reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 537 - Medicaid Reform Waiver › Section 537.002. Federal Authorization for Medicaid Reform

Text of section effective until April 01, 2025
Sec. 537.002.  FEDERAL AUTHORIZATION FOR MEDICAID REFORM.  (a)  The executive commissioner shall seek a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) to the state Medicaid plan.
(b)  The waiver under this section must be designed to achieve the following objectives regarding Medicaid and alternatives to Medicaid:
(1)  provide flexibility to determine Medicaid eligibility categories and income levels;
(2)  provide flexibility to design Medicaid benefits that meet the demographic, public health, clinical, and cultural needs of this state or regions within this state;
(3)  encourage use of the private health benefits coverage market rather than public benefits systems;
(4)  encourage people who have access to private employer-based health benefits to obtain or maintain those benefits;
(5)  create a culture of shared financial responsibility, accountability, and participation in Medicaid by:
(A)  establishing and enforcing copayment requirements similar to private sector principles for all eligibility groups;
(B)  promoting the use of health savings accounts to influence a culture of individual responsibility; and
(C)  promoting the use of vouchers for consumer-directed services in which consumers manage and pay for health-related services provided to them using program vouchers;
(6)  consolidate federal funding streams, including funds from the disproportionate share hospitals and upper payment limit supplemental payment programs and other federal Medicaid funds, to ensure the most effective and efficient use of those funding streams;
(7)  allow flexibility in the use of state funds used to obtain federal matching funds, including allowing the use of intergovernmental transfers, certified public expenditures, costs not otherwise matchable, or other funds and funding mechanisms to obtain federal matching funds;
(8)  empower individuals who are uninsured to acquire health benefits coverage through the promotion of cost-effective coverage models that provide access to affordable primary, preventive, and other health care on a sliding scale, with fees paid at the point of service; and
(9)  allow for the redesign of long-term care services and supports to increase access to patient-centered care in the most cost-effective manner.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 13.01, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.270, eff. April 2, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter A. General Provisions › Section 538.002. Effect of Chapter; Authority of Commission

Text of section effective until April 01, 2025
Sec. 538.002.  EFFECT OF CHAPTER; AUTHORITY OF COMMISSION.  This chapter does not affect or give the commission additional authority to:
(1)  affect any individual health care treatment decision for a Medicaid recipient;
(2)  replace or affect the process of determining Medicaid benefits, including the approval process for receiving benefits for durable medical equipment, or any applicable approval process required for reimbursement for services or other equipment under Medicaid;
(3)  implement a clinical initiative or associated rule or program policy that is otherwise prohibited under state or federal law; or
(4)  implement any initiative that would expand eligibility for benefits under Medicaid.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.271, eff. April 2, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter A. General Provisions › Section 538.003. Rules

Text of section effective until April 01, 2025
Sec. 538.003.  RULES.  The executive commissioner shall adopt rules necessary to implement this chapter.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.051. Medicaid Quality Improvement Process

Text of section effective until April 01, 2025
Sec. 538.051.  MEDICAID QUALITY IMPROVEMENT PROCESS.  The commission shall, according to the provisions of this chapter, develop and implement a quality improvement process by which the commission:
(1)  receives suggestions for clinical initiatives designed to improve:
(A)  the quality of care provided under Medicaid; and
(B)  the cost-effectiveness of Medicaid;
(2)  conducts a preliminary review under Section 538.053(4) of each suggestion received under Section 538.052 to determine whether the suggestion warrants further consideration and analysis; and
(3)  conducts an analysis under Section 538.054 of clinical initiative suggestions that are selected for analysis under Subdivision (2).
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.272, eff. April 2, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.052. Solicitation of Suggestions for Clinical Initiatives

Text of section effective until April 01, 2025
Sec. 538.052.  SOLICITATION OF SUGGESTIONS FOR CLINICAL INITIATIVES.
(a)  Subject to Subsection (b), the commission shall solicit and accept suggestions for clinical initiatives, in either written or electronic form, from:
(1)  a member of the state legislature;
(2)  the executive commissioner;
(3)  the commissioner of aging and disability services;
(4)  the commissioner of state health services;
(5)  the commissioner of the Department of Family and Protective Services;
(6)  the commissioner of assistive and rehabilitative services;
(7)  the medical care advisory committee established under Section 32.022, Human Resources Code; and
(8)  the physician payment advisory committee created under Section 32.022(d), Human Resources Code.
(b)  The commission may not accept suggestions under this section for an initiative that:
(1)  is undergoing clinical trials; or
(2)  expands a health care provider's scope of practice beyond the law governing the provider's practice.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.273, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.31, eff. January 1, 2016.
Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.31, eff. January 1, 2016.
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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.053. Clinical Initiative Evaluation Process

Text of section effective until April 01, 2025
Sec. 538.053.  CLINICAL INITIATIVE EVALUATION PROCESS.  The commission shall establish and implement an evaluation process for the submission, preliminary review, analysis, and approval of a clinical initiative.  The process must:
(1)  require that a suggestion for a clinical initiative be submitted to the state Medicaid director;
(2)  require that a suggestion for a clinical initiative selected for analysis under Section 538.054 be published on the Internet website created under Section 538.056 not later than the 30th day after the date on which the state Medicaid director receives the suggestion;
(3)  provide for a formal public comment period that lasts at least 30 days during which the public may submit comments and research relating to a suggested clinical initiative;
(4)  allow the commission to conduct with the assistance of appropriate advisory committees or similar groups as determined by the commission a preliminary review of each suggested clinical initiative to determine whether the initiative warrants further consideration and analysis under Section 538.054;
(5)  limit the number of suggestions that receive analysis under Section 538.054;
(6)  require the commission to publish on the Internet website created under Section 538.056 the criteria the commission uses in the preliminary review under Subdivision (4) to determine whether an initiative warrants analysis under Section 538.054;
(7)  require commission employees to perform an analysis of each suggested clinical initiative selected for analysis in accordance with Section 538.054; and
(8)  require the development and publication of a final report in accordance with Section 538.055 on each clinical initiative selected for analysis under Section 538.054 not later than the 180th day after the date on which the state Medicaid director receives the suggestion.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.054. Analysis of Clinical Initiatives

Text of section effective until April 01, 2025
Sec. 538.054.  ANALYSIS OF CLINICAL INITIATIVES.  The commission shall conduct an analysis of each clinical initiative selected by the commission after having conducted the commission's preliminary review under Section 538.053(4).  The analysis required under this section must include a review of:
(1)  any public comments and submitted research relating to the initiative;
(2)  the available clinical research and historical utilization information relating to the initiative;
(3)  published medical literature relating to the initiative;
(4)  any adoption of the initiative by medical societies or other clinical groups;
(5)  whether the initiative has been implemented under:
(A)  the Medicare program;
(B)  another state medical assistance program; or
(C)  a state-operated health care program, including the child health plan program;
(6)  the results of reports, research, pilot programs, or clinical studies relating to the initiative conducted by:
(A)  institutions of higher education, including related medical schools;
(B)  governmental entities and agencies; and
(C)  private and nonprofit think tanks and research groups;
(7)  the impact that the initiative would have on Medicaid if the initiative were implemented in this state, including:
(A)  an estimate of the number of recipients under Medicaid that would be impacted by implementation of the initiative; and
(B)  a description of any potential cost savings to the state that would result from implementation of the initiative; and
(8)  any statutory barriers to implementation of the initiative.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.274, eff. April 2, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.055. Final Report on Clinical Initiative

Text of section effective until April 01, 2025
Sec. 538.055.  FINAL REPORT ON CLINICAL INITIATIVE.  The commission shall prepare a final report based on the commission's analysis of a clinical initiative under Section 538.054.  The final report must include:
(1)  a final determination of:
(A)  the feasibility of implementing the initiative;
(B)  the likely impact implementing the initiative would have on the quality of care provided under Medicaid; and
(C)  the anticipated cost savings to the state that would result from implementing the initiative;
(2)  a summary of the public comments, including a description of any opposition to the initiative;
(3)  an identification of any statutory barriers to implementation of the initiative; and
(4)  if the initiative is not implemented, an explanation of the decision not to implement the initiative.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.275, eff. April 2, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.056. Internet Website

Text of section effective until April 01, 2025
Sec. 538.056.  INTERNET WEBSITE.  The commission shall maintain an Internet website related to the quality improvement process required under this chapter.  The website must include:
(1)  an explanation of the process for submission, preliminary review, analysis, and approval of clinical initiatives under this chapter;
(2)  an explanation of how members of the public may submit comments or research related to an initiative;
(3)  a copy of each initiative selected for analysis under Section 538.054;
(4)  the status of each initiative in the approval process; and
(5)  a copy of each final report prepared under this chapter.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 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 538 - Medicaid Quality Improvement Process for Clinical Initiatives › Subchapter B. Medicaid Quality Improvement Process to Assess Certain Clinical Initiatives › Section 538.057. Action on Clinical Initiative by Commission

Text of section effective until April 01, 2025
Sec. 538.057.  ACTION ON CLINICAL INITIATIVE BY COMMISSION.  After the commission conducts an analysis of a clinical initiative under Section 538.054:
(1)  if the commission has determined that the initiative is cost-effective and will improve the quality of care under Medicaid, the commission may:
(A)  implement the initiative if implementation of the initiative is not otherwise prohibited by law; or
(B)  if implementation requires a change in law, submit a copy of the final report together with recommendations relating to the initiative's implementation to the standing committees of the senate and house of representatives having jurisdiction over Medicaid; and
(2)  if the commission has determined that the initiative is not cost-effective or will not improve quality of care under Medicaid, the commission may not implement the initiative.
Added by Acts 2013, 83rd Leg., R.S., Ch. 619 (S.B. 1542), Sec. 1, eff. June 14, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.276, eff. April 2, 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 539 - Community Collaboratives › Section 539.001. Definition

Text of section effective until April 01, 2025
Sec. 539.001.  DEFINITION.  In this chapter, "department" means the Department of State Health Services.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.277, eff. April 2, 2015.
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 amendment of this section, this chapter was 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 539 - Community Collaboratives › Section 539.003. Acceptable Uses of Grant Money

Text of section effective until April 01, 2025
Sec. 539.003.  ACCEPTABLE USES OF GRANT MONEY.  An entity shall use money received from a grant made by the department and private funding sources for the establishment or expansion of a community collaborative.  Acceptable uses for the money include:
(1)  the development of the infrastructure of the collaborative and the start-up costs of the collaborative;
(2)  the establishment, operation, or maintenance of other community service providers in the community served by the collaborative, including intake centers, detoxification units, sheltering centers for food, workforce training centers, microbusinesses, and educational centers;
(3)  the provision of clothing, hygiene products, and medical services to and the arrangement of transitional and permanent residential housing for persons served by the collaborative;
(4)  the provision of mental health services and substance abuse treatment not readily available in the community served by the collaborative;
(5)  the provision of information, tools, and resource referrals to assist persons served by the collaborative in addressing the needs of their children; and
(6)  the establishment and operation of coordinated intake processes, including triage procedures, to protect the public safety in the community served by the collaborative.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, eff. September 1, 2013.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 486 (H.B. 3088), Sec. 5, eff. June 14, 2021.
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 539 - Community Collaboratives › Section 539.004. Elements of Community Collaboratives

Text of section effective until April 01, 2025
Sec. 539.004.  ELEMENTS OF COMMUNITY COLLABORATIVES.  (a)  If appropriate, an entity may incorporate into the community collaborative operated by the entity the use of the Homeless Management Information System, transportation plans, and case managers.  An entity may also consider incorporating into a collaborative mentoring and volunteering opportunities, strategies to assist homeless youth and homeless families with children, strategies to reintegrate persons who were recently incarcerated into the community, services for veterans, and strategies for persons served by the collaborative to participate in the planning, governance, and oversight of the collaborative.
(b)  The focus of a community collaborative shall be the eventual successful transition of persons from receiving services from the collaborative to becoming integrated into the community served by the collaborative through community relationships and family supports.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, 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 539 - Community Collaboratives › Section 539.005. Outcome Measures for Community Collaboratives

Text of section effective until April 01, 2025
Sec. 539.005.  OUTCOME MEASURES FOR COMMUNITY COLLABORATIVES.  Each entity that receives a grant from the department to establish or expand a community collaborative shall select at least four of the following outcome measures that the entity will focus on meeting through the implementation and operation of the collaborative:
(1)  persons served by the collaborative will find employment that results in those persons having incomes that are at or above 100 percent of the federal poverty level;
(2)  persons served by the collaborative will find permanent housing;
(3)  persons served by the collaborative will complete alcohol or substance abuse programs;
(4)  the collaborative will help start social businesses in the community or engage in job creation, job training, or other workforce development activities;
(5)  there will be a decrease in the use of jail beds by persons served by the collaborative;
(6)  there will be a decrease in the need for emergency care by persons served by the collaborative;
(7)  there will be a decrease in the number of children whose families lack adequate housing referred to the Department of Family and Protective Services or a local entity responsible for child welfare; and
(8)  any other appropriate outcome measure that measures whether a collaborative is meeting a specific need of the community served by the collaborative and that is approved by the department.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, 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 539 - Community Collaboratives › Section 539.0051. Plan Required for Certain Community Collaboratives

Text of section effective until April 01, 2025
Sec. 539.0051.  PLAN REQUIRED FOR CERTAIN COMMUNITY COLLABORATIVES.  (a)  The governing body of a county shall develop and make public a plan detailing:
(1)  how local mental health authorities, municipalities, local law enforcement agencies, and other community stakeholders in the county could coordinate to establish or expand a community collaborative to accomplish the goals of Section 539.002;
(2)  how entities in the county may leverage funding from private sources to accomplish the goals of Section 539.002 through the formation or expansion of a community collaborative; and
(3)  how the formation or expansion of a community collaborative could establish or support resources or services to help local law enforcement agencies to divert persons who have been arrested to appropriate mental health care or substance abuse treatment.
(b)  The governing body of a county in which an entity that received a grant under Section 539.002 before September 1, 2017, is located is not required to develop a plan under Subsection (a).
(c)  Two or more counties, each with a population of less than 100,000, may form a joint plan under Subsection (a).
Added by Acts 2017, 85th Leg., R.S., Ch. 950 (S.B. 1849), Sec. 2.04, 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 539 - Community Collaboratives › Section 539.006. Annual Review of Outcome Measures

Text of section effective until April 01, 2025
Sec. 539.006.  ANNUAL REVIEW OF OUTCOME MEASURES.  The department shall contract with an independent third party to verify annually whether a community collaborative is meeting the outcome measures under Section 539.005 selected by the entity that operates the collaborative.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, 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 539 - Community Collaboratives › Section 539.007. Reduction and Cessation of Funding

Text of section effective until April 01, 2025
Sec. 539.007.  REDUCTION AND CESSATION OF FUNDING.  The department shall establish processes by which the department may reduce or cease providing funding to an entity if the community collaborative operated by the entity does not meet the outcome measures selected by the entity for the collaborative under Section 539.005.  The department shall redistribute any funds withheld from an entity under this section to other entities operating high-performing collaboratives on a competitive basis.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, eff. September 1, 2013.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 486 (H.B. 3088), Sec. 6, eff. June 14, 2021.
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 539 - Community Collaboratives › Section 539.008. Rules

Text of section effective until April 01, 2025
Sec. 539.008.  RULES.  The executive commissioner shall adopt any rules necessary to implement the community collaborative grant program established under this chapter, including rules to establish the requirements for an entity to be eligible to receive a grant, the required elements of a community collaborative operated by an entity, and permissible and prohibited uses of money received by an entity from a grant made by the department under this chapter.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1143 (S.B. 58), Sec. 2, 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 539 - Community Collaboratives › Section 539.009. Administrative Costs

Text of section effective until April 01, 2025
Sec. 539.009.  ADMINISTRATIVE COSTS.  A reasonable amount not to exceed five percent of the money appropriated by the legislature for the purposes of this subchapter may be used by the commission to pay administrative costs of implementing this subchapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 486 (H.B. 3088), Sec. 7, eff. June 14, 2021.
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 section, this chapter was 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 539 - Community Collaboratives › Section 539.010. Biennial Report

Sec. 539.010.  BIENNIAL REPORT.  (a)  The department shall prepare a report that includes:
(1)  the method by which the department chose entities to award grants to under this chapter;
(2)  the amount of each grant awarded to an entity under this chapter;
(3)  the number of individuals served by each community collaborative receiving grant funds under this chapter; and
(4)  the results of the annual review of outcome measures required by Section 539.006.
(b)  Not later than September 1 of each even-numbered year, the department shall submit a report described by Subsection (a) to:
(1)  the lieutenant governor;
(2)  the speaker of the house of representatives;
(3)  the standing committees of the legislature having primary jurisdiction over the department and state finance; and
(4)  the Legislative Budget Board.
Added by Acts 2023, 88th Leg., R.S., Ch. 859 (H.B. 3466), Sec. 3, eff. September 1, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter A. General Provisions › Section 540.0001. Definitions

Text of section effective on April 01, 2025
Sec. 540.0001.  DEFINITIONS.  In this chapter:
(1)  Notwithstanding Section 521.0001(2), "commission" means the Health and Human Services Commission or an agency operating part of the Medicaid managed care program, as appropriate.
(2)  "Health care service region" or "region" means a Medicaid managed care service area the commission delineates.
(3)  "Managed care organization" means a person that is authorized or otherwise permitted by law to arrange for or provide a managed care plan.
(4)  "Managed care plan" means a plan under which a person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care service.  A part of the plan must consist of arranging for or providing health care services as distinguished from indemnification against the cost of those services on a prepaid basis through insurance or otherwise.  The term includes a primary care case management provider network.  The term does not include a plan that indemnifies a person for the cost of health care services through insurance.
(5)  "Potentially preventable event" has the meaning assigned by Section 543A.0001.
(6)  "Recipient" means a Medicaid recipient.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0051. Purpose and Implementation

Text of section effective on April 01, 2025
Sec. 540.0051.  PURPOSE AND IMPLEMENTATION.  The commission shall implement the Medicaid managed care program by contracting with managed care organizations in a manner that, to the extent possible:
(1)  improves the health of Texans by:
(A)  emphasizing prevention;
(B)  promoting continuity of care; and
(C)  providing a medical home for recipients;
(2)  ensures each recipient receives high quality, comprehensive health care services in the recipient's local community;
(3)  encourages training of and access to primary care physicians and providers;
(4)  maximizes cooperation with existing public health entities, including local health departments;
(5)  provides incentives to managed care organizations to improve the quality of health care services for recipients by providing value-added services; and
(6)  reduces administrative and other nonfinancial barriers for recipients in obtaining health care services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0052. Recipient Directory

Text of section effective on April 01, 2025
Sec. 540.0052.  RECIPIENT DIRECTORY.  The commission shall, in accordance with a single source of truth design:
(1)  maintain an accurate electronic directory of contact information for each recipient enrolled in a Medicaid managed care plan offered by a managed care organization, including, to the extent feasible, each recipient's:
(A)  home, work, and mobile telephone numbers;
(B)  e-mail address; and
(C)  home and work addresses; and
(2)  ensure that each Medicaid managed care organization and enrollment broker participating in the Medicaid managed care program update the electronic directory in real time.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0053. Statewide Effort to Promote Medicaid Eligibility Maintenance

Text of section effective on April 01, 2025
Sec. 540.0053.  STATEWIDE EFFORT TO PROMOTE MEDICAID ELIGIBILITY MAINTENANCE.  (a)  The commission shall develop and implement a statewide effort to assist recipients who satisfy Medicaid eligibility requirements and who receive Medicaid services through a Medicaid managed care organization with:
(1)  maintaining eligibility; and
(2)  avoiding lapses in Medicaid coverage.
(b)  As part of the commission's effort under Subsection (a), the commission shall:
(1)  require each Medicaid managed care organization to assist the organization's recipients with maintaining eligibility;
(2)  if the commission determines it is cost-effective, develop specific strategies for assisting recipients who receive Supplemental Security Income (SSI) benefits under 42 U.S.C. Section 1381 et seq. with maintaining eligibility; and
(3)  ensure information relevant to a recipient's eligibility status is provided to the recipient's Medicaid managed care organization.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0054. Provider and Recipient Education Programs

Text of section effective on April 01, 2025
Sec. 540.0054.  PROVIDER AND RECIPIENT EDUCATION PROGRAMS.  (a)  In adopting rules to implement a Medicaid managed care program, the executive commissioner shall establish guidelines for, and require Medicaid managed care organizations to provide, education programs for providers and recipients using a variety of techniques and media.
(b)  A provider education program must include information on:
(1)  Medicaid policies, procedures, eligibility standards, and benefits;
(2)  recipients' specific problems and needs; and
(3)  recipients' rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 532.0301.
(c)  A recipient education program must present information in a manner that is easy to understand.  A program must include information on:
(1)  a recipient's rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 532.0301;
(2)  how to access health care services;
(3)  how to access complaint procedures and the recipient's right to bypass the Medicaid managed care organization's internal complaint system and use the notice and appeal procedures otherwise required by Medicaid;
(4)  Medicaid policies, procedures, eligibility standards, and benefits;
(5)  the Medicaid managed care organization's policies and procedures; and
(6)  the importance of prevention, early intervention, and appropriate use of services.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0055. Marketing Guidelines

Text of section effective on April 01, 2025
Sec. 540.0055.  MARKETING GUIDELINES.  (a)  The commission shall establish marketing guidelines for Medicaid managed care organizations, including guidelines that prohibit:
(1)  door-to-door marketing to a recipient by a Medicaid managed care organization or the organization's agent;
(2)  using marketing materials with inaccurate or misleading information;
(3)  making a misrepresentation to a recipient or provider;
(4)  offering a recipient a material or financial incentive to choose a Medicaid managed care plan, other than a nominal gift or free health screening the commission approves that the Medicaid managed care organization offers to all recipients regardless of whether the recipients enroll in the plan;
(5)  using a marketing agent who is paid solely by commission; and
(6)  face-to-face marketing at a public assistance office by a Medicaid managed care organization or the organization's agent.
(b)  This section does not prohibit:
(1)  distributing approved marketing materials at a public assistance office; or
(2)  providing information directly to a recipient under marketing guidelines the commission establishes.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0056. Guidelines for Communications With Recipients

Text of section effective on April 01, 2025
Sec. 540.0056.  GUIDELINES FOR COMMUNICATIONS WITH RECIPIENTS.  The executive commissioner shall adopt and publish guidelines for Medicaid managed care organizations regarding how an organization may communicate by text message or e-mail with a recipient enrolled in the organization's Medicaid managed care plan using the contact information provided in the recipient's application for Medicaid benefits under Section 32.025(g)(2), Human Resources Code, including updated information provided to the organization in accordance with Section 32.025(h), Human Resources Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0057. Coordination of External Oversight Activities

Text of section effective on April 01, 2025
Sec. 540.0057.  COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES.  (a)  To the extent possible, the commission shall coordinate all external oversight activities to minimize duplicating oversight of Medicaid managed care plans and disrupting operations under those plans.
(b)  The executive commissioner, after consulting with the commission's office of inspector general, shall by rule define the commission's and office's roles in, jurisdiction over, and frequency of audits of Medicaid managed care organizations that are conducted by the commission and the office.
(c)  In accordance with Section 544.0109, the commission shall share with the commission's office of inspector general, at the office's request, the results of any informal audit or on-site visit that could inform the office's risk assessment when determining:
(1)  whether to conduct an audit of a Medicaid managed care organization; or
(2)  the scope of the audit.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0058. Information for Fraud Control

Text of section effective on April 01, 2025
Sec. 540.0058.  INFORMATION FOR FRAUD CONTROL.  (a)  Each Medicaid managed care organization shall submit at no cost to the commission and, on request, the office of the attorney general:
(1)  a description of any financial or other business relationship between the organization and any subcontractor providing health care services under the contract between the organization and the commission;
(2)  a copy of each type of contract between the organization and a subcontractor relating to the delivery of or payment for health care services;
(3)  a description of the fraud control program any subcontractor that delivers health care services uses; and
(4)  a description and breakdown of all funds paid to or by the organization, including a health maintenance organization, primary care case management provider, pharmacy benefit manager, and exclusive provider organization, necessary for the commission to determine the actual cost of administering the Medicaid managed care plan.
(b)  The information under this section must be:
(1)  submitted in the form the commission or the office of the attorney general, as applicable, requires; and
(2)  updated as the commission or the office of the attorney general, as applicable, requires.
(c)  The commission's office of inspector general or the office of the attorney general, as applicable, shall review the information a Medicaid managed care organization submits under this section as appropriate in investigating fraud in the Medicaid managed care program.
(d)  Information a Medicaid managed care organization submits to the commission or the office of the attorney general under Subsection (a)(1) is confidential and not subject to disclosure under Chapter 552.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0059. Managed Care Clinical Improvement Program

Text of section effective on April 01, 2025
Sec. 540.0059.  MANAGED CARE CLINICAL IMPROVEMENT PROGRAM.  (a)  In consultation with appropriate stakeholders with an interest in the provision of acute care services and long-term services and supports under the Medicaid managed care program, the commission shall:
(1)  establish a clinical improvement program to identify goals designed to:
(A)  improve quality of care and care management; and
(B)  reduce potentially preventable events; and
(2)  require Medicaid managed care organizations to develop and implement collaborative program improvement strategies to address the goals.
(b)  Goals established under this section may be set by geographic region and program type.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter B. Administration of Medicaid Managed Care Program › Section 540.0060. Complaint System Guidelines

Text of section effective on April 01, 2025
Sec. 540.0060.  COMPLAINT SYSTEM GUIDELINES.  (a)  The Texas Department of Insurance, in conjunction with the commission, shall establish complaint system guidelines for Medicaid managed care organizations.
(b)  The guidelines must require that information regarding a Medicaid managed care organization's complaint process be made available to a recipient in an appropriate communication format when the recipient enrolls in the Medicaid managed care program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter C. Fiscal Provisions › Section 540.0101. Fiscal Solvency Standards

Text of section effective on April 01, 2025
Sec. 540.0101.  FISCAL SOLVENCY STANDARDS.  The Texas Department of Insurance, in conjunction with the commission, shall establish fiscal solvency standards for Medicaid managed care organizations.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter C. Fiscal Provisions › Section 540.0102. Profit Sharing

Text of section effective on April 01, 2025
Sec. 540.0102.  PROFIT SHARING.  (a)  The executive commissioner shall adopt rules regarding the sharing of profits earned by a Medicaid managed care organization through a Medicaid managed care plan.
(b)  Except as provided by Subsection (c), any amount this state receives under this section shall be deposited in the general revenue fund.
(c)  If cost-effective, the commission may use amounts this state receives under this section to provide incentives to specific Medicaid managed care organizations to promote quality of care, encourage payment reform, reward local service delivery reform, increase efficiency, and reduce inappropriate or preventable service utilization.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter C. Fiscal Provisions › Section 540.0103. Treatment of State Taxes in Calculating Experience Rebate or Profit Sharing

Text of section effective on April 01, 2025
Sec. 540.0103.  TREATMENT OF STATE TAXES IN CALCULATING EXPERIENCE REBATE OR PROFIT SHARING.  The commission shall ensure that any experience rebate or profit sharing for Medicaid managed care organizations is calculated by treating premium, maintenance, and other taxes under the Insurance Code and any other taxes payable to this state as allowable expenses to determine the amount of the experience rebate or profit sharing.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter D. Strategy for Managing Audit Resources › Section 540.0151. Definitions

Text of section effective on April 01, 2025
Sec. 540.0151.  DEFINITIONS.  In this subchapter:
(1)  "Accounts receivable tracking system" means the system the commission uses to track experience rebates and other payments collected from managed care organizations.
(2)  "Agreed-upon procedures engagement" means an evaluation of a managed care organization's financial statistical reports or other data conducted by an independent auditing firm the commission engages as agreed in the managed care organization's contract with the commission.
(3)  "Experience rebate" means the amount a managed care organization is required to pay this state according to the graduated rebate method described in the organization's contract with the commission.
(4)  "External quality review organization" means an organization that performs an external quality review of a managed care organization in accordance with 42 C.F.R. Section 438.350.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter D. Strategy for Managing Audit Resources › Section 540.0152. Applicability and Construction of Subchapter

Text of section effective on April 01, 2025
Sec. 540.0152.  APPLICABILITY AND CONSTRUCTION OF SUBCHAPTER.  This subchapter does not apply to and may not be construed as affecting the conduct of audits by the commission's office of inspector general under the authority provided by Subchapter C, Chapter 544, including an audit of a managed care organization the office conducts after coordinating the office's audit and oversight activities with the commission as required by Section 544.0109(c).
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 540 - Medicaid Managed Care Program › Subchapter D. Strategy for Managing Audit Resources › Section 540.0153. Overall Strategy for Managing Audit Resources

Text of section effective on April 01, 2025
Sec. 540.0153.  OVERALL STRATEGY FOR MANAGING AUDIT RESOURCES.  The commission shall develop and implement an overall strategy for planning, managing, and coordinating audit resources that the commission uses to verify the accuracy and reliability of program and financial information managed care organizations report.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.