINITIONS.  In this subchapter:
(1)  "Capitation" means a method of compensating a provider on a monthly basis for providing or coordinating the provision of a defined set of services and supports that is based on a predetermined payment per services recipient.
(2)  "Pilot program" means the pilot program established under this subchapter.
(3)  "Pilot program workgroup" means the pilot program workgroup established under Section 534.1015.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.247, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 12, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.1015. Pilot Program Workgroup

Text of section effective until April 01, 2025
Sec. 534.1015.  PILOT PROGRAM WORKGROUP.  (a)  The executive commissioner, in consultation with the advisory committee, shall establish a pilot program workgroup to provide assistance in developing and advice concerning the operation of the pilot program.
(b)  The pilot program workgroup is composed of:
(1)  representatives of the advisory committee;
(2)  stakeholders representing individuals with an intellectual or developmental disability;
(3)  stakeholders representing individuals with similar functional needs as those individuals described by Subdivision (2); and
(4)  representatives of managed care organizations that contract with the commission to provide services under the STAR+PLUS Medicaid managed care program.
(c)  Chapter 2110 applies to the pilot program workgroup.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 13, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.102. Pilot Program to Test Person-Centered Managed Care Strategies and Improvements Based on Capitation

Text of section effective until April 01, 2025
Sec. 534.102.  PILOT PROGRAM TO TEST PERSON-CENTERED MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION.  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop and implement a pilot program in accordance with this subchapter to test, through the STAR+PLUS Medicaid managed care program, the delivery of long-term services and supports to individuals participating in the pilot program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.248, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 14, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.103. Stakeholder Input

Text of section effective until April 01, 2025
Sec. 534.103.  STAKEHOLDER INPUT.  As part of developing and implementing the pilot program, the commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop a process to receive and evaluate:
(1)  input from statewide stakeholders and stakeholders from a STAR+PLUS Medicaid managed care service area in which the pilot program will be implemented; and
(2)  other evaluations and data.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 14, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.1035. Managed Care Organization Selection

Text of section effective until April 01, 2025
Sec. 534.1035.  MANAGED CARE ORGANIZATION SELECTION.  (a)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop criteria regarding the selection of a managed care organization to participate in the pilot program.
(b)  The commission shall select and contract with not more than two managed care organizations that contract with the commission to provide services under the STAR+PLUS Medicaid managed care program to participate in the pilot program.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 15, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.105. Pilot Program: Measurable Goals

Text of section effective until April 01, 2025
Sec. 534.105.  PILOT PROGRAM: MEASURABLE GOALS.  (a)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup and using national core indicators, the National Quality Forum long-term services and supports measures, and other appropriate Consumer Assessment of Healthcare Providers and Systems measures, shall identify measurable goals to be achieved by the pilot program.
(b)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall develop specific strategies and performance measures for achieving the identified goals.  A proposed strategy may be evidence-based if there is an evidence-based strategy available for meeting the pilot program's goals.
(c)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall ensure that mechanisms to report, track, and assess specific strategies and performance measures for achieving the identified goals are established before implementing the pilot program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.106. Implementation, Location, and Duration

Text of section effective until April 01, 2025
Sec. 534.106.  IMPLEMENTATION, LOCATION, AND DURATION.  (a)  The commission shall implement the pilot program on September 1, 2023.
(b)  The pilot program shall operate for at least 24 months.
(c)  The pilot program shall be conducted in a STAR+PLUS Medicaid managed care service area selected by the commission.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1117 (H.B. 3523), Sec. 6, eff. June 19, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.107. Commission Responsibilities

Text of section effective until April 01, 2025
Sec. 534.107.  COMMISSION RESPONSIBILITIES.  (a)  The commission shall require that a managed care organization participating in the pilot program:
(1)  ensures that individuals participating in the pilot program have a choice among acute care and comprehensive long-term services and supports providers and service delivery options, including the consumer direction model;
(2)  demonstrates to the commission's satisfaction that the organization's network of acute care, long-term services and supports, and comprehensive long-term services and supports providers have experience and expertise in providing services for individuals with an intellectual or developmental disability and individuals with similar functional needs;
(3)  has a process for preventing inappropriate institutionalizations of individuals; and
(4)  ensures the timely initiation and consistent provision of services in accordance with an individual's person-centered plan.
(b)  For the duration of the pilot program, the commission shall ensure that comprehensive long-term services and supports providers are considered significant traditional providers and included in the provider network of a managed care organization participating in the pilot program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.250, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.108. Pilot Program Information

Text of section effective until April 01, 2025
Sec. 534.108.  PILOT PROGRAM INFORMATION.  (a)  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall determine which information will be collected from a managed care organization participating in the pilot program to use in conducting the evaluation and preparing the report under Section 534.112.
(b)  For the duration of the pilot program, a managed care organization participating in the pilot program shall submit to the commission and the advisory committee quarterly reports on the services provided to each pilot program participant that include information on:
(1)  the level of each requested service and the authorization and utilization rates for those services;
(2)  timelines of:
(A)  the delivery of each requested service;
(B)  authorization of each requested service;
(C)  the initiation of each requested service; and
(D)  each unplanned break in the delivery of requested services and the duration of the break;
(3)  the number of pilot program participants using employment assistance and supported employment services;
(4)  the number of service denials and fair hearings and the dispositions of fair hearings;
(5)  the number of complaints and inquiries received by the managed care organization and the outcome of each complaint; and
(6)  the number of pilot program participants who choose the consumer direction model and the reasons why other participants did not choose the consumer direction model.
(c)  The commission shall ensure that the mechanisms to report and track the information and data required by this section are established before implementing the pilot program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1117 (H.B. 3523), Sec. 7, eff. June 19, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.109. Person-Centered Planning

Text of section effective until April 01, 2025
Sec. 534.109.  PERSON-CENTERED PLANNING.  The commission, in consultation and collaboration with the advisory committee and pilot program workgroup, shall ensure that each individual who receives services and supports under Medicaid through the pilot program, or the individual's legally authorized representative, has access to a comprehensive, facilitated, person-centered plan that identifies outcomes for the individual and drives the development of the individualized budget.  The consumer direction model must be an available option for individuals to achieve self-determination, choice, and control.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.251, eff. April 2, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 18, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.110. Transition Between Programs; Continuity of Services

Text of section effective until April 01, 2025
Sec. 534.110.  TRANSITION BETWEEN PROGRAMS; CONTINUITY OF SERVICES.  (a)  During the evaluation of the pilot program required under Section 534.112, the commission may continue the pilot program to ensure continuity of care for pilot program participants.  If the commission does not continue the pilot program following the evaluation, the commission shall ensure that there is a comprehensive plan for transitioning the provision of Medicaid benefits for pilot program participants to the benefits provided before participating in the pilot program.
(b)  A transition plan under Subsection (a) shall be developed in consultation and collaboration with the advisory committee and pilot program workgroup and with stakeholder input as described by Section 534.103.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.252, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1117 (H.B. 3523), Sec. 8, eff. June 19, 2015.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 19, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter C. Stage One: Pilot Program for Improving Service Delivery Models › Section 534.111. Conclusion of Pilot Program

Text of section effective until April 01, 2025
Sec. 534.111.  CONCLUSION OF PILOT PROGRAM.  (a)  On September 1, 2025, the pilot program is concluded unless the commission continues the pilot program under Section 534.110.
(b)  If the commission continues the pilot program under Section 534.110, the commission shall publish notice of the pilot program's continuance in the Texas Register not later than September 1, 2025.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 1073 (H.B. 3295), Sec. 1, eff. September 1, 2017.
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 20, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter D. Stage One: Provision of Acute Care and Certain Other Services › Section 534.151. Delivery of Acute Care Services for Individuals With an Intellectual or Developmental Disability

Text of section effective until April 01, 2025
Sec. 534.151.  DELIVERY OF ACUTE CARE SERVICES FOR INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY. (a) Subject to Section 533.0025, the commission shall provide acute care Medicaid benefits to individuals with an intellectual or developmental disability through the STAR + PLUS Medicaid managed care program or the most appropriate integrated capitated managed care program delivery model and monitor the provision of those benefits.
(b)  The commission and the department, in consultation and collaboration with the advisory committee, shall analyze the outcomes of providing acute care Medicaid benefits to individuals with an intellectual or developmental disability under a model specified in Subsection (a).  The analysis must:
(1)  include an assessment of the effects on:
(A)  access to and quality of acute care services; and
(B)  the number and types of fair hearing and appeals processes in accordance with applicable federal law;
(2)  be incorporated into the annual report to the legislature required under Section 534.054; and
(3)  include recommendations for delivery model improvements and implementation for consideration by the legislature, including recommendations for needed statutory changes.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.253, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1117 (H.B. 3523), Sec. 9, eff. June 19, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter E. Stage Two: Transition of Icf-Iid Program Recipients and Long-Term Care Medicaid Waiver Program Recipients to Integrated Managed Care System › Section 534.203. Responsibilities of Commission Under Subchapter

Text of section effective until April 01, 2025
Sec. 534.203.  RESPONSIBILITIES OF COMMISSION UNDER SUBCHAPTER.  In administering this subchapter, the commission shall ensure, on making a determination to transition services under Section 534.202:
(1)  that the commission is responsible for setting the minimum reimbursement rate paid to a provider of ICF-IID services or a group home provider under the integrated managed care system, including the staff rate enhancement paid to a provider of ICF-IID services or a group home provider;
(2)  that an ICF-IID service provider or a group home provider is paid not later than the 10th day after the date the provider submits a clean claim in accordance with the criteria used by the commission for the reimbursement of ICF-IID service providers or a group home provider, as applicable;
(3)  the establishment of an electronic portal through which a provider of ICF-IID services or a group home provider participating in the STAR+PLUS Medicaid managed care program delivery model or the most appropriate integrated capitated managed care program delivery model, as appropriate, may submit long-term services and supports claims to any participating managed care organization; and
(4)  that the consumer direction model is an available option for each individual with an intellectual or developmental disability who receives Medicaid benefits in accordance with this subchapter to achieve self-determination, choice, and control, and that the individual or the individual's legally authorized representative has access to a comprehensive, facilitated, person-centered plan that identifies outcomes for the individual.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 1.01, eff. September 1, 2013.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 25, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter F. Other Implementation Requirements and Responsibilities › Section 534.251. Delayed Implementation Authorized

Text of section effective until April 01, 2025
Sec. 534.251.  DELAYED IMPLEMENTATION AUTHORIZED.  Notwithstanding any other law, the commission may delay implementation of a provision of this chapter without further investigation, adjustments, or legislative action if the commission determines the provision adversely affects the system of services and supports to persons and programs to which this chapter applies.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 26, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 534 - System Redesign for Delivery of Medicaid Acute Care Services and Long-Term Services and Supports to Persons With an Intellectual or Developmental Disability › Subchapter F. Other Implementation Requirements and Responsibilities › Section 534.252. Requirements Regarding Transition of Services

Text of section effective until April 01, 2025
Sec. 534.252.  REQUIREMENTS REGARDING TRANSITION OF SERVICES.  (a)  For purposes of implementing the pilot program under Subchapter C and transitioning the provision of services provided to recipients under certain Medicaid waiver programs to a Medicaid managed care delivery model following completion of the pilot program, the commission shall:
(1)  implement and maintain a certification process for and maintain regulatory oversight over providers under the Texas home living (TxHmL) and home and community-based services (HCS) waiver programs; and
(2)  require managed care organizations to include in the organizations' provider networks providers who are certified in accordance with the certification process described by Subdivision (1).
(b)  For purposes of implementing the pilot program under Subchapter C and transitioning the provision of services described by Section 534.202 to the STAR+PLUS Medicaid managed care program, a comprehensive long-term services and supports provider:
(1)  must report to the managed care organization in the network of which the provider participates each encounter of any directly contracted service;
(2)  must provide to the managed care organization quarterly reports on:
(A)  coordinated services and time frames for the delivery of those services; and
(B)  the goals and objectives outlined in an individual's person-centered plan and progress made toward meeting those goals and objectives; and
(3)  may not be held accountable for the provision of services specified in an individual's service plan that are not authorized or subsequently denied by the managed care organization.
(c)  On transitioning services under a Medicaid waiver program to a Medicaid managed care delivery model, the commission shall ensure that individuals do not lose benefits they receive under the Medicaid waiver program.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 26, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter A. General Provisions › Section 535.001. Definitions

Text of section effective until April 01, 2025
Sec. 535.001.  DEFINITIONS.  In this chapter:
(1)  "Community-based initiative" includes a social, health, human services, or volunteer income tax assistance initiative operated by a community-based organization.
(2)  "Community-based organization" means a nonprofit corporation or association that is located in close proximity to the population the organization serves.
(3)  "Faith-based initiative" means a social, health, or human services initiative operated by a faith-based organization.
(4)  "Faith-based organization" means a nonprofit corporation or association that:
(A)  is operated through a religious or denominational organization, including an organization that is operated for religious, educational, or charitable purposes and that is operated, supervised, or controlled, wholly or partly, by or in connection with a religious organization; or
(B)  clearly demonstrates through the organization's mission statement, policies, or practices that the organization is guided or motivated by religion.
(5)  "State Commission on National and Community Service" means the entity used as authorized by 42 U.S.C. Section 12638(a) to carry out the duties of a state commission under the National and Community Service Act of 1990 (42 U.S.C. Section 12501 et seq.).
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter A. General Provisions › Section 535.002. Purpose

Text of section effective until April 01, 2025
Sec. 535.002.  PURPOSE.  The purpose of this chapter is to strengthen the capacity of faith- and community-based organizations and to forge stronger partnerships between those organizations and state government for the legitimate public purpose of providing charitable and social services to persons in this state.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter A. General Provisions › Section 535.003. Construction

Text of section effective until April 01, 2025
Sec. 535.003.  CONSTRUCTION.  This chapter may not be construed to:
(1)  exempt a faith- or community-based organization from any applicable state or federal law; or
(2)  be an endorsement or sponsorship by this state of the religious character, expression, beliefs, doctrines, or practices of a faith-based organization.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 535 - Provision of Human Services and Other Social Services Through Faith- and Community-Based Organizations › Subchapter A. General Provisions › Section 535.004. Applicability of Certain Federal Law

Text of section effective until April 01, 2025
Sec. 535.004.  APPLICABILITY OF CERTAIN FEDERAL LAW.  A power authorized or duty imposed under this chapter must be performed in a manner that is consistent with 42 U.S.C. Section 604a.
Added by Acts 2009, 81st Leg., R.S., Ch. 259 (H.B. 492), Sec. 1(a), eff. May 30, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.