reglab/statecodes huggingface dataset:
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.031. Receipt and Expenditure of Funds

Sec. 32.031.  RECEIPT AND EXPENDITURE OF FUNDS.  (a)  The commission may accept federal funds for the support of the medical assistance program and may expend the funds in the manner prescribed by this chapter or other laws.  The expenditures must be made in accordance with appropriate agreements between the state and the federal government.
(b)  The commission may administer and expend state funds appropriated for the program in accordance with commission rules and the provisions of this chapter.
(c)  The amount of state funds spent for medical assistance on behalf of a qualified individual may not exceed the amount that is matchable with federal funds, and the total amount of state funds spent for all medical assistance on behalf of all qualified individuals may not exceed the amount that is matchable with federal funds.
(d)  The executive commissioner is empowered and authorized to pursue the use of local funds as part of the state share under the Medicaid program as provided by federal law and regulation.
(e)  Public hospitals, including hospitals owned, operated, or leased by a governmental entity, including a municipality, county, hospital district, or this state, and specifically including a state teaching hospital, may transfer funds to the commission for use as the state share under the Medicaid disproportionate share program.
Acts 1979, 66th Leg., p. 2352, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 1989, 71st Leg., ch. 1215, Sec. 4, eff. Sept. 1, 1989;  Acts 1995, 74th Leg., ch. 6, Sec. 6, eff. March 23, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.102, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0311. Drug Reimbursement Under Certain Programs

Sec. 32.0311.  DRUG REIMBURSEMENT UNDER CERTAIN PROGRAMS.  The commission shall require a recipient of medical assistance to exhaust drug benefits available under the medical assistance program before reimbursing the recipient, pharmacist, or other health care provider for drugs purchased by or on behalf of the recipient under the Kidney Health Care Program or the Children with Special Health Care Needs Services Program.
Added by Acts 1999, 76th Leg., ch. 669, Sec. 1, eff. June 18, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.103, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.03117. Reimbursement for Non-Opioid Treatments

Sec. 32.03117.  REIMBURSEMENT FOR NON-OPIOID TREATMENTS.  (a)  In this section, "non-opioid treatment" means a drug or biological product that is indicated to produce analgesia without acting on the body's opioid receptors.
(b)  The commission shall ensure that medical assistance reimbursement is provided to a provider who provides a non-opioid treatment to a recipient under the medical assistance program.
(c)  The executive commissioner by rule shall ensure that, to the extent permitted by federal law, a hospital provider that provides outpatient department services to a medical assistance recipient is reimbursed separately under the medical assistance program for any non-opioid treatment provided as a part of those services.
Added by Acts 2023, 88th Leg., R.S., Ch. 890 (H.B. 4888), Sec. 1, eff. September 1, 2023.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0312. Reimbursement for Services Associated With Preventable Adverse Events

Sec. 32.0312.  REIMBURSEMENT FOR SERVICES ASSOCIATED WITH PREVENTABLE ADVERSE EVENTS.  The executive commissioner shall adopt rules regarding the denial or reduction of reimbursement under the medical assistance program for preventable adverse events that occur in a hospital setting.  In adopting the rules, the executive commissioner:
(1)  shall ensure that the commission imposes the same reimbursement denials or reductions for preventable adverse events as the Medicare program imposes for the same types of health care-associated adverse conditions and the same types of health care providers and facilities under a policy adopted by the federal Centers for Medicare and Medicaid Services;
(2)  shall consult an advisory committee on health care quality, if established by the executive commissioner, to obtain the advice of that committee regarding denial or reduction of reimbursement claims for any other preventable adverse events that cause patient death or serious disability in health care settings, including events on the list of adverse events identified by the National Quality Forum; and
(3)  may allow the commission to impose reimbursement denials or reductions for preventable adverse events described by Subdivision (2).
Added by Acts 2009, 81st Leg., R.S., Ch. 724 (S.B. 203), Sec. 3(a), eff. September 1, 2009.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.104, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0313. Induced Deliveries or Cesarean Sections Before 39th Week

Sec. 32.0313.  INDUCED DELIVERIES OR CESAREAN SECTIONS BEFORE 39TH WEEK.  (a)  The commission shall achieve cost savings with improved outcomes by adopting and implementing quality initiatives that are evidence-based, tested, and fully consistent with established standards of clinical care and that are designed to reduce the number of elective or nonmedically indicated induced deliveries or cesarean sections performed at a hospital on a medical assistance recipient before the 39th week of gestation.
(b)  The commission shall coordinate with physicians, hospitals, managed care organizations, and the commission's billing contractor for the medical assistance program to develop a process for collecting information regarding the number of induced deliveries and cesarean sections described by Subsection (a) that occur during prescribed periods.
Added by Acts 2011, 82nd Leg., R.S., Ch. 299 (H.B. 1983), Sec. 1, eff. September 1, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.105, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0314. Reimbursement for Durable Medical Equipment and Supplies

Sec. 32.0314.  REIMBURSEMENT FOR DURABLE MEDICAL EQUIPMENT AND SUPPLIES.  The executive commissioner shall adopt rules requiring the electronic submission of any claim for reimbursement for durable medical equipment and supplies under the medical assistance program.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.18, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.105, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.03141. Authority of Advanced Practice Registered Nurses and Physician Assistants Regarding Durable Medical Equipment and Supplies

Sec. 32.03141.  AUTHORITY OF ADVANCED PRACTICE REGISTERED NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL EQUIPMENT AND SUPPLIES.  To the extent allowed by federal law, an advanced practice registered nurse or physician assistant acting under adequate physician supervision and to whom a physician has delegated the authority to prescribe and order drugs and devices under Chapter 157, Occupations Code, may order and prescribe durable medical equipment and supplies under the medical assistance program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 418 (S.B. 406), Sec. 26, eff. November 1, 2013.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0315. Funds for Graduate Medical Education

Sec. 32.0315.  FUNDS FOR GRADUATE MEDICAL EDUCATION.  (a)  Subject to appropriated state funds, the executive commissioner shall establish procedures and formulas for the allocation of federal medical assistance funds that are directed to be used to support graduate medical education in connection with the medical assistance program.
(b)  The executive commissioner shall allocate the funds in the manner the executive commissioner determines most effectively and equitably achieves the purposes for which those federal funds are received, consistent with the needs of this state for graduate medical education and the training of resident physicians in accredited residency programs in appropriate fields and specialties, taking into account other money available to support graduate medical education.  In determining the needs of this state for graduate medical education, the executive commissioner shall give primary emphasis to graduate medical education in primary care specialties and shall also recognize the growth in residency training slots since 1997 in the Lower Rio Grande Valley and other health care shortage areas of this state.
(c)  The executive commissioner shall consult with the Texas Higher Education Coordinating Board before adopting or revising a formula under this section.  At the request of the executive commissioner, the coordinating board shall provide the executive commissioner with any information the board possesses to assist the executive commissioner in administering this section.
Added by Acts 1997, 75th Leg., ch. 252, Sec. 1, eff. Sept. 1, 1997.  Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.100(a), (b), eff. Sept. 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 733 (H.B. 2420), Sec. 1, eff. September 1, 2005.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.106, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0316. Electronic Transactions; Medicaid

Sec. 32.0316.  ELECTRONIC TRANSACTIONS; MEDICAID.  The executive commissioner shall adopt and the commission shall implement policies that encourage the use of electronic transactions in Medicaid.  The policies shall require payment to Medicaid providers by electronic funds transfer, including electronic remittance and status reports.  The policies shall also include the establishment of incentives to submit claims electronically and of disincentives to submit claims on paper that are reasonably based on the higher administrative costs to process claims submitted on paper.
Added by Acts 1999, 76th Leg., ch. 1411, Sec. 1.10, eff. Sept. 1, 1999.
Transferred, redesignated and amended from Health and Safety Code, Section 12.0124 by Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0017, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0317. Reimbursement for Services Provided Under School Health and Related Services Program

Sec. 32.0317.  REIMBURSEMENT FOR SERVICES PROVIDED UNDER SCHOOL HEALTH AND RELATED SERVICES PROGRAM.  The executive commissioner shall adopt rules requiring parental consent for services provided under the school health and related services program in order for a school district to receive reimbursement for the services.  The rules must allow a school district to seek a waiver to receive reimbursement for services provided to a student who does not have a parent or legal guardian who can provide consent.
Added by Acts 2021, 87th Leg., R.S., Ch. 820 (H.B. 2658), Sec. 7, eff. September 1, 2021.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.032. Prevention and Detection of Fraud and Abuse

Sec. 32.032.  PREVENTION AND DETECTION OF FRAUD AND ABUSE.  The executive commissioner  shall adopt reasonable rules for minimizing the opportunity for fraud and abuse, for establishing and maintaining methods for detecting and identifying situations in which a question of fraud or abuse in the program may exist, and for referring cases where fraud or abuse appears to exist to the appropriate law enforcement agencies for prosecution.
Acts 1979, 66th Leg., p. 2352, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.104, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 257, Sec. 2, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.106, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0321. Surety Bond

Sec. 32.0321.  SURETY BOND.  (a)  The executive commissioner  by rule may require each provider of medical assistance in a provider type that has demonstrated significant potential for fraud or abuse to file with the commission a surety bond in a reasonable amount.  The executive commissioner by rule shall require a provider of medical assistance to file with the commission a surety bond in a reasonable amount if the commission identifies a pattern of suspected fraud or abuse involving criminal conduct relating to the provider's services under the medical assistance program that indicates the need for protection against potential future acts of fraud or abuse.
(b)  The bond under Subsection (a) must be payable to the commission to compensate the commission for damages resulting from or penalties or fines imposed in connection with an act of fraud or abuse committed by the provider under the medical assistance program.
(c)  Subject to Subsection (d) or (e), the executive commissioner by rule may require each provider of medical assistance that establishes a resident's trust fund account to post a surety bond to secure the account.  The bond must be payable to the commission to compensate residents of the bonded provider for trust funds that are lost, stolen, or otherwise unaccounted for if the provider does not repay any deficiency in a resident's trust fund account to the person legally entitled to receive the funds.
(d)  The executive commissioner may not require the amount of a surety bond posted for a single facility provider under Subsection (c) to exceed the average of the total average monthly balance of all the provider's resident trust fund accounts for the 12-month period preceding the bond issuance or renewal date.
(e)  If an employee of a provider of medical assistance is responsible for the loss of funds in a resident's trust fund account, the resident, the resident's family, and the resident's legal representative are not obligated to make any payments to the provider that would have been made out of the trust fund had the loss not occurred.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 2.03, eff. Sept. 1, 1997.  Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.105, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 257, Sec. 3, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.107, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.033. Subrogation

Sec. 32.033.  SUBROGATION.  (a)  The filing of an application for or receipt of medical assistance constitutes an assignment of the applicant's or recipient's right of recovery from:
(1)  personal insurance;
(2)  other sources;  or
(3)  another person for personal injury caused by the other person's negligence or wrong.
(b)  A person who applies for or receives medical assistance shall inform the commission, at the time of application or at any time during eligibility and receipt of services, of any unsettled tort claim which may affect medical needs and of any private accident or sickness insurance coverage that is or may become available.  A recipient shall inform the commission of any injury requiring medical attention that is caused by the act or failure to act of some other person.  An applicant or a recipient shall inform the commission as required by this subsection within 60 days of the date the person learns of his or her insurance coverage, tort claim, or potential cause of action.  An applicant or recipient who knowingly and intentionally fails to disclose the information required by this subsection commits a Class C misdemeanor.
(c)  A claim for damages for personal injury does not constitute grounds for denying or discontinuing assistance under this chapter.
(d)  A separate and distinct cause of action in favor of the state is hereby created, and the commission may, without written consent, take direct civil action in any court of competent jurisdiction.  A suit brought under this section need not be ancillary to or dependent upon any other action.
(e)  The commission's right of recovery is limited to the amount of the cost of medical care services paid by the commission.  Other subrogation rights granted under this section are limited to the cost of the services provided.
(f)  The executive commissioner may waive the commission's right of recovery in whole or in part when the executive commissioner finds that enforcement would tend to defeat the purpose of public assistance.
(g)  The commission may designate an agent to collect funds the commission has a right to recover from third parties under this section.  The commission shall use any funds collected to pay costs of administering the medical assistance program.
(h)  The executive commissioner may adopt rules for the enforcement of the commission's right of recovery.
Acts 1979, 66th Leg., p. 2352, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 1979, 66th Leg., p. 2436, ch. 842, art. 2, Sec. 10, eff. Sept. 1, 1979.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.109, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.034. Contract Cancellation; Notice and Hearing

Sec. 32.034.  CONTRACT CANCELLATION;  NOTICE AND HEARING.  (a)  The commission has authority to adjudicate claims of contested cases in accordance with Chapter 2001, Government Code.  When the commission intends to cancel its contract or impose monetary penalties under a contract with a person providing medical assistance, the commission shall give reasonable notice and an opportunity for hearing if one is requested.  The executive commissioner shall adopt rules consistent with Chapter 2001, Government Code, to implement this section, and hearings under this section are contested cases under that act.
(b)  The commission may not terminate a contract during the pendency of a hearing under this section.  The commission may withhold payments during the pendency of a hearing, but the commission shall pay the withheld payments and resume contract payments if the final determination is favorable to the contractor.  The commission's authority to withhold payments shall be established by contract.
(c)  The section does not apply if federal matching funds are not available to pay the facility whose contract is being cancelled.  If federal matching funds cannot be used, no state funds may be used to pay the facility.
Acts 1979, 66th Leg., p. 2352, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 1987, 70th Leg., ch. 1052, Sec. 2.02, eff. Sept. 1, 1987;  Acts 1991, 72nd Leg., 1st C.S., ch. 15, Sec. 5.22, eff. Sept. 1, 1991;  Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995;  Acts 1997, 75th Leg., ch. 1159, Sec. 2.03, eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.110, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.035. Appeals

Sec. 32.035.  APPEALS.  The provisions of Section 31.034 governing the right of appeal of an applicant for or recipient of financial assistance authorized under Chapter 31 also apply to applicants for medical assistance authorized in this chapter.
Acts 1979, 66th Leg., p. 2353, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.111, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.036. Program Payments Nonassignable and Exempt From Legal Process

Sec. 32.036.  PROGRAM PAYMENTS NONASSIGNABLE AND EXEMPT FROM LEGAL PROCESS.  (a)  Neither medical assistance nor payments to providers of medical assistance under this chapter are transferable or assignable at law or in equity.
(b)  No money paid or payable under the provisions of this chapter is subject to execution, levy, attachment, garnishment, or any other legal process, or the operation of any insolvency law.
(c)  This section does not apply to the extent that it conflicts with the Social Security Act (42 U.S.C. Section 1396a(a)(32)).
Acts 1979, 66th Leg., p. 2353, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 1997, 75th Leg., ch. 216, Sec. 1, eff. May 23, 1997.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.038. Collection of Insurance Payments

Sec. 32.038.  COLLECTION OF INSURANCE PAYMENTS.  (a)  The commission may receive directly from an insurance company any payments to which the commission is entitled under Section 1204.153, Insurance Code.
(b)  The executive commissioner shall adopt rules to implement this section, including rules establishing procedures relating to:
(1)  notification to the commission that a child receiving benefits under Chapter 31 or this chapter is covered by an insurance policy under which the commission is eligible to receive direct payments;
(2)  claims made by the commission to receive payments under Subsection (a);
(3)  notification to the commission of any change in the status of the child or the parent; and
(4)  notification to the insurance company that the commission is to receive payments under Subsection (a).
(c)  Commission rules relating to the notice prescribed by Subsection (b)(4) must require the notice to be attached to the claim for insurance benefits when the claim is first submitted to the insurance company.
Added by Acts 1987, 70th Leg., ch. 1052, Sec. 2.03, eff. Sept. 1, 1987.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.128, eff. September 1, 2005.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.112, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0381. Icf-Iid Payment Rates

Sec. 32.0381.  ICF-IID PAYMENT RATES.  (a)  The executive commissioner shall set the payment rates for ICF-IID facilities at least annually.
(b)  The executive commissioner shall adopt by rule the methodology used by the executive commissioner in setting payment rates for ICF-IID facilities.  The methodology shall clearly define the procedures and methods used in projecting the costs of economic and efficient facilities and the procedures and methods used in setting payment rates that reasonably reimburse facilities at each level of care and in each class of providers, including size categories.
(c)  The executive commissioner shall ensure that the methodology used in projecting costs and setting payment rates and its implementation is the same for state-operated ICF-IID facilities and for private ICF-IID facilities.  Methods used to project costs, including those involving the handling of gifts, grants, and donations, upper limits on facility and administrative costs, occupancy adjustments, and in assessing the cost impact of new or revised requirements, must be the same for state-operated and private facilities.
(d)  To the extent allowed by federal law, any differences in methodology or its implementation between state-operated facilities and private facilities must be stated explicitly in the rule, must be related to actual differences in the nature of the expenses incurred by the class of providers, including size categories, and must not favor state-operated facilities in setting payment rates.  When the proposed rule or amendments to the rule are published for public comment, the executive commissioner must certify that any differences in methodology between classes of providers, including size categories, are necessitated by cost structure and will not favor state-operated facilities in the setting of payment rates.
Added by Acts 1989, 71st Leg., ch. 1141, Sec. 11(a), eff. Sept. 1, 1989.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.112, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0391. Criminal Offense

Sec. 32.0391.  CRIMINAL OFFENSE.  (a)  A person commits an offense if the person intentionally or knowingly commits a violation under Section 32.039(b)(1-b), (1-c), (1-d), (1-e), or (1-f).
(b)  An offense under this section is a state jail felony.
(c)  If conduct constituting an offense under this section also constitutes an offense under another provision of law, including a provision in the Penal Code, the person may be prosecuted under either this section or the other provision.
(d)  With the consent of the appropriate local county or district attorney, the attorney general has concurrent jurisdiction with that consenting local prosecutor to prosecute an offense under this section.
Added by Acts 2003, 78th Leg., ch. 257, Sec. 6, eff. Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 127 (S.B. 1694), Sec. 3, eff. September 1, 2007.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.040. Identification of Husband or Alleged Father

Sec. 32.040.  IDENTIFICATION OF HUSBAND OR ALLEGED FATHER.  (a)  A woman receiving medical assistance in the form of prenatal care, child delivery care, and obstetrical care related to prenatal care and child delivery care shall identify her husband, or, if unmarried, shall provide the name and last known address of the alleged father of the unborn child.
(b)  If the woman receiving medical assistance is under 18 years of age and resides with one or both parents, the parents shall cooperate in identifying the husband or the alleged father.
Added by Acts 1989, 71st Leg., 1st C.S., ch. 25, Sec. 37, eff. Jan. 1, 1990.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0421. Administrative Penalty for Failure to Provide Information

Sec. 32.0421.  ADMINISTRATIVE PENALTY FOR FAILURE TO PROVIDE INFORMATION.  (a)  The commission may impose an administrative penalty on a person who does not comply with a request for information made under Section 32.0424(a).
(b)  The amount of the penalty may not exceed $10,000 for each day of noncompliance that occurs after the 180th day after the date of the request.  The amount shall be based on:
(1)  the seriousness of the violation, including the nature, circumstances, extent, and gravity of the violation;
(2)  the economic harm caused by the violation;
(3)  the history of previous violations;
(4)  the amount necessary to deter a future violation;
(5)  efforts to correct the violation;  and
(6)  any other matter that justice may require.
(c)  The enforcement of the penalty may be stayed during the time the order is under judicial review if the person pays the penalty to the clerk of the court or files a supersedeas bond with the court in the amount of the penalty.  A person who cannot afford to pay the penalty or file the bond may stay the enforcement by filing an affidavit in the manner required by the Texas Rules of Civil Procedure for a party who cannot afford to file security for costs, subject to the right of the commission to contest the affidavit as provided by those rules.
(d)  The attorney general may sue to collect the penalty.
(e)  A proceeding to impose the penalty is considered to be a contested case under Chapter 2001, Government Code.
Added by Acts 1999, 76th Leg., ch. 88, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.116, eff. April 2, 2015.
Acts 2023, 88th Leg., R.S., Ch. 1098 (S.B. 1342), Sec. 2, eff. September 1, 2023.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0423. Recovery of Reimbursements From Health Coverage Providers

Sec. 32.0423.  RECOVERY OF REIMBURSEMENTS FROM HEALTH COVERAGE PROVIDERS.  To the extent allowed by federal law, a health care service provider must seek reimbursement from available third-party health coverage or insurance that the provider knows about or should know about before billing the medical assistance program.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.106(a), eff. Sept. 1, 2003.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.04242. Payor of Last Resort

Sec. 32.04242.  PAYOR OF LAST RESORT.  The executive commissioner shall adopt rules to ensure, to the extent allowed by federal law, that the Medicaid program:
(1)  is the payor of last resort; and
(2)  provides reimbursement for services, including long-term care services, only if, and to the extent, other adequate public or private sources of payment are not available.
Added by Acts 2011, 82nd Leg., R.S., Ch. 821 (H.B. 2722), Sec. 1, eff. June 17, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.119, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.043. Procurement Rules for Public Disproportionate Share Hospitals

Sec. 32.043.  PROCUREMENT RULES FOR PUBLIC DISPROPORTIONATE SHARE HOSPITALS.  (a)  A public hospital that is designated as a disproportionate share hospital during a fiscal year may acquire goods and services in accordance with this section during the succeeding fiscal year.  A procurement of goods or services made in accordance with this section is considered to satisfy any state law requiring purchases by competitive bidding or competitive proposals.
(b)  The public hospital shall acquire goods or services by any procurement method approved by the commission that provides the best value to the public hospital.  The public hospital shall document that it considered all relevant factors under Subsection (c) in making the acquisition.
(c)  The public hospital may consider all relevant factors in determining the best value, including:
(1)  any installation costs;
(2)  the delivery terms;
(3)  the quality and reliability of the vendor's goods or services;
(4)  the extent to which the goods or services meet the public hospital's needs;
(5)  indicators of probable vendor performance under the contract such as past vendor performance, the vendor's financial resources and ability to perform, the vendor's experience and responsibility, and the vendor's ability to provide reliable maintenance agreements;
(6)  the impact on the ability of the public hospital to comply with laws and rules relating to historically underutilized businesses or relating to the procurement of goods and services from persons with disabilities;
(7)  the total long-term cost to the public hospital of acquiring the vendor's goods or services;
(8)  the cost of any employee training associated with the acquisition;
(9)  the effect of an acquisition on the public hospital's productivity;
(10)  the acquisition price;  and
(11)  any other factor relevant to determining the best value for the public hospital in the context of a particular acquisition.
(d)  The state auditor or the commission may audit the public hospital's acquisitions of goods and services to the extent that state money or federal money appropriated by the state is used to acquire the goods and services.
(e)  The public hospital may adopt rules and procedures for the acquisition of goods and services under this section.
Added by Acts 1997, 75th Leg., ch. 1045, Sec. 2, eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.122, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.044. Group Purchasing for Disproportionate Share Hospitals

Sec. 32.044.  GROUP PURCHASING FOR DISPROPORTIONATE SHARE HOSPITALS.  (a)  A public or private hospital that is designated as a disproportionate share hospital during a fiscal year may purchase goods and services in accordance with this section during the succeeding fiscal year.  A purchase of goods or services made in accordance with this section is considered to satisfy any state law requiring purchases by competitive bidding or competitive proposals.
(b)  A state or local governmental entity may allow the public or private hospital to purchase goods or services by participating in one or more of the entity's contracts for the purchase of goods or services.
(c)  The public or private hospital may purchase goods or services in accordance with this section through a group purchasing program that offers discount prices to hospitals or other providers of health care services.
(d)  The executive commissioner with the assistance of the comptroller shall adopt rules under this section that allow the public or private hospital to make purchases through group purchasing programs except when the commission has reason to believe that a better value is available through another procurement method.
(e)  This section applies to private hospitals only to the extent it authorizes private hospitals to participate in purchasing contracts with governmental entities or to satisfy any state law that may require goods and services the hospital purchases to be competitively procured.  This section does not impose new purchasing requirements on a private hospital, except to the extent that the private hospital agrees to be bound by the terms of a contract that is authorized by this section and that it chooses to enter.  This section does not affect any explicit or implicit authority that a private hospital has under other law to participate in a group purchasing program or to participate in a purchasing contract with a public entity.
Added by Acts 1997, 75th Leg., ch. 1045, Sec. 2, eff. Sept. 1, 1997.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 937 (H.B. 3560), Sec. 1.95, eff. September 1, 2007.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.123, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.045. Enhanced Reimbursement

Sec. 32.045.  ENHANCED REIMBURSEMENT.  The commission shall develop a procedure for:
(1)  identifying each service provided under the medical assistance program for which the state is eligible to receive enhanced reimbursement of costs from the federal government; and
(2)  ensuring that the state seeks the highest level of federal reimbursement available for each service provided.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 1.04(a), eff. June 20, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.046. Sanctions and Penalties Related to the Provision of Pharmacy Products

Sec. 32.046.  SANCTIONS AND PENALTIES RELATED TO THE PROVISION OF PHARMACY PRODUCTS.
Text of subsection effective until April 01, 2025
(a)  The executive commissioner shall adopt rules governing sanctions and penalties that apply to a provider who participates in the vendor drug program or is enrolled as a network pharmacy provider of a managed care organization contracting with the commission under Chapter 533, Government Code, or its subcontractor and who submits an improper claim for reimbursement under the program.
Text of subsection effective on April 01, 2025
(a)  The executive commissioner shall adopt rules governing sanctions and penalties that apply to a provider who participates in the vendor drug program or is enrolled as a network pharmacy provider of a managed care organization contracting with the commission under Chapter 540, Government Code, or its subcontractor and who submits an improper claim for reimbursement under the program.
(b)  The commission shall notify each provider in the vendor drug program that the provider is subject to sanctions and penalties for submitting an improper claim.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 3.02, eff. Sept. 1, 1997.
Amended by:
Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.02(k), eff. September 28, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.84, eff. April 1, 2025.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0461. Vendor Drug Program; Competitive Bidding

Sec. 32.0461.  VENDOR DRUG PROGRAM; COMPETITIVE BIDDING.  (a)  The commission shall seek competitive bids for the claims processing function of the vendor drug program.
(b)  The commission shall require any person seeking to contract for services under this section to comply with competitive bidding procedures adopted by the executive commissioner.
(c)  The commission may award a contract under this section to another person only if the commission determines that the provision of services under that contract would be more cost-effective and the time to process claims under the contract would be the same as or faster than having employees of the commission continue to process claims.
(d)  The commission may consult with the comptroller in administering this section.
Added by Acts 1999, 76th Leg., ch. 103, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
Acts 2017, 85th Leg., R.S., Ch. 24 (S.B. 706), Sec. 4, eff. September 1, 2017.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0462. Vendor Drug Program; Pricing Standard

Sec. 32.0462.  VENDOR DRUG PROGRAM; PRICING STANDARD.  (a)  Notwithstanding any other provision of state law, the commission shall:
(1)  consider a nationally recognized, unbiased pricing standard for prescription drugs in determining reimbursement amounts under the vendor drug program; and
(2)  update reimbursement amounts under the vendor drug program at least weekly.
(b)  The executive commissioner shall adopt rules implementing this section.  In adopting rules, the executive  commissioner shall ensure that implementation of this section does not adversely affect the amount of federal funds available to the state for providing benefits under the vendor drug program.
Added by Acts 2003, 78th Leg., ch. 1251, Sec. 10, eff. June 20, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.0463. Medications and Medical Supplies

Sec. 32.0463.  MEDICATIONS AND MEDICAL SUPPLIES.  The executive commissioner may adopt rules establishing procedures for the purchase and distribution of medically necessary, over-the-counter medications and medical supplies under the medical assistance program that were previously being provided by prescription if the executive commissioner determines it is more cost-effective than obtaining those medications and medical supplies through a prescription.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.107(a), eff. Sept. 1, 2003.
Renumbered from Human Resources Code, Section 32.0462 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(58), eff. September 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.047. Prohibition of Certain Health Care Service Providers

Sec. 32.047.  PROHIBITION OF CERTAIN HEALTH CARE SERVICE PROVIDERS.  (a)  A person is permanently prohibited from providing or arranging to provide health care services under the medical assistance program if:
(1)  the person is convicted of an offense arising from a fraudulent act under the program; and
(2)  the person's fraudulent act results in injury to an elderly person, as defined by Section 48.002(a)(1), a person with a disability, as defined by Section 48.002(a)(8)(A), or a person younger than 18 years of age.
(b)  The executive commissioner shall adopt rules for prohibiting a person from participating in the medical assistance program as a health care provider for a reasonable period, as determined by the executive commissioner, if the person:
(1)  fails to repay overpayments under the program; or
(2)  owns, controls, manages, or is otherwise affiliated with and has financial, managerial, or administrative influence over a provider who has been suspended or prohibited from participating in the program.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 3.03, eff. Sept. 1, 1997.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 30, eff. September 1, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.
2023 Texas Statutes › Human Resources Code › Title 2 - Human Services and Protective Services in General › Subtitle C - Assistance Programs › Chapter 32 - Medical Assistance Program › Subchapter B. Administrative Provisions › Section 32.048. Managed Care Information and Training Plan

Sec. 32.048.  MANAGED CARE INFORMATION AND TRAINING PLAN.  (a)  Subject to the availability of funds, the commission shall develop a comprehensive plan to provide information and training about the requirements of a managed care plan to recipients of medical assistance, providers of medical assistance, local health and human services agencies, and other interested parties in each service area in which the commission provides medical assistance through a managed care plan.
(b)  The commission shall include in the comprehensive plan:
(1)  information and training at regular intervals determined by the commission; and
(2)  performance measures to evaluate the effectiveness of the information and training.
(c)  In developing the comprehensive plan, the commission shall consult with the Medicaid medical care advisory committee.
Added by Acts 1997, 75th Leg., ch. 618, Sec. 1, eff. June 11, 1997.  Renumbered from Sec. 32.043 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(74), eff. Sept. 1, 1999.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1050 (S.B. 71), Sec. 23(6), eff. September 1, 2011.
Acts 2011, 82nd Leg., R.S., Ch. 1083 (S.B. 1179), Sec. 25(108), eff. June 17, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.124, eff. April 2, 2015.