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 32.023. Cooperation With Other State Agencies

Sec. 32.023.  COOPERATION WITH OTHER STATE AGENCIES.  (a)  The commission's plan for administering medical assistance must include procedures for using health services administered by other state agencies pursuant to cooperative arrangements.
(b)  The commission may enter into agreements with appropriate state agencies that will enable the commission to implement Title XIX of the federal Social Security Act (42 U.S.C. Section 1396 et seq.) to provide medical assistance for individuals in institutions or in alternate care arrangements.  The agreements must comply with federal law and rules.  The commission may make medical assistance payments in accordance with the agreements.  The agreements are not subject to Chapter 771, Government Code.
(c)  State agencies responsible for the administration or supervision of facilities to which medical assistance payments may be made under federal law shall enter into the agreements with the commission and maintain compliance with the agreements so that the commission may receive federal matching funds to support the medical assistance program.
(d)  The commission may pay medical assistance to other facilities as required under federal law and rules.
Acts 1979, 66th Leg., p. 2349, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.079, 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 32.0231. Announcement of Funding or Program Change

Sec. 32.0231.  ANNOUNCEMENT OF FUNDING OR PROGRAM CHANGE.  (a)  The executive commissioner shall publish notice in the Texas Register of:
(1)  any attempt to obtain a waiver of federal regulations in the medical assistance program;
(2)  any attempt to obtain or the receipt of funding under Title XIX of the federal Social Security Act (42 U.S.C. Section 1396 et seq.) for a pilot program; and
(3)  any amendment to the state medical assistance plan.
(b)  The notice must include the name and telephone number of a commission employee who can provide information relating to the matter for which notice was published under this section.
(c)  The commission shall provide to any requestor information relating to a matter for which notice was published, including the effect and cost of the change, any possible cost savings, the criteria for receiving services, and the number of people to be served.
Added by Acts 1989, 71st Leg., ch. 1085, Sec. 2, eff. Sept. 1, 1989.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.079, eff. April 2, 2015.
See note following this section.
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 32.0241. Review of Waiver Request

Sec. 32.0241.  REVIEW OF WAIVER REQUEST.  The commission shall, at least biennially, review the feasibility of requesting a waiver for the elderly under Section 1915(c), federal Social Security Act (42 U.S.C. Section 1396n), if the reimbursement rates for nursing facilities under the medical assistance program have increased since the preceding review.
Added by Acts 1989, 71st Leg., ch. 1085, Sec. 2, eff. Sept. 1, 1989.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.082, 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 32.0242. Verification of Certain Information

Sec. 32.0242.  VERIFICATION OF CERTAIN INFORMATION.  To the extent possible, the commission shall verify an applicant's residential address at the time the application for medical assistance is filed.
Added by Acts 1999, 76th Leg., ch. 1289, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.082, eff. April 2, 2015.
Sec. 32.0243.  PERIODIC REVIEW OF ELIGIBILITY FOR CERTAIN RECIPIENTS.  (a)  The commission, in cooperation with the United States Social Security Administration, shall periodically review the eligibility of a recipient of medical assistance who is eligible on the basis of the recipient's eligibility for Supplemental Security Income (SSI) benefits under 42 U.S.C. Section 1381 et seq., as amended.
(b)  In reviewing the eligibility of a recipient as required by Subsection (a), the commission shall ensure that only recipients who reside in this state and who continue to be eligible for Supplemental Security Income (SSI) benefits under 42 U.S.C. Section 1381 et seq., as amended, remain eligible for medical assistance.
Added by Acts 1999, 76th Leg., ch. 1289, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.082, 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 32.0244. Nursing Facility Beds in Certain Counties

Sec. 32.0244.  NURSING FACILITY BEDS IN CERTAIN COUNTIES.  (a)  At the request of the commissioners court of a county in which not more than two nursing facilities are certified to participate in the state Medicaid program, and subject to Subsection (d), the commission may contract for additional nursing facility beds under the state Medicaid program in the county without regard to the occupancy rate of available Medicaid beds.
(b)  A commissioners court that intends to make a request under Subsection (a) shall publish notice of its intent in the Texas Register and in a newspaper of general circulation in the county.  The notice must request:
(1)  comments on whether the request should be made;  and
(2)  proposals from persons interested in providing additional Medicaid beds in the county, including persons providing Medicaid beds in a nursing facility with a high occupancy rate.
(c)  A commissioners court shall determine whether to proceed with a request after considering all comments and proposals received in response to the notices provided under Subsection (b).  If the commissioners court proceeds with the request, the court may recommend that the commission contract with a specific nursing facility that submitted a proposal.  In determining whether to proceed with the request and whether to recommend a specific nursing facility, the commissioners court shall consider:
(1)  the demographic and economic needs of the county;
(2)  the quality of existing nursing facility services under the state Medicaid program in the county;
(3)  the quality of the proposals submitted; and
(4)  the degree of community support for additional nursing facility services.
(d)  The commission may not contract under this section for more than 120 additional nursing facility beds per county per year and may not exceed 500 additional nursing facility beds statewide in a calendar year.
Added by Acts 1997, 75th Leg., ch. 555, Sec. 1, eff. Sept. 1, 1997.  Renumbered from Sec. 32.0246 by Acts 1999, 76th Leg., ch. 62, Sec. 19.01(73), eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.083, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.084, 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 32.0245. Nursing Facility Beds for Certain Facilities Treating Alzheimer's Disease

Sec. 32.0245.  NURSING FACILITY BEDS FOR CERTAIN FACILITIES TREATING ALZHEIMER'S DISEASE.  The commission shall waive for a nursing facility a restriction imposed by state law on the authority to contract under the state Medicaid program for nursing facility beds based on the percentage of beds that are occupied in a geographical area if the facility:
(1)  is affiliated with a medical school operated by the state;
(2)  is participating in a research program for the care and treatment of persons with Alzheimer's disease; and
(3)  is designed to separate and treat Alzheimer's disease by stage or functional level.
Added by Acts 1995, 74th Leg., ch. 841, Sec. 1, eff. Aug. 28, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.085, 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 32.02451. Additional Personal Needs Allowance for Guardianship Expenses of Certain Recipients

Sec. 32.02451.  ADDITIONAL PERSONAL NEEDS ALLOWANCE FOR GUARDIANSHIP EXPENSES OF CERTAIN RECIPIENTS.  (a)  In this section, "applied income" has the meaning assigned by Section 1155.201, Estates Code.
(b)  To the extent allowed by federal law, the commission, in computing the applied income of a recipient of medical assistance, shall deduct in the manner provided by this section an additional personal needs allowance from the earned and unearned income of the recipient or, if applicable, the recipient and the recipient's spouse, for compensation and costs ordered to be deducted under Section 1155.202, Estates Code.  Subject to Subsection (f), a deduction ordered by the court under Section 1155.202, Estates Code, is effective beginning on the later of:
(1)  the month in which the order is signed; or
(2)  the first month of medical assistance eligibility for which the recipient is subject to a copayment.
(c)  The commission shall compute the applied income of a recipient of medical assistance as follows:
(1)  the commission shall deduct from the earned and unearned income the personal needs allowance authorized by Section 32.024(w) before making any other deduction;
(2)  if after the deduction under Subdivision (1) the recipient has remaining income, the commission shall deduct the lesser of the following:
(A)  the amount of the remaining income; or
(B)  the amount of the additional personal needs allowance for compensation and costs ordered to be deducted under Section 1155.202, Estates Code; and
(3)  if after the deductions under Subdivisions (1) and (2) the recipient has remaining income, the commission shall deduct any other authorized allowances.
(d)  The amount of income remaining, if any, after the commission makes the deductions as provided by Subsection (c) is the amount of the applied income of the recipient of medical assistance.
(e)  The executive commissioner shall adopt rules providing a procedure by which a recipient of medical assistance for whom amounts are ordered deducted under Section 1155.202, Estates Code, may submit to the commission a copy of the court order issued under that section to receive a deduction of those amounts from the recipient's income as provided by this section.
(f)  The commission may not allow a deduction for the additional personal needs allowance for compensation and costs ordered to be deducted under Section 1155.202, Estates Code, if the order is issued after the recipient of medical assistance dies.
Added by Acts 2009, 81st Leg., R.S., Ch. 859 (S.B. 2435), Sec. 1, eff. September 1, 2009.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 599 (S.B. 220), Sec. 2, eff. September 1, 2011.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.086, 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 32.0246. Medical Assistance Reimbursement for Certain Behavioral Health and Physical Health Services

Text of section effective until April 01, 2025
Sec. 32.0246.  MEDICAL ASSISTANCE REIMBURSEMENT FOR CERTAIN BEHAVIORAL HEALTH AND PHYSICAL HEALTH SERVICES.  (a)  In this section, "behavioral health services" has the meaning assigned by Section 533.00255(a), Government Code, and includes targeted case management and psychiatric rehabilitation services.
(b)  The commission shall provide to a public or private provider of behavioral health services medical assistance reimbursement through a fee-for-service delivery model for behavioral health or physical health services provided to a recipient before that recipient's enrollment with and receipt of medical assistance services through a managed care organization under Chapter 533, Government Code.
(c)  The commission shall ensure that a public or private provider of behavioral health services who is reimbursed under Subsection (b) through a fee-for-service delivery model is provided medical assistance reimbursement through a managed care model for behavioral health or physical health services provided to a recipient after that recipient's enrollment with and receipt of medical assistance services through a managed care organization under Chapter 533, Government Code.
Added by Acts 2021, 87th Leg., R.S., Ch. 966 (S.B. 1921), Sec. 1, eff. September 1, 2022.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.80, 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 32.02471. Medical Assistance for Certain Former Foster Care Adolescents Enrolled in Higher Education

Sec. 32.02471.  MEDICAL ASSISTANCE FOR CERTAIN FORMER FOSTER CARE ADOLESCENTS ENROLLED IN HIGHER EDUCATION.  (a)  In this section, "independent foster care adolescent" has the meaning assigned by Section 32.0247.
(b)  The commission shall provide medical assistance to a person who:
(1)  is 21 years of age or older but younger than 23 years of age;
(2)  would be eligible to receive assistance as an independent foster care adolescent under Section 32.0247 if the person were younger than 21 years of age; and
(3)  is enrolled in an institution of higher education, as defined by Section 61.003(8), Education Code, or a private or independent institution of higher education, as defined by Section 61.003(15), Education Code, that is located in this state and is making satisfactory academic progress as determined by the institution.
Added by Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 17, eff. September 1, 2007.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.088, 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 32.024715. Streamlined Eligibility Determination Process for Certain Former Foster Care Youth

Sec. 32.024715.  STREAMLINED ELIGIBILITY DETERMINATION PROCESS FOR CERTAIN FORMER FOSTER CARE YOUTH.  (a)  This section applies to a former foster care youth who is eligible for Medicaid under Section 1902(a)(10)(A)(i)(IX), Social Security Act (42 U.S.C. Section 1396a(a)(10)(A)(i)(IX)), or any other law.
(b)  The commission, in consultation with the Department of Family and Protective Services, shall design and implement a streamlined process for determining a former foster care youth's eligibility for Medicaid.  The streamlined process must:
(1)  provide for the automatic enrollment and recertification of a former foster care youth in the STAR Health program, the STAR Medicaid managed care program, or another Medicaid program, as appropriate;
(2)  be designed to prevent any unnecessary interruption of the youth's Medicaid benefits, including any interruption related to having to recertify the youth for benefits; and
(3)  if recertification is required under federal law, use a simple application and recertification process that:
(A)  to the extent permitted by federal law, does not require that a youth verify that the youth is a resident of this state unless the commission determines that the youth is receiving Medicaid benefits outside of this state; or
(B)  if federal law requires that a youth verify that the youth is a resident of this state, allows the youth to attest to that fact without providing additional documentation or evidence that proves the youth is a resident of this state.
Added by Acts 2021, 87th Leg., R.S., Ch. 432 (S.B. 1059), Sec. 2, 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 32.0249. Mental Health Screenings in Texas Health Steps Program

Sec. 32.0249.  MENTAL HEALTH SCREENINGS IN TEXAS HEALTH STEPS PROGRAM.  The executive commissioner, in the rules governing the Texas Health Steps program, shall allow a provider to:
(1)  conduct a mental health screening using one or more validated, standardized mental health screening tools during each annual medical exam of a recipient who is at least 12 years of age but younger than 19 years of age; and
(2)  be reimbursed for conducting one mental health screening using one or more validated, standardized mental health screening tools during each annual medical exam of a recipient described by Subdivision (1).
Added by Acts 2017, 85th Leg., R.S., Ch. 1028 (H.B. 1600), Sec. 1, 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 32.0251. Eligibility Notification and Review for Certain Children

Sec. 32.0251.  ELIGIBILITY NOTIFICATION AND REVIEW FOR CERTAIN CHILDREN.  (a)  The executive commissioner shall establish and the commission shall implement procedures under which the commission automatically reviews a child's eligibility for medical assistance if:
(1)  the child originally establishes eligibility for medical assistance on the basis of receipt of financial assistance under Chapter 31, as provided by Section 32.025(a); and
(2)  that receipt of financial assistance under Chapter 31 ceases.
(b)  If the review required by this section indicates that the child may be eligible for medical assistance on a basis other than receipt of financial assistance under Chapter 31, the commission may provide for provisional eligibility for medical assistance for the child pending a recertification review.  The provisional eligibility period authorized by this subsection may not exceed one month.
(c)  In addition to the review required by this section, the commission shall also promote continued medical assistance for a child described by Subsection (a) through:
(1)  revising client education and notification policies relating to a child's eligibility for medical assistance; and
(2)  providing specific notification of a child's potential eligibility for medical assistance to the child's parent or other caretaker at the time the parent or caretaker is notified of:
(A)  a scheduled eligibility recertification review; or
(B)  the termination of financial assistance.
Added by Acts 1999, 76th Leg., ch. 704, Sec. 1, eff. June 18, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.090, 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 32.0255. Transitional Medical Assistance

Sec. 32.0255.  TRANSITIONAL MEDICAL ASSISTANCE.  (a)  The commission shall provide transitional medical assistance, in accordance with state rules and federal law, to a person who was receiving financial assistance under Chapter 31 but is no longer eligible to receive the assistance because:
(1)  the person's household income has increased; or
(2)  the person has exhausted the person's benefits under Section 31.0065.
(b)  Except as provided by Section 31.012(c), the commission may provide the medical assistance only until the earlier of:
(1)  the end of the applicable period prescribed by Section 31.0065 for the provision of transitional benefits; or
(2)  the first anniversary of the date on which the person becomes ineligible for financial assistance because of increased household income.
Added by Acts 1995, 74th Leg., ch. 655, Sec. 3.03, eff. Sept. 1, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.090, 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 32.0256. Continuation of Medical Assistance for Certain Individuals

Sec. 32.0256.  CONTINUATION OF MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS.  (a)  A recipient described by Section 32.025(a) who experiences a temporary increase in income of a duration of one month or less that would result in the recipient being ineligible for medical assistance continues to be eligible for that assistance if the individual:
(1)  either:
(A)  receives services through a program for individuals with an intellectual or developmental disability authorized under Section 1915(c), Social Security Act (42 U.S.C. Section 1396n(c)); or
(B)  resides in an ICF-IID facility; and
(2)  continues to meet the functional and diagnostic criteria for the receipt of services under a program described by Subdivision (1)(A) or for residency in an ICF-IID facility.
(b)  To continue to be eligible for medical assistance, a recipient described by Subsection (a) must submit an application for medical assistance in accordance with Section 32.025(b) not later than the 90th day after the date on which the recipient is determined ineligible.
Added by Acts 2017, 85th Leg., R.S., Ch. 1072 (H.B. 3292), Sec. 1, 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 32.026101. Determination of Eligibility by Health Care Exchanges Prohibited

Sec. 32.026101.  DETERMINATION OF ELIGIBILITY BY HEALTH CARE EXCHANGES PROHIBITED.  (a)  The commission may not accept Medicaid eligibility determinations from an exchange established under 42 U.S.C. Section 18041(c).
(b)  The commission may accept eligibility assessments from an exchange, but the commission must determine the eligibility of an individual for Medicaid.
Added by Acts 2021, 87th Leg., R.S., Ch. 879 (S.B. 1341), Sec. 3, 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 32.02611. Exclusion of Assets in Prepaid Tuition Programs and Higher Education Savings Plans

Sec. 32.02611.  EXCLUSION OF ASSETS IN PREPAID TUITION PROGRAMS AND HIGHER EDUCATION SAVINGS PLANS.  (a)  Except as provided by Subsection (b), in determining eligibility and need for medical assistance, the commission may not consider as assets or resources, to the extent applicable under federal law, a right to assets held in or a right to receive payments or benefits under:
(1)  any fund or plan established under Subchapter G, H, or I, Chapter 54, Education Code, including an interest in a savings trust account, prepaid tuition contract, or related matching account;
(2)  any qualified tuition program of any state that meets the requirements of Section 529, Internal Revenue Code of 1986; or
(3)  any school-based account or bond described by Section 28.0024(b)(2), Education Code.
(a-1)  The amount of exclusion under Subsection (a)(3) of assets held in or the right to receive payments or benefits under a school-based account or bond described by Section 28.0024(b)(2)(C), (D), or (E), Education Code, is limited to the amount of the cost of undergraduate resident tuition and required fees for one academic year consisting of 30 semester credit hours charged by the general academic teaching institution with the highest such tuition and fee costs for the most recent academic year, as determined by the Texas Higher Education Coordinating Board under Section 54.753, Education Code.
(b)  In determining eligibility and need for medical assistance for an applicant who may be eligible on the basis of the applicant's eligibility for medical assistance for the aged, blind, or disabled under 42 U.S.C. Section 1396a(a)(10), the commission may consider as assets or resources, to the extent applicable under federal law, a right to assets held in or a right to receive payments or benefits under any fund, account, bond, plan, or tuition program described by Subsection (a).
(c)  Notwithstanding Subsection (b), the commission shall seek a federal waiver authorizing the commission to exclude, for purposes of determining the eligibility of an applicant described by that subsection and to the extent included under federal law, the right to assets held in or a right to receive payments or benefits under any fund, account, bond, plan, or tuition program described by Subsection (a) if the fund, account, bond, plan, or tuition program was established before the 21st birthday of the beneficiary of the fund, account, bond, plan, or tuition program.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1186 (H.B. 3708), Sec. 9, eff. June 17, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.090, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1265 (H.B. 3987), Sec. 4, eff. June 20, 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 32.0262. Eligibility Transition

Sec. 32.0262.  ELIGIBILITY TRANSITION.  (a)  The executive commissioner shall develop procedures to ensure that all necessary information regarding a child who will be denied continued medical assistance under this chapter because of an increase in income, assets, or resources but who is eligible for enrollment in the child health plan under Chapter 62, Health and Safety Code, is promptly transmitted to the child health plan in accordance with the standards established under Section 62.104(d), Health and Safety Code.
(b)  The executive commissioner shall develop procedures to ensure that the parent or caretaker of a child who will be denied continued medical assistance under this chapter because of a failure to keep an appointment, including an appointment for recertification of eligibility, a failure to provide information, or for another procedural reason, is promptly contacted and informed of:
(1)  the need to recertify eligibility for continued medical assistance under this chapter; and
(2)  the availability of medical coverage under the child health plan under Chapter 62, Health and Safety Code.
(c)  The commission shall develop materials under this section in consultation with the appropriate agencies administering all or part of the child health plan under Chapter 62, Health and Safety Code.
(d)  The executive commissioner by rule shall adopt procedures to assist a family whose child loses eligibility for medical assistance under this chapter in making a transition to the child health plan under Chapter 62, Health and Safety Code, with no interruption in coverage.
Added by Acts 2001, 77th Leg., ch. 584, Sec. 4.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.092, 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 32.0263. Health Care Orientation

Sec. 32.0263.  HEALTH CARE ORIENTATION.  (a)  The commission shall require that the parent or guardian of a child under 19 years of age who originally establishes eligibility for medical assistance must:
(1)  attend an in-person counseling session with a commission representative not later than the 31st day after the date the child originally establishes eligibility; or
(2)  accompany the child to an appointment with a health care provider for a comprehensive health care orientation not later than the 61st day after the date the child originally establishes eligibility.
(b)  The executive commissioner by rule shall develop procedures to verify that:
(1)  the parent or guardian of the child who originally establishes eligibility complies with the requirement of Subsection (a)(2), if applicable; and
(2)  the child is provided a comprehensive health care orientation at the appointment with the health care provider.
Added by Acts 2001, 77th Leg., ch. 584, Sec. 4.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.092, 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 32.0264. Suspension and Reinstatement of Eligibility for Children in Juvenile Facilities

Sec. 32.0264.  SUSPENSION AND REINSTATEMENT OF ELIGIBILITY FOR CHILDREN IN JUVENILE FACILITIES.  (a)  In this section, "juvenile facility" means a facility for the placement, detention, or commitment of a child under Title 3, Family Code.
(b)  To the extent allowed under federal law, if a child is placed in a juvenile facility, the commission shall suspend the child's eligibility for medical assistance during the period the child is placed in the facility.
(b-1)  Notwithstanding Subsection (b), if, during the period a child is placed in a juvenile facility, the child is hospitalized or becomes an inpatient in another type of medical facility, the commission shall reinstate the child's eligibility for medical assistance during the period of the child's inpatient stay.  The executive commissioner shall adopt rules necessary to implement this subsection, including rules governing the procedure for reinstating a child's eligibility for medical assistance under this subsection.
(c)  Not later than 48 hours after the commission is notified of the release from a juvenile facility of a child whose eligibility for medical assistance has been suspended under this section, the commission shall reinstate the child's eligibility.  Following the reinstatement, the child remains eligible until the expiration of the period for which the child was certified as eligible, excluding the period during which the child's eligibility was suspended.
Added by Acts 2015, 84th Leg., R.S., Ch. 862 (H.B. 839), Sec. 2, eff. June 18, 2015.
Amended by:
Acts 2021, 87th Leg., R.S., Ch. 667 (H.B. 1664), Sec. 1, eff. September 1, 2021.
Acts 2021, 87th Leg., R.S., Ch. 667 (H.B. 1664), Sec. 2, 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 32.0265. Notice of Certain Placements in Juvenile Facilities

Sec. 32.0265.  NOTICE OF CERTAIN PLACEMENTS IN JUVENILE FACILITIES.  (a)  In this section:
(1)  "Custodian" and "guardian" have the meanings assigned by Section 51.02, Family Code.
(2)  "Juvenile facility" has the meaning assigned by Section 32.0264.
(b)  A juvenile facility may notify the commission on the placement in the facility of a child who is receiving medical assistance benefits.
(c)  If a juvenile facility chooses to provide the notice described by Subsection (b), the facility shall provide the notice electronically or by other appropriate means as soon as possible, but not later than the 30th day, after the date of the child's placement.
(d)  A juvenile facility may notify the commission of the release of a child who, immediately before the child's placement in the facility, was receiving medical assistance benefits.
(e)  If a juvenile facility chooses to provide the notice described by Subsection (d), the facility shall provide the notice electronically or by other appropriate means not later than 48 hours after the child's release from the facility.
(f)  If a juvenile facility chooses to provide the notice described by Subsection (d), at the time of the child's release, the facility shall provide the child's guardian or custodian, as appropriate, with a written copy of the notice and a telephone number at which the commission may be contacted regarding confirmation of or assistance relating to reinstatement of the child's eligibility for medical assistance benefits.
(g)  The commission shall establish a means by which a juvenile facility, or an employee of the facility, may determine whether a child placed in the facility is or was, as appropriate, receiving medical assistance benefits for purposes of this section.
(h)  A juvenile facility, or an employee of the facility, is not liable in a civil action for damages resulting from a failure to comply with this section.
Added by Acts 2015, 84th Leg., R.S., Ch. 862 (H.B. 839), Sec. 2, eff. June 18, 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 32.0266. Suspension, Termination, and Automatic Reinstatement of Eligibility for Individuals Confined in County Jails

Sec. 32.0266.  SUSPENSION, TERMINATION, AND AUTOMATIC REINSTATEMENT OF ELIGIBILITY FOR INDIVIDUALS CONFINED IN COUNTY JAILS. (a)  In this section, "county jail" means a facility operated by or for a county for the confinement of persons accused or convicted of an offense.
(b)  To the extent allowed by federal law, if an individual is confined in a county jail and the sheriff of the county has notified the commission of the confinement under Section 351.046, Local Government Code, the commission shall suspend or terminate, as appropriate, the individual's eligibility for medical assistance during the period the individual is confined in the county jail.
(c)  Not later than 48 hours after the commission is notified under Section 351.046, Local Government Code, of the release from a county jail of an individual whose eligibility for medical assistance has been suspended under this section, the commission shall reinstate the individual's eligibility, provided the individual's eligibility certification period has not elapsed.  To the extent allowed by federal law, following the reinstatement, the individual remains eligible until the expiration of the period for which the individual was certified as eligible.
Added by Acts 2017, 85th Leg., R.S., Ch. 778 (H.B. 337), Sec. 1, 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 32.0275. Military Medical Treatment Facilities and Affiliated Health Care Providers; Reimbursement

Sec. 32.0275.  MILITARY MEDICAL TREATMENT FACILITIES AND AFFILIATED HEALTH CARE PROVIDERS; REIMBURSEMENT.  (a) In this section, "military medical treatment facility" means a military medical treatment facility described by 10 U.S.C. Section 1073d(b), (c), or (d).
(b)  This section applies only to a military medical treatment facility located in this state that has been verified as a Level 1 trauma center by the American College of Surgeons or an equivalent organization.
(c)  A military medical treatment facility or a health care provider providing services at a military medical treatment facility is considered a provider under Medicaid for purposes of providing and receiving reimbursement for:
(1)  inpatient emergency services; and
(2)  related outpatient services to the extent those services are not available from an enrolled Medicaid provider at the time the services are needed.
Added by Acts 2021, 87th Leg., R.S., Ch. 696 (H.B. 2365), Sec. 1, 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 32.0281. Rules and Notice Relating to Payment Rates

Sec. 32.0281.  RULES AND NOTICE RELATING TO PAYMENT RATES.  (a)  The executive commissioner shall by rule describe the process used to determine payment rates for medical assistance and shall notify providers, consumers, the Legislative Budget Board, and the Governor's Office of Budget, Planning, and Policy of that process.
(b)  The executive commissioner shall adopt rules relating to payment rates that include:
(1)  a description of the process used to determine payment rates;
(2)  a description of each cost of living index used in calculating inflation rates and the procedure for determining the level of inflation used in the executive commissioner's calculations;
(3)  the criteria for desk audits;
(4)  the procedure for notifying providers of exclusions and adjustments to reported expenses, if notification is requested; and
(5)  a method of adjusting rates if new legislation, regulations, or economic factors affect costs.
(c)  The commission shall include in the Title XIX State Medicaid Plan submitted to the federal government for approval the procedures for making available to the public the data and methodology used in establishing payment rates.
(d)  The procedures for adopting rules under this section shall be governed by Chapter 2001, Government Code.
(e)  An interested party may appeal an action taken by the commission under this section, and an appeal of such action shall be governed by the procedures for a contested case hearing under Chapter 2001, Government Code.  The filing of an appeal under this section shall not stay the implementation of payment rates adopted by the executive commissioner in accordance with commission rules.
Added by Acts 1989, 71st Leg., ch. 1085, Sec. 2, eff. Sept. 1, 1989.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.097, 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 32.0282. Public Hearing on Rates

Sec. 32.0282.  PUBLIC HEARING ON RATES.  (a)  The commission shall hold a public hearing to allow interested persons to present comments relating to proposed payment rates for medical assistance.
(b)  The commission shall provide notice of each hearing to the public.
Added by Acts 1989, 71st Leg., ch. 1085, Sec. 2, eff. Sept. 1, 1989.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.098, 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 32.0284. Calculation of Payments Under Certain Supplemental Hospital Payment Programs

Sec. 32.0284.  CALCULATION OF PAYMENTS UNDER CERTAIN SUPPLEMENTAL HOSPITAL PAYMENT PROGRAMS.  (a)  In this section, "supplemental hospital payment program" means:
(1)  the disproportionate share hospitals supplemental payment program administered according to 42 U.S.C. Section 1396r-4; and
(2)  the uncompensated care payment program established under the Texas Health Care Transformation and Quality Improvement Program waiver issued under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315).
(b)  For purposes of calculating the hospital-specific limit used to determine a hospital's uncompensated care payment under a supplemental hospital payment program, the commission shall ensure that to the extent a third-party commercial payment exceeds the Medicaid allowable cost for a service provided to a recipient and for which reimbursement was not paid under the medical assistance program, the payment is not considered a medical assistance payment.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 6.07, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.099, 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 32.0285. Calculation of Medical Education Add-on for Reimbursement of Teaching Hospitals That Provide Behavioral Health and Physical Health Services

Sec. 32.0285.  CALCULATION OF MEDICAL EDUCATION ADD-ON FOR REIMBURSEMENT OF TEACHING HOSPITALS THAT PROVIDE BEHAVIORAL HEALTH AND PHYSICAL HEALTH SERVICES.  The commission shall, on request from a teaching hospital that provides behavioral health and physical health services, update on a biannual basis the education adjustment factor used to calculate the medical education add-on using the most current Medicare education adjustment factor data available under 42 C.F.R. Section 412.105 at the time the commission makes the update.
Added by Acts 2021, 87th Leg., R.S., Ch. 966 (S.B. 1921), Sec. 3, eff. September 1, 2022.
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 32.0287. Prescribed Pediatric Extended Care Center Reimbursement

Sec. 32.0287.  PRESCRIBED PEDIATRIC EXTENDED CARE CENTER REIMBURSEMENT.  (a)  In this section, "center" means a prescribed pediatric extended care center licensed under Chapter 248A, Health and Safety Code.
(b)  In adopting rules governing the reimbursement of a center for services provided under the medical assistance program, the executive commissioner shall clearly identify the documentation a center must obtain and maintain to be eligible for reimbursement.  The rules may not:
(1)  authorize a center to combine documentation for transportation with documentation for other services provided by the center; or
(2)  condition reimbursement of non-transportation services on:
(A)  a recipient's decision to use transportation services on a specific date or on an ongoing basis; or
(B)  a center's obtaining and maintaining transportation documentation.
Added by Acts 2023, 88th Leg., R.S., Ch. 862 (H.B. 3550), Sec. 5, 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 32.029. Methods of Payment

Sec. 32.029.  METHODS OF PAYMENT.  (a)  The commission may prescribe a method of payment for medical assistance claims by establishing a direct vendor payment program that is administered by the commission, or by an insurance plan, a hospital or medical service plan, or any other health service plan authorized to do business in the state, or by a combination of those plans.
(b)  The commission may use any fiscal intermediary, method of payment, or combination of methods it finds most satisfactory and economical.  The commission may make whatever changes it finds necessary from time to time to administer the program in an economical and equitable manner consistent with simplicity of administration and the best interest of the recipients of medical assistance.
(c)  If the commission elects to make direct vendor payments, the payments shall be made by vouchers and warrants drawn by the comptroller on the proper account.  The commission shall furnish the comptroller with a list of those vendors entitled to payments and the amounts to which each is entitled.  When the warrants are drawn, they must be delivered to the commission, which shall supervise the delivery to vendors.
(d)  If at any time state funds are not available to fully pay all claims for medical assistance, the executive commissioner shall prorate the claims.
(e)  The commission or its designee must notify providers of health care services in clear and concise language of the status of their claims on any claim not paid or denied within 30 days of receipt by the payor.
Acts 1979, 66th Leg., p. 2351, ch. 842, art. 1, Sec. 1, eff. Sept. 1, 1979.  Amended by Acts 1985, 69th Leg., ch. 264, Sec. 12, eff. Aug. 26, 1985;  Acts 1993, 73rd Leg., ch. 390, Sec. 3, eff. Sept. 1, 1993;  Acts 1995, 74th Leg., ch. 6, Sec. 4, eff. March 23, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.100, 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 32.0291. Prepayment Reviews and Payment Holds

Sec. 32.0291.  PREPAYMENT REVIEWS AND PAYMENT HOLDS.  (a)  Notwithstanding any other law, the commission may:
(1)  perform a prepayment review of a claim for reimbursement under the medical assistance program to determine whether the claim involves fraud or abuse; and
(2)  as necessary to perform that review, withhold payment of the claim for not more than five working days without notice to the person submitting the claim.
Text of subsection effective until April 01, 2025
(b)  Subject to Section 531.102, Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.
Text of subsection effective on April 01, 2025
(b)  Subject to Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, and notwithstanding any other law, the commission may impose a payment hold on future claims submitted by a provider.
Text of subsection effective until April 01, 2025
(c)  A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Section 531.102, Government Code, including the notice requirements under Subsection (g) of that section.
Text of subsection effective on April 01, 2025
(c)  A payment hold authorized by this section is governed by the requirements and procedures specified for a payment hold under Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544, Government Code, including the notice requirements under Section 544.0302.
(d)  Repealed by Acts 2013, 83rd Leg., R.S., Ch. 622, Sec. 6, eff. September 1, 2013.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.103, eff. Sept. 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 4, eff. September 1, 2013.
Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 5, eff. September 1, 2013.
Acts 2013, 83rd Leg., R.S., Ch. 622 (S.B. 1803), Sec. 6, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.101, eff. April 2, 2015.
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.81, eff. April 1, 2025.