reglab/statecodes huggingface dataset:
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0212. Medicaid Bill of Rights and Bill of Responsibilities

Text of section effective until April 01, 2025
Sec. 531.0212.  MEDICAID BILL OF RIGHTS AND BILL OF RESPONSIBILITIES.  (a)  The executive commissioner by rule shall adopt a bill of rights and a bill of responsibilities for each person enrolled in Medicaid.
(b)  The bill of rights must address a client's right to:
(1)  respect, dignity, privacy, confidentiality, and nondiscrimination;
(2)  a reasonable opportunity to choose a health care plan and primary care provider and to change to another plan or provider in a reasonable manner;
(3)  consent to or refuse treatment and actively participate in treatment decisions;
(4)  ask questions and receive complete information relating to the client's medical condition and treatment options, including specialty care;
(5)  access each available complaint process, receive a timely response to a complaint, and receive a fair hearing;  and
(6)  timely access to care that does not have any communication or physical access barriers.
(c)  The bill of responsibilities must address a client's responsibility to:
(1)  learn and understand each right the client has under Medicaid;
(2)  abide by the health plan and Medicaid policies and procedures;
(3)  share information relating to the client's health status with the primary care provider and become fully informed about service and treatment options; and
(4)  actively participate in decisions relating to service and treatment options, make personal choices, and take action to maintain the client's health.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.03(a), eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.024, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02131. Grievances Related to Medicaid

Text of section effective until April 01, 2025
Sec. 531.02131.  GRIEVANCES RELATED TO MEDICAID.  (a)  The commission shall adopt a definition of "grievance" related to Medicaid and ensure the definition is consistent among divisions within the commission to ensure all grievances are managed consistently.
(b)  The commission shall standardize Medicaid grievance data reporting and tracking among divisions within the commission.
(c)  The commission shall implement a no-wrong-door system for Medicaid grievances reported to the commission.
(d)  The commission shall establish a procedure for expedited resolution of a grievance related to Medicaid that allows the commission to:
(1)  identify a grievance related to a Medicaid access to care issue that is urgent and requires an expedited resolution; and
(2)  resolve the grievance within a specified period.
(e)  The commission shall verify grievance data reported by a Medicaid managed care organization.
(f)  The commission shall:
(1)  aggregate Medicaid recipient and provider grievance data to provide a comprehensive data set of grievances; and
(2)  make the aggregated data available to the legislature and the public in a manner that does not allow for the identification of a particular recipient or provider.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 2, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0214. Medicaid Data Collection System

Text of section effective until April 01, 2025
Sec. 531.0214.  MEDICAID DATA COLLECTION SYSTEM.  (a)  The commission and each health and human services agency that administers a part of Medicaid shall jointly develop a system to coordinate and integrate state Medicaid databases to:
(1)  facilitate the comprehensive analysis of Medicaid data; and
(2)  detect fraud perpetrated by a program provider or client.
(b)  To minimize cost and duplication of activities, the commission shall assist and coordinate:
(1)  the efforts of the agencies that are participating in the development of the system required by Subsection (a);  and
(2)  the efforts of those agencies with the efforts of other agencies involved in a statewide health care data collection system provided for by Section 108.006, Health and Safety Code, including avoiding duplication of expenditure of state funds for computer hardware, staff, or services.
(c)  On the request of the executive commissioner, a state agency that administers any part of Medicaid shall assist the commission in developing the system required by this section.
(d)  The commission shall develop the database system in a manner that will enable a complete analysis of the use of prescription medications, including information relating to:
(1)  Medicaid clients for whom more than three medications have been prescribed;  and
(2)  the medical effect denial of Medicaid coverage for more than three medications has had on Medicaid clients.
(e)  The commission shall ensure that the database system is used each month to match vital statistics unit death records with a list of persons eligible for Medicaid, and that each person who is deceased is promptly removed from the list of persons eligible for Medicaid.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.03(a), eff. Sept. 1, 1997.  Amended by Acts 1999, 76th Leg., ch. 215, Sec. 1, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.026, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02142. Public Access to Certain Medicaid Data

Text of section effective until April 01, 2025
Sec. 531.02142.  PUBLIC ACCESS TO CERTAIN MEDICAID DATA.  (a)  To the extent permitted by federal law, the commission in consultation and collaboration with the appropriate advisory committees related to Medicaid shall make available to the public on the commission's Internet website in an easy-to-read format data relating to the quality of health care received by Medicaid recipients and the health outcomes of those recipients.  Data made available to the public under this section must be made available in a manner that does not identify or allow for the identification of individual recipients.
(b)  In performing its duties under this section, the commission may collaborate with an institution of higher education or another state agency with experience in analyzing and producing public use data.
Added by Acts 2019, 86th Leg., R.S., Ch. 1330 (H.B. 4533), Sec. 2, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02143. Data Regarding Postnatal Alcohol and Controlled Substance Treatment

Text of section effective until April 01, 2025
Sec. 531.02143.  DATA REGARDING POSTNATAL ALCOHOL AND CONTROLLED SUBSTANCE TREATMENT.  (a)  The commission shall collect hospital discharge data for Medicaid recipients regarding treatment of a newborn child for prenatal exposure to alcohol or a controlled substance.
(b)  The commission shall provide the data collected under Subsection (a) to the Department of Family and Protective Services.
Added by Acts 2019, 86th Leg., R.S., Ch. 417 (S.B. 195), Sec. 3, eff. January 1, 2020.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0215. Compilation of Statistics Relating to Fraud

Text of section effective until April 01, 2025
Sec. 531.0215.  COMPILATION OF STATISTICS RELATING TO FRAUD.  The commission and each health and human services agency that administers a part of Medicaid shall maintain statistics on the number, type, and disposition of fraudulent claims for benefits submitted under the part of the program the agency administers.
Added by Acts 1997, 75th Leg., ch. 1153, Sec. 6.02(a), eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.028, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02162. Medicaid Services Provided Through Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services to Children With Special Health Care Needs

Text of section effective until April 01, 2025
Sec. 531.02162.  MEDICAID SERVICES PROVIDED THROUGH TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.  (a)  In this section, "child with special health care needs" has the meaning assigned by Section 35.0022, Health and Safety Code.
(b)  The executive commissioner by rule shall establish policies that permit reimbursement under Medicaid and the child health plan program for services provided through telemedicine medical services, teledentistry dental services, and telehealth services to children with special health care needs.
(c)  The policies required under this section must:
(1)  be designed to:
(A)  prevent unnecessary travel and encourage efficient use of telemedicine medical services, teledentistry dental services, and telehealth services for children with special health care needs in all suitable circumstances; and
(B)  ensure in a cost-effective manner the availability to a child with special health care needs of services appropriately performed using telemedicine medical services, teledentistry dental services, and telehealth services that are comparable to the same types of services available to that child without the use of telemedicine medical services, teledentistry dental services, and telehealth services; and
(2)  provide for reimbursement of multiple providers of different services who participate in a single session of telemedicine medical services, teledentistry dental services, telehealth services, or any combination of those services, for a child with special health care needs, if the commission determines that reimbursing each provider for the session is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without the use of telemedicine medical services, teledentistry dental services, and telehealth services, including the costs of transportation and lodging and other direct costs.
Added by Acts 2001, 77th Leg., ch. 959, Sec. 2, eff. June 14, 2001.  Renumbered from Government Code Sec. 531.02161 by Acts 2003, 78th Leg., ch. 1275, Sec. 2(63), eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.031, eff. April 2, 2015.
Acts 2021, 87th Leg., R.S., Ch. 811 (H.B. 2056), Sec. 19, eff. September 1, 2021.
Acts 2021, 87th Leg., R.S., Ch. 811 (H.B. 2056), Sec. 20, eff. September 1, 2021.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
Without reference to the amendment of this section, this section was repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02171. Reimbursement for Certain Telehealth Services

Text of section effective until April 01, 2025
Sec. 531.02171.  REIMBURSEMENT FOR CERTAIN TELEHEALTH SERVICES.  (a)  In this section, "health professional" means an individual who is:
(1)  licensed, registered, certified, or otherwise authorized by this state to practice as a social worker, occupational therapist, or speech-language pathologist;
(2)  a licensed professional counselor;
(3)  a licensed marriage and family therapist; or
(4)  a licensed specialist in school psychology.
(b)  The commission shall ensure that Medicaid reimbursement is provided to a school district or open-enrollment charter school for telehealth services provided through the school district or charter school by a health professional, even if the health professional is not the patient's primary care provider, if:
(1)  the school district or charter school is an authorized health care provider under Medicaid; and
(2)  the parent or legal guardian of the patient provides consent before the service is provided.
Added by Acts 2017, 85th Leg., R.S., Ch. 589 (S.B. 922), Sec. 1, eff. September 1, 2017.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02172. Reimbursement for Teledentistry Dental Services

Text of section effective until April 01, 2025
Sec. 531.02172.  REIMBURSEMENT FOR TELEDENTISTRY DENTAL SERVICES.  (a)  The commission by rule shall require each health and human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for teledentistry dental services provided by a dentist licensed to practice dentistry in this state.
(b)  The commission shall require reimbursement for a teledentistry dental service at the same rate as the Medicaid program reimburses for the same in-person dental service.  A request for reimbursement may not be denied solely because an in-person dental service between a dentist and a patient did not occur.  The commission may not limit a dentist's choice of platform for providing a teledentistry dental service by requiring that the dentist use a particular platform to receive reimbursement for the service.
(c)  The State Board of Dental Examiners, in consultation with the commission and the commission's office of inspector general, as appropriate, may adopt rules as necessary to:
(1)  ensure that appropriate care, including quality of care, is provided to patients who receive teledentistry dental services; and
(2)  prevent abuse and fraud through the use of teledentistry dental services, including rules relating to filing claims and the records required to be maintained in connection with teledentistry dental services.
Added by Acts 2021, 87th Leg., R.S., Ch. 811 (H.B. 2056), Sec. 21, eff. September 1, 2021.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02174. Additional Authority Regarding Telemedicine Medical Services

Text of section effective until April 01, 2025
Sec. 531.02174.  ADDITIONAL AUTHORITY REGARDING TELEMEDICINE MEDICAL SERVICES.  (a)  In addition to the authority granted by other law regarding telemedicine medical services, the executive commissioner may review rules and procedures applicable to reimbursement of telemedicine medical services provided through any government-funded health program subject to the commission's oversight.
(b)  The executive commissioner may modify rules and procedures described by Subsection (a) as necessary to ensure that reimbursement for telemedicine medical services is provided in a cost-effective manner and only in circumstances in which the provision of those services is clinically effective.
(c)  This section does not affect the commission's authority or duties under other law regarding reimbursement of telemedicine medical services under Medicaid.
Added by Acts 2003, 78th Leg., ch. 870, Sec. 1, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.037, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02175. Reimbursement for Online Medical Consultations

Text of section effective until April 01, 2025
Sec. 531.02175.  REIMBURSEMENT FOR ONLINE MEDICAL CONSULTATIONS.  (a)  In this section, "physician" means a person licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.
(b)  Subject to the requirements of this subsection, the executive commissioner by rule may require the commission and each health and human services agency that administers a part of Medicaid to provide Medicaid reimbursement for a medical consultation that is provided by a physician or other health care professional using the Internet as a cost-effective alternative to an in-person consultation.  The executive commissioner may require the commission or a health and human services agency to provide the reimbursement described by this subsection only if the Centers for Medicare and Medicaid Services develop an appropriate Current Procedural Terminology code for medical services provided using the Internet.
(c)  The executive commissioner may develop and implement a pilot program in one or more sites chosen by the executive commissioner under which Medicaid reimbursements are paid for medical consultations provided by physicians or other health care professionals using the Internet.  The pilot program must be designed to test whether an Internet medical consultation is a cost-effective alternative to an in-person consultation under Medicaid.  The executive commissioner may modify the pilot program as necessary throughout its implementation to maximize the potential cost-effectiveness of Internet medical consultations.  If the executive commissioner determines from the pilot program that Internet medical consultations are cost-effective, the executive commissioner may expand the pilot program to additional sites or may implement Medicaid reimbursements for Internet medical consultations statewide.
(d)  The executive commissioner is not required to implement the pilot program authorized under Subsection (c) as a prerequisite to providing Medicaid reimbursement authorized by Subsection (b) on a statewide basis.
Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 11(b), eff. September 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.038, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0218. Long-Term Care Medicaid Programs

Text of section effective until April 01, 2025
Sec. 531.0218.  LONG-TERM CARE MEDICAID PROGRAMS.  (a)  To the extent authorized by state and federal law, the commission shall make uniform the functions relating to the administration and delivery of Section 1915(c) waiver programs, including:
(1)  rate-setting;
(2)  the applicability and use of service definitions;
(3)  quality assurance;  and
(4)  intake data elements.
(b)  Subsection (a) does not apply to functions of a Section 1915(c) waiver program that is operated in conjunction with a federally funded program of the state under Medicaid that is authorized under Section 1915(b) of the federal Social Security Act (42 U.S.C. Section 1396n(b)).
(c)  The commission shall ensure that information on individuals seeking to obtain services from Section 1915(c) waiver programs is maintained in a single computerized database that is accessible to staff of each of the state agencies administering those programs.
Added by Acts 1999, 76th Leg., ch. 899, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.040, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02191. Public Input

Text of section effective until April 01, 2025
Sec. 531.02191.  PUBLIC INPUT.  In complying with the requirements of Section 531.0218, the commission shall regularly consult with and obtain input from:
(1)  consumers and family members;
(2)  providers;
(3)  advocacy groups;
(4)  state agencies that administer a Section 1915(c) waiver program; and
(5)  other interested persons.
Added by Acts 1999, 76th Leg., ch. 899, Sec. 2, eff. Sept. 1, 1999.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 759 (S.B. 705), Sec. 2, eff. September 15, 2009.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02192. Federally Qualified Health Center and Rural Health Clinic Services

Text of section effective until April 01, 2025
Sec. 531.02192.  FEDERALLY QUALIFIED HEALTH CENTER AND RURAL HEALTH CLINIC SERVICES.  (a)  In this section:
(1)  "Federally qualified health center" has the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B).
(2)  "Federally qualified health center services" has the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
(3)  "Rural health clinic" and "rural health clinic services" have the meanings assigned by 42 U.S.C. Section 1396d(l)(1).
(b)  Notwithstanding any provision of this chapter, Chapter 32, Human Resources Code, or any other law, the commission shall:
(1)  promote Medicaid recipient access to federally qualified health center services or rural health clinic services; and
(2)  ensure that payment for federally qualified health center services or rural health clinic services is in accordance with 42 U.S.C. Section 1396a(bb).
Added by Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 1, eff. September 1, 2007.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02193. Certain Conditions on Medicaid Reimbursement of Rural Health Clinics Prohibited

Text of section effective until April 01, 2025
Sec. 531.02193.  CERTAIN CONDITIONS ON MEDICAID REIMBURSEMENT OF RURAL HEALTH CLINICS PROHIBITED.  The commission may not impose any condition on the reimbursement of a rural health clinic under the Medicaid program if the condition is more stringent than the conditions imposed by the Rural Health Clinic Services Act of 1977 (Pub. L. No. 95-210) or the laws of this state regulating the practice of medicine, pharmacy, or professional nursing.
Added by Acts 2015, 84th Leg., R.S., Ch. 1236 (S.B. 1296), Sec. 19.015(a), eff. September 1, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0222. Local Mental Health Authority Group Regional Planning

Text of section effective until April 01, 2025
Sec. 531.0222.  LOCAL MENTAL HEALTH AUTHORITY GROUP REGIONAL PLANNING.  (a)  In this section, "local mental health authority group" means a group of local mental health authorities established by the commission under Chapter 963 (S.B. 633), Acts of the 86th Legislature, Regular Session, 2019.
(b)  The commission shall require each local mental health authority group to meet at least quarterly to collaborate on planning and implementing regional strategies to reduce:
(1)  costs to local governments of providing services to persons experiencing a mental health crisis;
(2)  transportation to mental health facilities of persons served by an authority that is a member of the group;
(3)  incarceration of persons with mental illness in county jails that are located in an area served by an authority that is a member of the group; and
(4)  visits by persons with mental illness at hospital emergency rooms located in an area served by an authority that is a member of the group.
(c)  The commission shall use federal funds in accordance with state and federal guidelines to implement this section.
(d)  The commission, in coordination with each local mental health authority group, shall annually update the mental health services development plan that was initially developed by the commission and each local mental health authority group under Chapter 963 (S.B. 633), Acts of the 86th Legislature, Regular Session, 2019. The commission and each group's updated plan must include a description of:
(1)  actions taken by the group to implement regional strategies in the plan; and
(2)  new regional strategies identified by the group to reduce the circumstances described by Subsection (b), including the estimated number of outpatient and inpatient beds necessary to meet the goals of each group's regional strategy.
(e)  Not later than December 1 of each year, the commission shall produce and publish on its Internet website a report containing the most recent version of each mental health services development plan developed by the commission and a local mental health authority group.
Added by Acts 2021, 87th Leg., R.S., Ch. 295 (S.B. 454), Sec. 1, eff. June 4, 2021.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0224. Planning and Policy Direction of Temporary Assistance for Needy Families Program

Text of section effective until April 01, 2025
Sec. 531.0224.  PLANNING AND POLICY DIRECTION OF TEMPORARY ASSISTANCE FOR NEEDY FAMILIES PROGRAM.  (a) The commission shall:
(1)  plan and direct the financial assistance program under Chapter 31, Human Resources Code, including the procurement, management, and monitoring of contracts necessary to implement the program; and
(2)   establish requirements for and define the scope of the ongoing evaluation of the financial assistance program under Chapter 31, Human Resources Code.
(b)  The executive commissioner shall adopt rules and standards governing the financial assistance program under Chapter 31, Human Resources Code.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.07, eff. Sept. 1, 2003.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.043, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
For expiration of this section, see Subsection (p).
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0225. Mental Health and Substance Abuse Services

Text of section effective until April 01, 2025
Sec. 531.0225.  MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES.  (a)  To ensure appropriate delivery of mental health and substance abuse services, the commission shall regularly evaluate program contractors and subcontractors that provide or arrange for the services for persons enrolled in:
(1)  the Medicaid managed care program;  and
(2)  the state child health plan program.
(b)  The commission shall monitor:
(1)  penetration rates, as they relate to mental health and substance abuse services provided by or through contractors and subcontractors;
(2)  utilization rates, as they relate to mental health and substance abuse services provided by or through contractors and subcontractors;  and
(3)  provider networks used by contractors and subcontractors to provide mental health or substance abuse services.
Added by Acts 2003, 78th Leg., ch. 358, Sec. 2, eff. June 18, 2003.
Renumbered from Government Code, Section 531.0224 by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 23.001(32), eff. September 1, 2005.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02253. Telehealth Treatment for Substance Use Disorders

Text of section effective until April 01, 2025
Sec. 531.02253.  TELEHEALTH TREATMENT FOR SUBSTANCE USE DISORDERS.  The executive commissioner by rule shall establish a program to increase opportunities and expand access to telehealth treatment for substance use disorders in this state.
Added by Acts 2019, 86th Leg., R.S., Ch. 1167 (H.B. 3285), Sec. 3, eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0226. Chronic Health Conditions Services Medicaid Waiver Program

Text of section effective until April 01, 2025
Sec. 531.0226.  CHRONIC HEALTH CONDITIONS SERVICES MEDICAID WAIVER PROGRAM.  (a)  If feasible and cost-effective, the commission may apply for a waiver from the federal Centers for Medicare and Medicaid Services or another appropriate federal agency to more efficiently leverage the use of state and local funds in order to maximize the receipt of federal Medicaid matching funds by providing benefits under Medicaid to individuals who:
(1)  meet established income and other eligibility criteria; and
(2)  are eligible to receive services through the county for chronic health conditions.
(b)  In establishing the waiver program under this section, the commission shall:
(1)  ensure that the state is a prudent purchaser of the health care services that are needed for the individuals described by Subsection (a);
(2)  solicit broad-based input from interested persons;
(3)  ensure that the benefits received by an individual through the county are not reduced once the individual is enrolled in the waiver program; and
(4)  employ the use of intergovernmental transfers and other procedures to maximize the receipt of federal Medicaid matching funds.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 4 (S.B. 1), Sec. 71.01, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.044, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0227. Person First Respectful Language Promotion

Text of section effective until April 01, 2025
Sec. 531.0227.  PERSON FIRST RESPECTFUL LANGUAGE PROMOTION.  The executive commissioner shall ensure that the commission and each health and human services agency use the terms and phrases listed as preferred under the person first respectful language initiative in Chapter 392 when proposing, adopting, or amending the commission's or agency's rules, reference materials, publications, and electronic media.
Added by Acts 2011, 82nd Leg., R.S., Ch. 272 (H.B. 1481), Sec. 3, eff. September 1, 2011.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.023. Submission of Plans and Updates by Agencies

Text of section effective until April 01, 2025
Sec. 531.023.  SUBMISSION OF PLANS AND UPDATES BY AGENCIES.  (a)  All health and human services agencies shall submit to the commission strategic plans and biennial updates on a date to be determined by commission rule.  The commission shall review and comment on the strategic plans and biennial updates.
(b)  Not later than January 1 of each even-numbered year, the commission shall begin formal discussions with each health and human services agency regarding that agency's strategic plan or biennial update.
Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept. 1, 1995.  Amended by Acts 1997, 75th Leg., ch. 165, Sec. 14.05(a), eff. Sept. 1, 1997.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.0241. Streamlining Delivery of Services

Text of section effective until April 01, 2025
Sec. 531.0241.  STREAMLINING DELIVERY OF SERVICES.  To integrate and streamline service delivery and facilitate access to services, the executive commissioner may request a health and human services agency to take a specific action and may recommend the manner in which the streamlining is to be accomplished, including requesting each health and human services agency to:
(1)  simplify agency procedures;
(2)  automate agency procedures;
(3)  coordinate service planning and management tasks between and among health and human services agencies;
(4)  reallocate staff resources;
(5)  waive existing rules; or
(6)  take other necessary actions.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.07(a), eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.047, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02411. Streamlining Administrative Processes

Text of section effective until April 01, 2025
Sec. 531.02411.  STREAMLINING ADMINISTRATIVE PROCESSES.  The commission shall make every effort using the commission's existing resources to reduce the paperwork and other administrative burdens placed on Medicaid recipients and providers and other participants in Medicaid and shall use technology and efficient business practices to decrease those burdens.  In addition, the commission shall make every effort to improve the business practices associated with the administration of Medicaid by any method the commission determines is cost-effective, including:
(1)  expanding the utilization of the electronic claims payment system;
(2)  developing an Internet portal system for prior authorization requests;
(3)  encouraging Medicaid providers to submit their program participation applications electronically;
(4)  ensuring that the Medicaid provider application is easy to locate on the Internet so that providers may conveniently apply to the program;
(5)  working with federal partners to take advantage of every opportunity to maximize additional federal funding for technology in Medicaid; and
(6)  encouraging the increased use of medical technology by providers, including increasing their use of:
(A)  electronic communications between patients and their physicians or other health care providers;
(B)  electronic prescribing tools that provide up-to-date payer formulary information at the time a physician or other health care practitioner writes a prescription and that support the electronic transmission of a prescription;
(C)  ambulatory computerized order entry systems that facilitate physician and other health care practitioner orders at the point of care for medications and laboratory and radiological tests;
(D)  inpatient computerized order entry systems to reduce errors, improve health care quality, and lower costs in a hospital setting;
(E)  regional data-sharing to coordinate patient care across a community for patients who are treated by multiple providers; and
(F)  electronic intensive care unit technology to allow physicians to fully monitor hospital patients remotely.
Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 4(a), eff. September 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.048, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.024115. Service Delivery Area Alignment

Text of section effective until April 01, 2025
Sec. 531.024115.  SERVICE DELIVERY AREA ALIGNMENT.  Notwithstanding Section 533.0025(e) or any other law, to the extent possible, the commission shall align service delivery areas under Medicaid and the child health plan program.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1310 (S.B. 7), Sec. 6.03, eff. September 1, 2013.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.049, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.02412. Service Delivery Audit Mechanisms

Text of section effective until April 01, 2025
Sec. 531.02412.  SERVICE DELIVERY AUDIT MECHANISMS.  (a)  The commission shall make every effort to ensure the integrity of Medicaid.  To ensure that integrity, the commission shall:
(1)  perform risk assessments of every element of the program and audit those elements of the program that are determined to present the greatest risks;
(2)  ensure that sufficient oversight is in place for the Medicaid medical transportation program;
(3)  ensure that a quality review assessment of the Medicaid medical transportation program occurs; and
(4)  evaluate Medicaid with respect to use of the metrics developed through the Texas Health Steps performance improvement plan to guide changes and improvements to the program.
Added by Acts 2005, 79th Leg., Ch. 349 (S.B. 1188), Sec. 4(a), eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 268 (S.B. 10), Sec. 32(f), eff. September 1, 2008.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.050, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.024131. Expansion of Billing Coordination and Information Collection Activities

Sec. 531.024131.  EXPANSION OF BILLING COORDINATION AND INFORMATION COLLECTION ACTIVITIES.
Without reference to the amendment of this subsection, this subsection was repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(1), eff. April 1, 2025.
(a)  If cost-effective, the commission may:
(1)  contract to expand all or part of the billing coordination system established under Section 531.02413 to process claims for services provided through other benefits programs administered by the commission or a health and human services agency;
(2)  expand any other billing coordination tools and resources used to process claims for health care services provided through Medicaid to process claims for services provided through other benefits programs administered by the commission or a health and human services agency; and
(3)  expand the scope of persons about whom information is collected under Section 32.0424(a), Human Resources Code, to include recipients of services provided through other benefits programs administered by the commission or a health and human services agency.
Text of subsection effective until April 01, 2025
(b)  Notwithstanding any other state law, each health and human services agency shall provide the commission with any information necessary to allow the commission or the commission's designee to perform the billing coordination and information collection activities authorized by this section.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 1.10, eff. September 28, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.052, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(1), eff. April 1, 2025.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 1098 (S.B. 1342), Sec. 1, eff. September 1, 2023.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.024161. Reimbursement Claims for Certain Medicaid or Child Health Plan Services Involving Supervised Providers

Text of section effective until April 01, 2025
Sec. 531.024161.  REIMBURSEMENT CLAIMS FOR CERTAIN MEDICAID OR CHILD HEALTH PLAN SERVICES INVOLVING SUPERVISED PROVIDERS.  (a)  If a provider, including a nurse practitioner or physician assistant, under Medicaid or the child health plan program provides a referral for or orders health care services for a recipient or enrollee, as applicable, at the direction or under the supervision of another provider, and the referral or order is based on the supervised provider's evaluation of the recipient or enrollee, the names and associated national provider identifier numbers of the supervised provider and the supervising provider must be included on any claim for reimbursement submitted by a provider based on the referral or order.  For purposes of this section, "national provider identifier" means the national provider identifier required under Section 1128J(e), Social Security Act (42 U.S.C. Section 1320a-7k(e)).
(b)  The executive commissioner shall adopt rules necessary to implement this section.
Added by Acts 2011, 82nd Leg., R.S., Ch. 980 (H.B. 1720), Sec. 2, eff. September 1, 2011.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.054, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.055, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.
2023 Texas Statutes › Government Code › Title 4 - Executive Branch › Subtitle I - Health and Human Services › Chapter 531 - Health and Human Services Commission › Subchapter B. Powers and Duties › Section 531.024162. Notice Requirements Regarding Medicaid Coverage or Prior Authorization Denial and Incomplete Requests

Text of section effective until April 01, 2025
Sec. 531.024162.  NOTICE REQUIREMENTS REGARDING MEDICAID COVERAGE OR PRIOR AUTHORIZATION DENIAL AND INCOMPLETE REQUESTS.  (a)  The commission shall ensure that notice sent by the commission or a Medicaid managed care organization to a Medicaid recipient or provider regarding the denial, partial denial, reduction, or termination of coverage or denial of prior authorization for a service includes:
(1)  information required by federal and state law and applicable regulations;
(2)  for the recipient:
(A)  a clear and easy-to-understand explanation of the reason for the decision, including a clear explanation of the medical basis, applying the policy or accepted standard of medical practice to the recipient's particular medical circumstances;
(B)  a copy of the information sent to the provider; and
(C)  an educational component that includes a description of the recipient's rights, an explanation of the process related to appeals and Medicaid fair hearings, and a description of the role of an external medical review; and
(3)  for the provider, a thorough and detailed clinical explanation of the reason for the decision, including, as applicable, information required under Subsection (b).
(b)  The commission or a Medicaid managed care organization that receives from a provider a coverage or prior authorization request that contains insufficient or inadequate documentation to approve the request shall issue a notice to the provider and the Medicaid recipient on whose behalf the request was submitted.  The notice issued under this subsection must:
(1)  include a section specifically for the provider that contains:
(A)  a clear and specific list and description of the documentation necessary for the commission or organization to make a final determination on the request;
(B)  the applicable timeline, based on the requested service, for the provider to submit the documentation and a description of the reconsideration process described by Section 533.00284, if applicable; and
(C)  information on the manner through which a provider may contact a Medicaid managed care organization or other entity as required by Section 531.024163; and
(2)  be sent:
(A)  to the provider:
(i)  using the provider's preferred method of communication, to the extent practicable using existing resources; and
(ii)  as applicable, through an electronic notification on an Internet portal; and
(B)  to the recipient using the recipient's preferred method of communication, to the extent practicable using existing resources.
Added by Acts 2019, 86th Leg., R.S., Ch. 623 (S.B. 1207), Sec. 3(b), eff. September 1, 2019.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01, eff. April 1, 2025.