Sec. 533.0061. PROVIDER ACCESS STANDARDS; REPORT. (a) The commission shall establish minimum provider access standards for the provider network of a managed care organization that contracts with the commission to provide health care services to recipients. The access standards must ensure that a managed care organization provides recipients sufficient access to:
(1) preventive care;
(2) primary care;
(3) specialty care;
(4) after-hours urgent care;
(5) chronic care;
(6) long-term services and supports;
(7) nursing services;
(8) therapy services, including services provided in a clinical setting or in a home or community-based setting; and
(9) any other services identified by the commission.
(b) To the extent it is feasible, the provider access standards established under this section must:
(1) distinguish between access to providers in urban and rural settings; and
(2) consider the number and geographic distribution of Medicaid-enrolled providers in a particular service delivery area.
(c) The commission shall biennially submit to the legislature and make available to the public a report containing information and statistics about recipient access to providers through the provider networks of the managed care organizations and managed care organization compliance with contractual obligations related to provider access standards established under this section. The report must contain:
(1) a compilation and analysis of information submitted to the commission under Section 533.005(a)(20)(D);
(2) for both primary care providers and specialty providers, information on provider-to-recipient ratios in an organization's provider network, as well as benchmark ratios to indicate whether deficiencies exist in a given network; and
(3) a description of, and analysis of the results from, the commission's monitoring process established under Section 533.007(l).
Added by Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 5, eff. September 1, 2015.
Section: Previous 533.0051 533.00511 533.0052 533.0053 533.0055 533.006 533.0061 533.0062 533.0063 533.0064 533.0066 533.007 533.0071 533.0072 NextLast modified: September 28, 2016