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State Law
Federal Law
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Texas Human Resources Code - Chapter 32 Medical Assistance ProgramLegal Research Home > Texas Lawyer > Human Resources Code > Texas Human Resources Code - Chapter 32 Medical Assistance Program The purpose of this chapter is to enable the state to provide medical assistance on behalf of needy individuals and to enable the state to ... (a) This chapter shall be liberally construed and applied in relation to applicable federal laws and regulations so that adequate and high quality health care ... In this chapter: (1) "Board" means the Health and Human Services Commission or the governing body of an agency operating part of the medical assistance ... (a) The department is the state agency designated to administer the medical assistance program provided in this chapter. (b) The department shall enter into agreements ... (a) After service in the department ends, a former member of the board or a former commissioner may not knowingly represent a person before an ... Notwithstanding any other law and subject to Section 533.0025, Government Code, the department shall provide medical assistance for acute care through the Medicaid managed care ... (a) The department by rule shall establish procedures for: (1) controlling the number of Medicaid beds in nursing facilities; (2) decertification of unused Medicaid beds ... (a) The department may include in a contract for the delivery of medical assistance by a home or community care provider a provision for monetary ... (a) The board, on the recommendation of the commissioner, shall appoint a medical care advisory committee to advise the board and the department in developing ... (a) The department's plan for administering medical assistance must include procedures for using health services administered by other state agencies pursuant to cooperative arrangements. (b) ... (a) The department shall publish notice in the Texas Register of: (1) any attempt to obtain a waiver of federal regulations in the medical assistance ... (a) The department shall provide medical assistance to all persons who receive financial assistance from the state under Chapter 31 of this code and to ... The department 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. ... To the extent possible, the department shall verify an applicant's residential address at the time the application for medical assistance is filed. Added by Acts ... (a) The department, in cooperation with the United States Social Security Administration, shall periodically review the eligibility of a recipient of medical assistance who is ... (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 ... The department shall waive for a nursing facility a restriction imposed by state law on the authority to contract under the state Medicaid program for ... (a) The Texas Department of Human Services, in cooperation with all appropriate state and federal agencies and with the advisory committee established in Subsection (b), ... (a) In this section, "independent foster care adolescent" has the meaning assigned by 42 U.S.C. Section 1396d(w)(1), as amended. (b) The department shall provide medical ... Text of section effective until September 1, 2011 (a) The department shall establish a five-year demonstration project through the medical assistance program to expand ... (a) A recipient of benefits under Chapter 31 of this code or supplemental security income from the federal government is automatically eligible for medical assistance, ... (a) The department shall establish and implement procedures under which the department automatically reviews a child's eligibility for medical assistance if: (1) the child originally ... (a) The state shall provide transitional medical assistance, in accordance with state rules and federal law, to a person who was receiving financial assistance under ... (a) The department shall promulgate rules for determining and certifying a person's eligibility and need for medical assistance. (b) The department shall promulgate rules to ... The department shall adopt rules in accordance with 42 U.S.C. Section 1396a(e)(12), as amended, to provide for a period of continuous eligibility for a child ... (a) The department shall develop procedures to ensure that all necessary information regarding a child who will be denied continued medical assistance under this chapter ... (a) The department shall require that the parent or guardian of a child under 19 years of age who originally establishes eligibility for medical assistance ... [Without reference to the amendment of subsec. (b) by Acts 2003, 78th Leg., ch. 1251, § 9, Acts 2003, 78th Leg., ch. 198, § ... (a) The department shall adopt reasonable rules and standards governing the determination of fees, charges, and rates for medical assistance payments. (b) The fee, charge, ... (a) The department shall by rule describe the process used to determine payment rates for medical assistance and shall notify providers, consumers, the Legislative Budget ... (a) The department shall hold a public hearing to allow interested persons to present comments relating to proposed payment rates for medical assistance. (b) The ... (a) The department may prescribe a method of payment for medical assistance claims by establishing a direct vendor payment program that is administered by the ... (a) Notwithstanding any other law, the department may: (1) perform a prepayment review of a claim for reimbursement under the medical assistance program to determine ... (a) The medical assistance fund is a special fund in the treasury and constitutes a separate account. The fund may be expended only for the ... (a) The department may accept federal funds for the support of the medical assistance program and may expend the funds in the manner prescribed by ... The department shall require a recipient of medical assistance to exhaust drug benefits available under the medical assistance program before reimbursing the recipient, pharmacist, or ... (a) Subject to appropriated state funds, the department shall establish procedures and formulas for the allocation of federal medical assistance funds that are directed to ... The department shall adopt reasonable rules for minimizing the opportunity for fraud and abuse, for establishing and maintaining methods for detecting and identifying situations in ... (a) The department by rule may require each provider of medical assistance in a provider type that has demonstrated significant potential for fraud or abuse ... (a) The department may obtain from any law enforcement or criminal justice agency the criminal history record information that relates to a provider under the ... (a) The filing of an application for or receipt of medical assistance constitutes an assignment of the applicant's or recipient's right of recovery from: (1) ... (a) The department has authority to adjudicate claims of contested cases in accordance with Chapter 2001, Government Code. When the department intends to cancel its ... The provisions of Section 31.034 of this code governing the right of appeal of an applicant for or recipient of financial assistance authorized under Chapter ... (a) Neither medical assistance nor payments to providers of medical assistance under this chapter are transferable or assignable at law or in equity. (b) No ... (a) The department may receive directly from an insurance company any payments to which the department is entitled under Section 1204.153, Insurance Code. (b) The ... (a) The board shall set the payment rates for ICF-MR facilities at least annually. (b) The board shall adopt by rule the methodology used by ... (a) In this section: (1) "Claim" means an application for payment of health care services under Title XIX of the federal Social Security Act that ... (a) A person commits an offense if the person intentionally or knowingly commits a violation under Section 32.039(b)(1-b), (1-c), (1-d), or (1-e). (b) An offense ... (a) A woman receiving medical assistance in the form of prenatal care, child delivery care, and obstetrical care related to prenatal care and child delivery ... (a) Beginning September 1, 1991, the department in consultation with the Medicaid analysis and cost control unit of the Legislative Budget Board shall initiate the ... (a) An insurer shall maintain a file system that contains: (1) the name, address, including claim submission address, group policy number, employer's mailing address, social ... (a) The department may impose an administrative penalty on a person who does not comply with a request for information made under Section 32.042(b). (b) ... (a) In this section: (1) "Department" means the Texas Department of Health. (2) "Group health benefit plan" means a plan described by Section 1207.001, Insurance ... To the extent allowed by federal law, a health care service provider must seek reimbursement from available third-party health coverage or insurance that the provider ... (a) A public hospital that is designated as a disproportionate share hospital during a fiscal year may acquire goods and services in accordance with this ... (a) A public or private hospital that is designated as a disproportionate share hospital during a fiscal year may purchase goods and services in accordance ... The department shall develop a procedure for: (1) identifying each service provided under the medical assistance program for which the state is eligible to receive ... (a) The department shall adopt rules governing sanctions and penalties that apply to a provider in the vendor drug program who submits an improper claim ... (a) In consultation and coordination with the State Council on Competitive Government, the Texas Department of Health shall seek competitive bids for the claims processing ... (a) Notwithstanding any other provision of state law, the department shall: (1) consider a nationally recognized, unbiased pricing standard for prescription drugs in determining reimbursement ... The department may adopt rules establishing procedures for the purchase and distribution of medically necessary, over-the-counter medications and medical supplies under the medical assistance program ... A person is permanently prohibited from providing or arranging to provide health care services under the medical assistance program if: (1) the person is convicted ... (a) Subject to the availability of funds, the department shall develop a comprehensive plan to provide information and training about the requirements of a managed ... (a) The department shall review each managed care organization that has contracted with the department to provide medical assistance to medical assistance recipients through a ... (a) At least annually the department shall identify each individual receiving medical assistance under the medical assistance program who is eligible to receive similar assistance ... To the extent authorized by federal law, the department shall develop a procedure for the state to: (1) match claims for payment for medical assistance ... (a) This section applies to services under the medical assistance program provided to children younger than 23 years of age with disabilities or special health ... ... (a) For purposes of this section, the "dental necessity" for a dental service or product is based on whether a prudent dentist, acting in accordance ... (a) The department shall develop and implement a catastrophic case management system to be used in providing medical assistance to persons with catastrophic health problems. ... The Health and Human Services Commission shall: (1) create and coordinate staffing and other administrative efficiencies for case management initiatives across the commission and health ... The commissioner by rule shall develop procedures to ensure that recipients of medical assistance who are eligible for Texas Health Steps comply with the regimen ... (a) The department shall request contract proposals from providers of disease management programs to provide program services to recipients of medical assistance who: (1) have ... (a) In this section: (1) "Institution" means a nursing facility or an ICF-MR facility. (2) "Medical assistance waiver program" means: (A) the community-based alternatives program; ... The department by rule shall require that respiratory therapy services for ventilator-dependent persons furnished as part of a plan of care under this chapter be ... Text of section as added by Acts 2003, 78th Leg., ch. 198, § 2.109(a) (a) The nursing facility quality assurance team is established to ... Text of section as added by Acts 2003, 78th Leg., ch. 204, § 16.01 (a) The following are not admissible as evidence in a civil ... Any home and community-based services that the department provides under Section 1929, Social Security Act (42 U.S.C. Section 1396t) and its subsequent amendments to functionally ... (a) A third-party billing vendor may not submit a claim with the department for reimbursement on behalf of a provider of medical services under the ... (a) To the extent permitted under Title XIX, Social Security Act (42 U.S.C. Section 1396 et seq.), as amended, and any other applicable law or ... Text of section effective until September 1, 2007 (a) In this section: (1) "Consumer" means a participant in the consumer-directed services program established under ... (a) In this section, "certified agency" and "home health service" have the meanings assigned by Section 142.001, Health and Safety Code. (b) The department shall ... Text of section effective until September 1, 2009 (a) The Health and Human Services Commission shall establish a pilot program to provide recipients of ... A provider of disease management programs under Section 32.059, as added by Chapter 208, Acts of the 78th Legislature, Regular Session, 2003, shall develop a ... (a) In this section, "provider" means an individual, firm, partnership, corporation, agency, association, institution, or other entity that is or was approved by the department ... (a) The department shall develop and implement a comprehensive medical assistance education campaign for recipients and providers to ensure that care is provided in such ... Last modified: August 10, 2007 |