Texas Human Resources Code Title 2, Chapter 32 - Medical Assistance Program

SUBCHAPTER A GENERAL PROVISIONS

• Texas Section 32.001 - Purpose Of Chapter
  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...
• Texas Section 32.002 - Construction Of Chapter
  (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...

SUBCHAPTER B ADMINISTRATIVE PROVISIONS

• Texas Section 32.003 - Definitions
  In this chapter: (1) "Health and human services agencies" has the meaning assigned by Section 531.001, Government Code. (2) Repealed by Acts 2015, 84th Leg.,...
• Texas Section 32.021 - Administration Of The Program
  (a) The commission is the single state agency designated to administer the medical assistance program provided in this chapter in accordance with 42 U.S.C. Section...
• Texas Section 32.0211 - Restrictions On Executive Commissioners, Former Members Of A Board, Commissioners, And Their Business Partners
  (a) After service in the commission or a health and human services agency, including an agency that formerly operated part of the medical assistance program...
• Texas Section 32.0212 - Delivery Of Medical Assistance
  Notwithstanding any other law and subject to Section 533.0025, Government Code, the commission shall provide medical assistance for acute care services through the Medicaid managed...
• Texas Section 32.0213 - Nursing Facility Bed Certification And Decertification
  (a) The executive commissioner by rule shall establish procedures for: (1) controlling the number of Medicaid beds in nursing facilities; (2) decertification of unused Medicaid...
• Texas Section 32.0214 - Designations Of Primary Care Provider By Certain Recipients
  (a) If the commission determines that it is cost-effective and feasible and subject to Subsection (b), the commission shall require each recipient of medical assistance...
• Texas Section 32.0215 - Home Or Community Care Providers: Civil Monetary Penalties
  (a) The commission may include in a contract for the delivery of medical assistance by a home or community care provider a provision for monetary...
• Texas Section 32.022 - Medical And Hospital Care Advisory Committees
  (a) The executive commissioner shall appoint a medical care advisory committee to advise the executive commissioner and the commission in developing and maintaining the medical...
• Texas Section 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)...
• Texas Section 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...
• Texas Section 32.024 - Authority And Scope Of Program; Eligibility
  (a) The commission shall provide medical assistance to all persons who receive financial assistance from the state under Chapter 31 and to other related groups...
• Texas Section 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....
• Texas Section 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...
• Texas Section 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...
• Texas Section 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...
• Texas Section 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...
• Texas Section 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,...
• Texas Section 32.0247 - Medical Assistance For Certain Persons Making Transition From Foster Care To Independent Living
  (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 commission shall provide medical...
• Texas Section 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...
• Texas Section 32.025 - Application For Medical Assistance
  (a) A recipient of benefits under Chapter 31 or supplemental security income from the federal government is automatically eligible for medical assistance, and an application...
• Texas Section 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:...
• Texas Section 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...
• Texas Section 32.026 - Certification Of Eligibility And Need For Medical Assistance
  (a) The executive commissioner shall promulgate rules for determining and certifying a person's eligibility and need for medical assistance. (b) The executive commissioner shall promulgate...
• Texas Section 32.0261 - Continuous Eligibility
  The executive commissioner 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...
• Texas Section 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...
• Texas Section 32.02613 - Life Insurance Assets; Life Insurance Policy Conversion
  (a) For purposes of this section, "long-term care services and support" includes home health care, assisted living, and nursing facility services. (b) The owner of...
• Texas Section 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...
• Texas Section 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...
• Texas Section 32.0264 - Suspension And Automatic 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...
• Texas Section 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...
• Texas Section 32.027 - Selection Of Provider Of Medical Assistance
  (a) Except as provided by Subsections (f) and (g), a recipient of medical assistance authorized in this chapter may select any provider authorized by the...
• Texas Section 32.028 - Fees, Charges, And Rates
  (a) The executive commissioner shall adopt reasonable rules and standards governing the determination of fees, charges, and rates for medical assistance payments. (b) The fee,...
• Texas Section 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...
• Texas Section 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...
• Texas Section 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...
• Texas Section 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...
• Texas Section 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...
• Texas Section 32.031 - Receipt And Expenditure Of Funds
  (a) The commission may accept federal funds for the support of the medical assistance program and may expend the funds in the manner prescribed by...
• Texas Section 32.0311 - Drug Reimbursement Under Certain Programs
  The commission shall require a recipient of medical assistance to exhaust drug benefits available under the medical assistance program before reimbursing the recipient, pharmacist, or...
• Texas Section 32.0312 - Reimbursement For Services Associated With Preventable Adverse Events
  The executive commissioner shall adopt rules regarding the denial or reduction of reimbursement under the medical assistance program for preventable adverse events that occur in...
• Texas Section 32.0313 - Induced Deliveries Or Cesarean Sections Before 39th Week
  (a) The commission shall achieve cost savings with improved outcomes by adopting and implementing quality initiatives that are evidence-based, tested, and fully consistent with established...
• Texas Section 32.0314 - Reimbursement For Durable Medical Equipment And Supplies
  The executive commissioner shall adopt rules requiring the electronic submission of any claim for reimbursement for durable medical equipment and supplies under the medical assistance...
• Texas Section 32.03141 - Authority Of Advanced Practice Registered Nurses And Physician Assistants Regarding Durable Medical Equipment And Supplies
  To the extent allowed by federal law, an advanced practice registered nurse or physician assistant acting under adequate physician supervision and to whom a physician...
• Texas Section 32.0315 - Funds For Graduate Medical Education
  (a) Subject to appropriated state funds, the executive commissioner shall establish procedures and formulas for the allocation of federal medical assistance funds that are directed...
• Texas Section 32.0316 - Electronic Transactions; Medicaid
  The executive commissioner shall adopt and the commission shall implement policies that encourage the use of electronic transactions in Medicaid. The policies shall require payment...
• Texas Section 32.032 - Prevention And Detection Of Fraud And Abuse
  The executive commissioner shall adopt reasonable rules for minimizing the opportunity for fraud and abuse, for establishing and maintaining methods for detecting and identifying situations...
• Texas Section 32.0321 - Surety Bond
  (a) The executive commissioner by rule may require each provider of medical assistance in a provider type that has demonstrated significant potential for fraud or...
• Texas Section 32.0322 - Criminal History Record Information; Enrollment Of Providers
  (a) The commission or the office of inspector general established under Chapter 531, Government Code, may obtain from any law enforcement or criminal justice agency...
• Texas Section 32.033 - Subrogation
  (a) The filing of an application for or receipt of medical assistance constitutes an assignment of the applicant's or recipient's right of recovery from: (1)...
• Texas Section 32.034 - Contract Cancellation; Notice And Hearing
  (a) The commission has authority to adjudicate claims of contested cases in accordance with Chapter 2001, Government Code. When the commission intends to cancel its...
• Texas Section 32.035 - Appeals
  The provisions of Section 31.034 governing the right of appeal of an applicant for or recipient of financial assistance authorized under Chapter 31 also apply...
• Texas Section 32.036 - Program Payments Nonassignable And Exempt From Legal Process
  (a) Neither medical assistance nor payments to providers of medical assistance under this chapter are transferable or assignable at law or in equity. (b) No...
• Texas Section 32.038 - Collection Of Insurance Payments
  (a) The commission may receive directly from an insurance company any payments to which the commission is entitled under Section 1204.153, Insurance Code. (b) The...
• Texas Section 32.0381 - Icf-iid Payment Rates
  (a) The executive commissioner shall set the payment rates for ICF-IID facilities at least annually. (b) The executive commissioner shall adopt by rule the methodology...
• Texas Section 32.039 - Damages And Penalties
  (a) In this section: (1) "Claim" means an application for payment of health care services under Title XIX of the federal Social Security Act (42...
• Texas Section 32.0391 - Criminal Offense
  (a) A person commits an offense if the person intentionally or knowingly commits a violation under Section 32.039(b)(1-b), (1-c), (1-d), (1-e), or (1-f). (b) An...
• Texas Section 32.040 - Identification Of Husband Or Alleged Father
  (a) A woman receiving medical assistance in the form of prenatal care, child delivery care, and obstetrical care related to prenatal care and child delivery...
• Texas Section 32.042 - Information Required From Health Insurers
  (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...
• Texas Section 32.0421 - Administrative Penalty For Failure To Provide Information
  (a) The commission may impose an administrative penalty on a person who does not comply with a request for information made under Section 32.042(b). (b)...
• Texas Section 32.0422 - Health Insurance Premium Payment Reimbursement Program For Medical Assistance Recipients
  (a) In this section, "group health benefit plan" means a plan described by Section 1207.001, Insurance Code. (b) The commission shall identify individuals, otherwise entitled...
• Texas Section 32.0423 - Recovery Of Reimbursements From Health Coverage Providers
  To the extent allowed by federal law, a health care service provider must seek reimbursement from available third-party health coverage or insurance that the provider...
• Texas Section 32.0424 - Requirements Of Third-party Health Insurers
  (a) A third-party health insurer is required to provide to the commission, on the commission's request, information in a form prescribed by the executive commissioner...
• Texas Section 32.04242 - Payor Of Last Resort
  The executive commissioner shall adopt rules to ensure, to the extent allowed by federal law, that the Medicaid program: (1) is the payor of last...
• Texas Section 32.0425 - Reimbursement For Wheeled Mobility Systems
  (a) In this section: (2) "Wheeled mobility system" means an item of durable medical equipment that is a customized powered or manual mobility device or...
• Texas Section 32.043 - Procurement Rules For Public Disproportionate Share Hospitals
  (a) A public hospital that is designated as a disproportionate share hospital during a fiscal year may acquire goods and services in accordance with this...
• Texas Section 32.044 - Group Purchasing For Disproportionate Share Hospitals
  (a) A public or private hospital that is designated as a disproportionate share hospital during a fiscal year may purchase goods and services in accordance...
• Texas Section 32.045 - Enhanced Reimbursement
  The commission shall develop a procedure for: (1) identifying each service provided under the medical assistance program for which the state is eligible to receive...
• Texas Section 32.046 - Sanctions And Penalties Related To The Provision Of Pharmacy Products
  (a) The executive commissioner shall adopt rules governing sanctions and penalties that apply to a provider who participates in the vendor drug program or is...
• Texas Section 32.0461 - Vendor Drug Program; Competitive Bidding
  (a) In consultation and coordination with the State Council on Competitive Government, the commission shall seek competitive bids for the claims processing function of the...
• Texas Section 32.0462 - Vendor Drug Program; Pricing Standard
  (a) Notwithstanding any other provision of state law, the commission shall: (1) consider a nationally recognized, unbiased pricing standard for prescription drugs in determining reimbursement...
• Texas Section 32.0463 - Medications And Medical Supplies
  The executive commissioner may adopt rules establishing procedures for the purchase and distribution of medically necessary, over-the-counter medications and medical supplies under the medical assistance...
• Texas Section 32.047 - Prohibition Of Certain Health Care Service Providers
  (a) A person is permanently prohibited from providing or arranging to provide health care services under the medical assistance program if: (1) the person is...
• Texas Section 32.048 - Managed Care Information And Training Plan
  (a) Subject to the availability of funds, the commission shall develop a comprehensive plan to provide information and training about the requirements of a managed...
• Texas Section 32.049 - Managed Care Contract Compliance
  (a) The commission shall review each managed care organization that has contracted with the commission to provide medical assistance to medical assistance recipients through a...
• Texas Section 32.050 - Dual Medicaid And Medicare Coverage
  (a) At least annually the commission shall identify each individual receiving medical assistance under the medical assistance program who is eligible to receive similar assistance...
• Texas Section 32.051 - Misdirected Billing
  To the extent authorized by federal law, the commission shall develop a procedure for the state to: (1) match claims for payment for medical assistance...
• Texas Section 32.052 - Waiver Programs For Children With Disabilities Or Special Health Care Needs
  (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...
• Texas Section 32.053 - Program Of All-inclusive Care For The Elderly (Pace)
  Sec. 32.053. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE). (a) The commission, as an integral part of the medical assistance program, shall develop and...
• Texas Section 32.0531 - Pace Program Team
  (a) The Department of Aging and Disability Services shall establish a PACE program team composed of experienced personnel. The team is responsible for: (1) increasing...
• Texas Section 32.0532 - Pace Program Reimbursement Methodology
  (a) In this section and Sections 32.0533 and 32.0534, "PACE program" means the program of all-inclusive care for the elderly (PACE) established under Section 32.053....
• Texas Section 32.0533 - Data Collection: Pace And Star + Plus Medicaid Managed Care Programs
  Sec. 32.0533. DATA COLLECTION: PACE AND STAR + PLUS MEDICAID MANAGED CARE PROGRAMS. The commission, in collaboration with the Department of Aging and Disability Services...
• Texas Section 32.0534 - Evaluation And Report Comparing Pace And Star + Plus Medicaid Managed Care Programs
  Sec. 32.0534. EVALUATION AND REPORT COMPARING PACE AND STAR + PLUS MEDICAID MANAGED CARE PROGRAMS. (a) The commission, in collaboration with the Department of Aging...
• Texas Section 32.054 - Dental Services
  (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...
• Texas Section 32.055 - Catastrophic Case Management
  (a) The commission shall develop and implement a catastrophic case management system to be used in providing medical assistance to persons with catastrophic health problems....
• Texas Section 32.0551 - Optimization Of Case Management Systems
  The commission shall: (1) create and coordinate staffing and other administrative efficiencies for case management initiatives across the commission and health and human services agencies;...
• Texas Section 32.056 - Compliance With Texas Health Steps Comprehensive Care Program
  The executive commissioner by rule shall develop procedures to ensure that recipients of medical assistance who are eligible for Texas Health Steps Comprehensive Care Program...
• Texas Section 32.057 - Contracts For Disease Management Programs
  (a) The commission shall request contract proposals from providers of disease management programs to provide program services to recipients of medical assistance who: (1) have...
• Texas Section 32.058 - Limitation On Medical Assistance In Certain Alternative Community-based Care Settings
  (a) In this section: (1) "Department" means the Department of Aging and Disability Services. (2) "Medical assistance waiver program" means a program operated by the...
• Texas Section 32.059 - Use Of Respiratory Therapists For Respiratory Therapy Services
  The executive commissioner by rule shall require that respiratory therapy services for ventilator-dependent persons furnished as part of a plan of care under this chapter...
• Texas Section 32.061 - Community Attendant Services Program
  (a) Any home and community-based services that the commission provides under Section 1929, Social Security Act (42 U.S.C. Section 1396t) and its subsequent amendments to...
• Texas Section 32.062 - Admissibility Of Certain Evidence Relating To Nursing Institutions
  Sec. 32.062. ADMISSIBILITY OF CERTAIN EVIDENCE RELATING TO NURSING INSTITUTIONS. (a) The following are not admissible as evidence in a civil action: (1) any finding...
• Texas Section 32.063 - Third-party Billing Vendors
  (a) A third-party billing vendor may not submit a claim with the commission for reimbursement on behalf of a provider of medical services under the...
• Texas Section 32.064 - Cost Sharing
  (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...
• Texas Section 32.0641 - Recipient Accountability Provisions; Cost-sharing Requirement To Improve Appropriate Utilization Of Services
  (a) To the extent permitted under and in a manner that is consistent with Title XIX, Social Security Act (42 U.S.C. Section 1396 et seq.)...
• Texas Section 32.067 - Delivery Of Comprehensive Care Services To Certain Recipients Of Medical Assistance
  (a) In this section, "certified agency" and "home health service" have the meanings assigned by Section 142.001, Health and Safety Code. (b) The commission shall...
• Texas Section 32.068 - In-person Evaluation Required For Certain Services
  (a) A medical assistance provider may order or otherwise authorize the provision of home health services for a recipient only if the provider has conducted...
• Texas Section 32.069 - Chronic Kidney Disease Management Initiative
  A provider of disease management programs under Section 32.057 shall develop a program to provide screening for and diagnosis and treatment of chronic kidney disease...
• Texas Section 32.070 - Audits Of Providers
  (a) In this section, "provider" means an individual, firm, partnership, corporation, agency, association, institution, or other entity that is or was approved by the commission...
• Texas Section 32.0705 - External Audits Of Certain Medicaid Contractors Based On Risk
  (a) In this section, "Medicaid contractor" means an entity that: (1) is not a health and human services agency as defined by Section 531.001, Government...
• Texas Section 32.071 - Recipient And Provider Education
  (a) The commission shall develop and implement a comprehensive medical assistance education campaign for recipients and providers to ensure that care is provided in such...
• Texas Section 32.072 - Direct Access To Eye Health Care Services
  (a) Notwithstanding any other law, a recipient of medical assistance is entitled to: (1) select an ophthalmologist or therapeutic optometrist who is a medical assistance...
• Texas Section 32.073 - Health Information Technology Standards
  (a) In this section, "health information technology" means information technology used to improve the quality, safety, or efficiency of clinical practice, including the core functionalities...
• Texas Section 32.074 - Access To Personal Emergency Response System
  (a) In this section, "personal emergency response system" has the meaning assigned by Section 1702.331, Occupations Code. (b) The commission shall ensure that each Medicaid...
• Texas Section 32.075 - Employment Assistance And Supported Employment
  (a) In this section: (1) "Employment assistance" means assistance provided to an individual to help the individual locate paid employment in the community. Employment assistance...

SUBCHAPTER C MEDICAL ASSISTANCE PROGRAM PROVIDER DATABASE

• Texas Section 32.076 - Substitute Dentists
  To the extent allowed by federal law, the executive commissioner of the Health and Human Services Commission shall adopt rules ensuring that the same standards...
• Texas Section 32.101 - Definitions
  In this subchapter: (1) Repealed by Acts 2015, 84th Leg., R.S., Ch. 1 , Sec. 4.465(a)(43), eff. April 2, 2015. (2) "Health care provider" means...
• Texas Section 32.102 - Database Of Medical Assistance Program Providers
  (a) The executive commissioner shall establish and administer an electronic, searchable, Internet-based database of all participating providers in the medical assistance program. (b) The database...
• Texas Section 32.103 - Certain Fees Prohibited
  A person, including the executive commissioner, a person acting under a contract under Section 32.104, or a managed care organization, may not charge a participating...
• Texas Section 32.104 - Authority To Contract
  (a) The executive commissioner may contract with a state agency or a private entity for the creation, operation, and maintenance of the database required by...

SUBCHAPTER E ELECTRONIC COMMUNICATIONS

• Texas Section 32.105 - Rules
  The executive commissioner shall adopt rules to implement and administer this subchapter. Added by Acts 2007, 80th Leg., R.S., Ch. 883 (H.B. 2042), Sec. 1,...
• Texas Section 32.201 - Definitions
  In this subchapter: (1) "Electronic health record" means electronically originated and maintained health and claims information regarding the health status of an individual that may...

SUBCHAPTER F PARTNERSHIP FOR LONG-TERM CARE PROGRAM

• Texas Section 32.202 - Electronic Communications
  (a) To the extent allowed by federal law, the executive commissioner may adopt rules allowing the commission to permit, facilitate, and implement the use of...
• Texas Section 32.251 - Definitions
  In this subchapter: (1) "Approved plan" means a long-term care benefit plan that is approved by the Texas Department of Insurance under Subchapter C, Chapter...
• Texas Section 32.252 - Partnership For Long-term Care Program
  The partnership for long-term care program is administered as part of the medical assistance program by the commission with the assistance of the Texas Department...
• Texas Section 32.253 - Asset Disregard
  (a) To the extent allowed by the federal Deficit Reduction Act of 2005 (Pub. L. No. 109-171) and other federal law, the executive commissioner, in...
• Texas Section 32.254 - Reciprocal Agreements
  The commission may enter into reciprocal agreements with other states to extend asset protection to a resident of this state who purchased a long-term care...
• Texas Section 32.255 - Training; Information And Technical Assistance
  The commission shall provide information and technical assistance to the Texas Department of Insurance regarding that department's role in ensuring that each individual who sells...
• Texas Section 32.256 - Rules
  (a) The executive commissioner shall adopt rules as necessary to administer the partnership for long-term care program and to implement this subchapter. (b) In adopting...

Last modified: September 28, 2016