SUBCHAPTER A GENERAL PROVISIONS; ORGANIZATION OF COMMISSION
- Texas Section 531.001 - Definitions
In this subtitle: (1) "Caseload standards" means the minimum and maximum number of cases that an employee can reasonably be expected to perform in a...
- Texas Section 531.0011 - References In Law Meaning Commission Or Appropriate Division
(a) In this code or in any other law, a reference to any of the following state agencies or entities in relation to a function...
- Texas Section 531.0012 - References In Law Meaning Executive Commissioner Or Designee
(a) In this code or in any other law, a reference to any of the following persons in relation to a function transferred to the...
- Texas Section 531.002 - Health And Human Services Commission; Responsibility
(a) The Health and Human Services Commission is an agency of the state. (b) The commission is the state agency with primary responsibility for ensuring...
- Texas Section 531.0025 - Restrictions On Awards To Family Planning Service Providers
(a) Notwithstanding any other law, money appropriated to the Department of State Health Services for the purpose of providing family planning services must be awarded:...
- Texas Section 531.003 - Goals
The commission's goals are to: (1) maximize federal funds through the efficient use of available state and local resources; (2) provide a system that delivers...
- Texas Section 531.004 - Sunset Provision
The Health and Human Services Commission is subject to Chapter 325 (Texas Sunset Act). Unless continued in existence as provided by that chapter, the commission...
- Texas Section 531.005 - Executive Commissioner
(a) The commission is governed by an executive commissioner appointed by the governor with the advice and consent of the senate. (b) The executive commissioner...
- Texas Section 531.0051 - Health And Human Services Commission Executive Council
(a) The Health and Human Services Commission Executive Council is established to receive public input and advise the executive commissioner regarding the operation of the...
- Texas Section 531.0055 - Executive Commissioner: General Responsibility For Health And Human Services System
(a) In this section and in Section 531.0056, "agency director" means the commissioner of a health and human services agency. (b) The commission shall: (1)...
- Texas Section 531.00551 - Procedures For Adopting Rules And Policies
(a) The executive commissioner shall develop procedures for adopting rules for the health and human services agencies. The procedures must specify the manner in which...
- Texas Section 531.00552 - Consolidated Internal Audit Program
(a) Notwithstanding Section 2102.005, the commission shall operate the internal audit program required under Chapter 2102 for the commission and each health and human services...
- Texas Section 531.00553 - Criminal Background Checks
(a) In this section, "eligible person" means a person whose criminal history record information the executive commissioner, or the executive commissioner's designee, is entitled to...
- Texas Section 531.00553 - Administrative Support Services
(a) In this section, the term "administrative support services" includes strategic planning and evaluation, audit, legal, human resources, information resources, purchasing, contracting, financial management, and...
- Texas Section 531.0056 - Appointment Of Agency Director By Executive Commissioner
(a) The executive commissioner shall appoint an agency director for each health and human services agency with the approval of the governor. (b) An agency...
- Texas Section 531.00561 - Appointment And Qualifications Of Division Directors
(a) The executive commissioner shall appoint a director for each division established within the commission under Section 531.008, except that the director of the office...
- Texas Section 531.00562 - Division Director Duties
(a) The executive commissioner shall clearly define the duties and responsibilities of a division director and develop clear policies for the delegation of specific decision-making...
- Texas Section 531.0057 - Medical Transportation Services
(a) The commission shall provide medical transportation services for clients of eligible health and human services programs. (b) The commission may contract with any public...
- Texas Section 531.006 - Eligibility For Appointment As Executive Commissioner; Employee Restrictions
(a) In this section, "Texas trade association" means a cooperative and voluntarily joined statewide association of business or professional competitors in this state designed to...
- Texas Section 531.007 - Term
The executive commissioner serves a two-year term expiring February 1 of each odd-numbered year. Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff....
- Texas Section 531.008 - Divisions Of Commission
(a) The executive commissioner shall establish divisions within the commission along functional lines as necessary for effective administration and for the discharge of the commission's...
- Texas Section 531.0081 - Medical Technology
(b) The commission shall explore and evaluate new developments in medical technology and propose implementing the technology in Medicaid, if appropriate and cost-effective. (c)...
- Texas Section 531.0082 - Data Analysis Unit
(a) The executive commissioner shall establish a data analysis unit within the commission to establish, employ, and oversee data analysis processes designed to: (1) improve...
- Texas Section 531.0083 - Office Of Policy And Performance
(a) In this section, "office" means the office of policy and performance established by this section. (b) The executive commissioner shall establish the office of...
- Texas Section 531.009 - Personnel
(a) The executive commissioner shall employ a medical director to provide medical expertise to the executive commissioner and the commission and may employ other personnel...
- Texas Section 531.010 - Merit System
(a) The commission may establish a merit system for its employees. (b) The merit system may be maintained in conjunction with other state agencies that...
- Texas Section 531.011 - Public Input Information And Complaints
(a) The commission shall develop and implement policies that provide the public a reasonable opportunity to appear before the commission and to speak on any...
- Texas Section 531.012 - Advisory Committees
Sec. 531.012. ADVISORY COMMITTEES. Text of subsection as amended by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.02 (a) The executive commissioner...
- Texas Section 531.0121 - Public Access To Advisory Committee Meetings
(a) This section applies to an advisory committee established under Section 531.012. (b) The commission shall create a master calendar that includes all advisory committee...
- Texas Section 531.013 - Electronic Availability Of Technical Assistance
(a) Health and human services agencies shall, in conjunction with the Department of Information Resources, coordinate and enhance their existing Internet sites to provide technical...
- Texas Section 531.014 - Consolidation Of Reports
The commission may consolidate any annual or biennial reports required to be made under this chapter or another law if: (1) the consolidated report is...
- Texas Section 531.0141 - Report To Secretary Of State
(a) In this section, "colonia" means a geographic area that: (1) is an economically distressed area as defined by Section 17.921, Water Code; (2) is...
- Texas Section 531.015 - New Facilities In Certain Counties
A health and human services agency is prohibited from establishing a new facility in a county with a population of less than 200,000 until the...
- Texas Section 531.0161 - Negotiated Rulemaking And Alternative Dispute Procedures
(a) The commission shall develop and implement a policy, for the commission and each health and human services agency, to encourage the use of: (1)...
- Texas Section 531.0162 - Use Of Technology
(a) The commission shall develop and implement a policy requiring the agency commissioner and employees of each health and human services agency to research and...
- Texas Section 531.0163 - Memorandum Of Understanding
(a) The memorandum of understanding under Section 531.0055(k) must be adopted by the executive commissioner by rule in accordance with the procedures prescribed by Subchapter...
- Texas Section 531.0164 - Health And Human Services System Internet Website Coordination
The commission shall establish a process to ensure Internet websites across the health and human services system are developed and maintained according to standard criteria...
- Texas Section 531.017 - Purchasing Unit
(a) The commission shall establish a purchasing unit for the management of administrative activities related to the purchasing functions within the health and human services...
- Texas Section 531.0171 - Office Of Ombudsman
(a) The executive commissioner shall establish the commission's office of the ombudsman with authority and responsibility over the health and human services system in performing...
- Texas Section 531.018 - Certain Contracts For Health Care Purposes; Review By Attorney General
(a) This section applies to any contract with a contract amount of $250 million or more: (1) under which a person provides goods or services...
- Texas Section 531.019 - Administrative And Judicial Review Of Certain Decisions
(a) In this section, "public assistance benefits" means benefits provided under a public assistance program under Chapter 31, 32, or 33, Human Resources Code. (b)...
- Texas Section 531.0191 - Services Provided By Contractor To Persons With Limited English Proficiency
(a) Each contract with the commission or a health and human services agency that requires the provision of call center services or written communications related...
- Texas Section 531.0192 - Health And Human Services System Hotline And Call Center Coordination
(a) The commission shall establish a process to ensure all health and human services system hotlines and call centers are necessary and appropriate. Under the...
SUBCHAPTER A-1 CONSOLIDATION OF HEALTH AND HUMAN SERVICES SYSTEM
- Texas Section 531.020 - Office Of Community Access And Services
The executive commissioner shall establish within the commission an office of community access and services. The office is responsible for: (1) collaborating with community, state,...
- Texas Section 531.02001 - Consolidation Of Health And Human Services System Generally
In accordance with this subchapter, the functions of the health and human services system described under Sections 531.0201, 531.02011, and 531.02012 are consolidated through a...
- Texas Section 531.02002 - Meaning Of Function In Relation To Transfers
For purposes of the transfers mandated by this subchapter, "function" includes a power, duty, program, or activity of a state agency or entity. Added by...
- Texas Section 531.0201 - Phase One: Initial Transfers
(a) On the dates specified in the transition plan required under Section 531.0204, the following functions are transferred to the commission as provided by this...
- Texas Section 531.02011 - Phase Two: Final Transfers To Commission
On the dates specified in the transition plan required under Section 531.0204, the following functions are transferred to the commission as provided by this subchapter:...
- Texas Section 531.02012 - Transfer And Consolidation Of Administrative Support Services Functions
(a) In this section, "administrative support services" has the meaning assigned under Section 531.00553. (b) As soon as practicable after the first day of the...
- Texas Section 531.02013 - Functions Remaining With Certain Agencies
The following functions are not subject to transfer under Sections 531.0201 and 531.02011: (1) the functions of the Department of Family and Protective Services, including...
- Texas Section 531.02014 - Related Transfers; Effect Of Consolidation
(a) All of the following that relate to a function that is transferred under Section 531.0201, 531.02011, or 531.02012 are transferred to the commission or...
- Texas Section 531.0202 - Abolition Of State Agencies And Entities; Effect Of Transfers
(a) Each of the following state agencies and entities is abolished on a date that is within the period prescribed by Section 531.02001(1), that is...
- Texas Section 531.0203 - Health And Human Services Transition Legislative Oversight Committee
(a) In this section, "committee" means the Health and Human Services Transition Legislative Oversight Committee established under this section. (b) The Health and Human Services...
- Texas Section 531.02031 - Study On Continuing Need For Certain State Agencies
(a) Not later than September 1, 2018, the executive commissioner shall conduct a study and submit a report and recommendation to the Health and Human...
- Texas Section 531.0204 - Transition Plan For Implementation Of Consolidation
(a) The transfers of functions under Sections 531.0201, 531.02011, and 531.02012 must be accomplished in accordance with a transition plan developed by the executive commissioner...
- Texas Section 531.02041 - Required Reports After Transition Plan Submission
If, at any time after the executive commissioner submits the transition plan in accordance with Section 531.0204(e), the executive commissioner proposes to make a substantial...
- Texas Section 531.0205 - Applicability Of Former Law
An action brought or proceeding commenced before the date of a transfer prescribed by this subchapter in accordance with the transition plan required under Section...
- Texas Section 531.0206 - Limited-scope Sunset Review
(a) The Sunset Advisory Commission shall conduct a limited-scope review of the commission during the state fiscal biennium ending August 31, 2023, in the manner...
SUBCHAPTER B POWERS AND DUTIES
- Texas Section 531.0207 - Expiration Of Subchapter
This subchapter expires September 1, 2023. Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 1.01(a), eff. September 1, 2015.
- Texas Section 531.021 - Administration Of Medicaid
(a) The commission is the state agency designated to administer federal Medicaid funds. (b) The commission shall: (1) plan and direct Medicaid in each agency...
- Texas Section 531.0211 - Managed Care Medicaid Program: Rules; Education Programs
(a) In adopting rules to implement a managed care Medicaid program, the executive commissioner shall establish guidelines for, and require managed care organizations to provide,...
- Texas Section 531.02111 - Biennial Medicaid Financial Report
(a) The commission shall prepare a biennial Medicaid financial report covering each state agency that operates any part of Medicaid and each component of Medicaid...
- Texas Section 531.02112 - Quarterly Report Of Medicaid Expenditures
Sec. 531.02112. QUARTERLY REPORT OF MEDICAID EXPENDITURES. Without reference to the amendment of this subsection, this section was repealed by Acts 2015, 84th Leg., R.S.,...
- Texas Section 531.02113 - Optimization Of Medicaid Financing
The commission shall ensure that the Medicaid finance system is optimized to: (1) maximize the state's receipt of federal funds; (2) create incentives for providers...
- Texas Section 531.02114 - Dental Director
The executive commissioner shall appoint for Medicaid a dental director who is a licensed dentist under Subtitle D, Title 3, Occupations Code, and rules adopted...
- Texas Section 531.02115 - Marketing Activities By Providers Participating In Medicaid Or Child Health Plan Program
(a) A provider participating in Medicaid or the child health plan program, including a provider participating in the network of a managed care organization that...
- Texas Section 531.02118 - Streamlining Medicaid Provider Enrollment And Credentialing Processes
(a) The commission shall streamline provider enrollment and credentialing processes under Medicaid. (b) In streamlining the Medicaid provider enrollment process, the commission shall establish a...
- Texas Section 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...
- Texas Section 531.0213 - Support Services For Medicaid Recipients
(a) The commission shall provide support and information services to a person enrolled in or applying for Medicaid coverage who experiences barriers to receiving health...
- Texas Section 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...
- Texas Section 531.02141 - Medicaid Information Collection And Analysis
(a) The commission shall make every effort to improve data analysis and integrate available information associated with Medicaid. The commission shall use the decision support...
- Texas Section 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...
- Texas Section 531.0216 - Participation And Reimbursement Of Telemedicine Medical Service Providers And Telehealth Service Providers Under Medicaid
(a) The executive commissioner by rule shall develop and implement a system to reimburse providers of services under Medicaid for services performed using telemedicine medical...
- Texas Section 531.02161 - Telemedicine, Telehealth, And Home Telemonitoring Technology Standards
(b) The executive commissioner by rule shall establish and adopt minimum standards for an operating system used in the provision of telemedicine medical services, telehealth...
- Texas Section 531.02162 - Medicaid Services Provided Through Telemedicine Medical 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...
- Texas Section 531.02163 - Telepresenters
(a) In this section, "health professional" means an individual who: (1) is licensed or certified in this state to perform health care services; and (2)...
- Texas Section 531.02164 - Medicaid Services Provided Through Home Telemonitoring Services
(a) In this section: (1) "Home and community support services agency" means a person licensed under Chapter 142, Health and Safety Code, to provide home...
- Texas Section 531.0217 - Reimbursement For Certain Medical Consultations
(a) In this section: (1) "Health professional" means: (A) a physician; (B) an individual who is: (i) licensed or certified in this state to perform...
- Texas Section 531.02173 - Alignment Of Medicaid Telemedicine Reimbursement Policies With Medicare Reimbursement Policies
(a) The commission shall periodically review policies regarding reimbursement under Medicaid for telemedicine medical services to identify variations between permissible reimbursement under that program and...
- Texas Section 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...
- Texas Section 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...
- Texas Section 531.02176 - Expiration Of Medicaid Reimbursement For Provision Of Home Telemonitoring Services
Notwithstanding any other law, the commission may not reimburse providers under Medicaid for the provision of home telemonitoring services on or after September 1, 2019....
- Texas Section 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...
- Texas Section 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;...
- Texas Section 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...
- Texas Section 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...
- Texas Section 531.022 - Coordinated Strategic Plan For Health And Human Services
(a) The executive commissioner shall develop a coordinated, six-year strategic plan for health and human services in this state and shall update the plan biennially....
- Texas Section 531.02221 - Women's Health Advisory Committee
(a) The executive commissioner shall establish a women's health advisory committee to provide recommendations to the commission on the consolidation of women's health programs. (b)...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 531.0235 - Biennial Disability Reports
(a) The executive commissioner shall direct and require the Texas Council for Developmental Disabilities and the Office for the Prevention of Developmental Disabilities to prepare...
- Texas Section 531.024 - Planning And Delivery Of Health And Human Services; Data Sharing
(a) The executive commissioner shall: (1) facilitate and enforce coordinated planning and delivery of health and human services, including: (A) compliance with the coordinated strategic...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 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...
- Texas Section 531.02413 - Billing Coordination System
(a) If cost-effective and feasible, the commission shall, on or before March 1, 2008, contract through an existing procurement process for the implementation of an...
- Texas Section 531.024131 - Expansion Of Billing Coordination And Information Collection Activities
(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...
- Texas Section 531.02414 - Administration And Operation Of Medical Transportation Program
(a) In this section: (2) "Regional contracted broker" means an entity that contracts with the commission to provide or arrange for the provision of nonemergency...
- Texas Section 531.02415 - Electronic Eligibility Information Pilot Project
(a) The commission shall establish a pilot project in at least one urban area of this state to determine the feasibility, costs, and benefits of...
- Texas Section 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...
- Texas Section 531.02417 - Medicaid Nursing Services Assessments
(a) In this section, "acute nursing services" means home health skilled nursing services, home health aide services, and private duty nursing services. (b) If cost-effective,...
- Texas Section 531.024171 - Therapy Services Assessments
(a) In this section, "therapy services" includes occupational, physical, and speech therapy services. (b) After implementing the objective assessment process for acute nursing services in...
- Texas Section 531.024172 - Electronic Visit Verification System
(a) In this section, "acute nursing services" has the meaning assigned by Section 531.02417. (b) If it is cost-effective and feasible, the commission shall implement...
- Texas Section 531.02418 - Medicaid And Child Health Plan Program Eligibility Determinations For Certain Individuals
(a) The commission shall enter into a memorandum of understanding with the Texas Juvenile Justice Department to ensure that each individual who is committed, placed,...
- Texas Section 531.024181 - Verification Of Immigration Status Of Applicants For Certain Benefits Who Are Qualified Aliens
(a) This section applies only with respect to the following benefits programs: (1) the child health plan program under Chapter 62, Health and Safety Code;...
- Texas Section 531.024182 - Verification Of Sponsorship Information For Certain Benefits Recipients; Reimbursement
(a) In this section, "sponsored alien" means a person who has been lawfully admitted to the United States for permanent residence under the Immigration and...
- Texas Section 531.0242 - Use Of Agency Staff
To the extent requested by the commission, a health and human services agency shall assign existing staff to perform a function imposed under this chapter....
- Texas Section 531.0244 - Ensuring Appropriate Care Setting For Persons With Disabilities
(a) The commission and appropriate health and human services agencies shall implement a comprehensive, effectively working plan that provides a system of services and support...
- Texas Section 531.02441 - Interagency Task Force On Ensuring Appropriate Care Settings For Persons With Disabilities
(a) The executive commissioner shall establish an interagency task force to assist the commission and appropriate health and human services agencies in developing a comprehensive,...
- Texas Section 531.02442 - Community Living Options Information Process For Certain Persons With An Intellectual Disability
(a) In this section: (1) "Department" means the Department of Aging and Disability Services. (1-a) "Institution" means: (A) a residential care facility operated or maintained...
- Texas Section 531.02443 - Implementation Of Community Living Options Information Process At State Institutions For Certain Adult Residents
(a) In this section: (1) "Adult resident" means a person with an intellectual disability who: (A) is at least 22 years of age; and (B)...
- Texas Section 531.02444 - Medicaid Buy-in Programs For Certain Persons With Disabilities
(a) The executive commissioner shall develop and implement: (1) a Medicaid buy-in program for persons with disabilities as authorized by the Ticket to Work and...
- Texas Section 531.02445 - Transition Services For Youth With Disabilities
(a) The executive commissioner shall monitor programs and services offered through health and human services agencies designed to assist youth with disabilities to transition from...
- Texas Section 531.02447 - Employment-first Policy
(a) It is the policy of the state that earning a living wage through competitive employment in the general workforce is the priority and preferred...
- Texas Section 531.02448 - Employment-first Task Force
(a) The executive commissioner shall establish an interagency employment-first task force, or may use an existing committee or task force, to promote competitive employment of...
- Texas Section 531.0245 - Permanency Planning For Certain Children
(a) The commission and each appropriate health and human services agency shall develop procedures to ensure that permanency planning is provided for each child residing...
- Texas Section 531.0246 - Regional Management Of Health And Human Services Agencies
(a) The commission may require a health and human services agency, under the direction of the commission, to: (1) ensure that the agency's location is...
- Texas Section 531.0247 - Annual Business Plan
The commission shall develop and implement an annual business services plan for each health and human services region that establishes performance objectives for all health...
- Texas Section 531.0248 - Community-based Support Systems
(a) Subject to Section 531.0055(d), the commission shall assist communities in this state in developing comprehensive, community-based support systems for health and human services. At...
- Texas Section 531.02481 - Community-based Support And Service Delivery Systems For Long-term Care Services
(a) The commission and the Department of Aging and Disability Services shall assist communities in this state in developing comprehensive, community-based support and service delivery...
- Texas Section 531.02482 - Faith- And Community-based Organization Support For Certain Persons Receiving Public Assistance
(a) In this section, "community-based organization" and "faith-based organization" have the meanings assigned by Section 535.001. (b) The commission shall establish a program under which...
- Texas Section 531.02491 - Joint Training For Certain Caseworkers
(a) The executive commissioner shall provide for joint training for health and human services caseworkers whose clients are children, including caseworkers employed by: (1) the...
- Texas Section 531.02492 - Delivery Of Health And Human Services To Young Texans
(b) The commission shall electronically publish on the commission's Internet website a biennial report and, on or before the date the report is due,...
- Texas Section 531.025 - Statewide Needs Appraisal Project
(a) The commission may implement the Statewide Needs Appraisal Project to obtain county-specific demographic data concerning health and human services needs in this state. Any...
- Texas Section 531.026 - Consolidated Budget Recommendation
(a) The commission shall prepare and submit to the Legislative Budget Board and the governor a consolidated health and human services budget recommendation not later...
- Texas Section 531.027 - Appropriations Request By Agencies
(a) Each health and human services agency shall submit to the commission a biennial agency legislative appropriations request on a date to be determined by...
- Texas Section 531.0271 - Health And Human Services Agencies Operating Budgets
The commission may, within the limits established by and subject to the General Appropriations Act, transfer amounts appropriated to health and human services agencies among...
- Texas Section 531.0273 - Information Resources Planning And Management
(a) The commission is responsible for strategic planning for information resources at each health and human services agency and shall direct the management of information...
- Texas Section 531.02731 - Report Of Information Resources Manager To Commission
Notwithstanding Section 2054.075(b), the information resources manager of a health and human services agency shall report directly to the executive commissioner or a deputy executive...
- Texas Section 531.0274 - Coordination And Approval Of Caseload Estimates
(a) The commission shall coordinate and approve caseload estimates made for programs administered by health and human services agencies. (b) To implement this section, the...
- Texas Section 531.028 - Monitoring And Effective Management Of Funds
(a) The commission, within the limits established by and subject to the General Appropriations Act, shall be responsible for planning for, and managing the use...
- Texas Section 531.031 - Management Information And Cost Accounting System
The executive commissioner shall establish a management information system and a cost accounting system for all health and human services that is compatible with and...
- Texas Section 531.0312 - Texas Information And Referral Network
(a) The Texas Information and Referral Network at the commission is the program responsible for the development, coordination, and implementation of a statewide information and...
- Texas Section 531.0313 - Electronic Access To Health And Human Services Referral Information
(a) The Texas Information and Referral Network may develop an Internet site to provide information to the public regarding the health and human services provided...
- Texas Section 531.03131 - Electronic Access To Child-care And Education Services Referral Information
(a) In this section, "child-care and education services" means: (1) subsidized child-care services administered by the Texas Workforce Commission and local workforce development boards and...
- Texas Section 531.03132 - Electronic Access To Referral Information About Housing Options For Persons With Mental Illness
(a) The commission shall make available through the Texas Information and Referral Network Internet site established under Section 531.0313 information regarding housing options for persons...
- Texas Section 531.0315 - Implementing National Electronic Data Interchange Standards For Health Care Information
(a) Each health and human services agency and every other state agency that acts as a health care provider or a claims payer for the...
- Texas Section 531.0317 - Health And Human Services Information Made Available Through The Internet
(a) In this section, "Internet" means the largest nonproprietary, nonprofit cooperative public computer network, popularly known as the Internet. (b) The commission, in cooperation with...
- Texas Section 531.0318 - Long-term Care Consumer Information Made Available Through The Internet
(a) The Internet site maintained under Section 531.0317 must include information for consumers concerning long-term care services that complies with this section. The Internet site...
- Texas Section 531.032 - Application Of Other Laws
The commission is subject to Chapters 2001 and 2002. Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept. 1, 1995.
- Texas Section 531.033 - Rules
The executive commissioner shall adopt rules necessary to carry out the commission's duties under this chapter. Added by Acts 1995, 74th Leg., ch. 76, Sec....
- Texas Section 531.0335 - Prohibition On Punitive Action For Failure To Immunize
(a) In this section: (1) "Person responsible for a child's care, custody, or welfare" has the meaning assigned by Section 261.001, Family Code. (2) "Punitive...
- Texas Section 531.035 - Dispute Arbitration
The executive commissioner shall arbitrate and render the final decision on interagency disputes. Added by Acts 1995, 74th Leg., ch. 76, Sec. 8.002(a), eff. Sept....
- Texas Section 531.036 - Public Hearings
(a) The commission biennially shall conduct a series of public hearings in diverse locations throughout the state to give citizens of the state an opportunity...
- Texas Section 531.037 - Notice Of Public Hearings
(a) In addition to the notice required by Chapter 551, the commission shall: (1) provide written notification to public officials in the affected area; and...
- Texas Section 531.038 - Gifts And Grants
The commission may accept a gift or grant from a public or private source to perform any of the commission's powers or duties. Added by...
- Texas Section 531.0381 - Certain Gifts And Grants To Health And Human Services Agencies
(a) Subject to this section, a health and human services agency may accept a gift or grant of money, drugs, equipment, or any other item...
- Texas Section 531.039 - Contracts
The commission may enter into contracts as necessary to perform any of the commission's powers or duties. Added by Acts 1995, 74th Leg., ch. 76,...
- Texas Section 531.0391 - Subrogation And Third-party Reimbursement Collection Contract
(a) The commission shall enter into a contract under which the contractor is authorized on behalf of the commission or a health and human services...
- Texas Section 531.0392 - Recovery Of Certain Third-party Reimbursements Under Medicaid
(a) In this section, "dually eligible individual" means an individual who is eligible to receive health care benefits under both Medicaid and the Medicare program....
- Texas Section 531.040 - Reference Guide; Dictionary
(a) The commission shall publish a biennial reference guide describing available public health and human services in this state and shall make the guide available...
- Texas Section 531.041 - General Powers And Duties
The executive commissioner and the commission have all the powers and duties necessary to administer this chapter. Added by Acts 1995, 74th Leg., ch. 76,...
- Texas Section 531.0411 - Rules Regarding Refugee Resettlement
(a) In this section, "local resettlement agency" and "national voluntary agency" have the meanings assigned by 45 C.F.R. Section 400.2. (b) The executive commissioner shall...
- Texas Section 531.042 - Information And Assistance Regarding Care And Support Options
(a) The executive commissioner by rule shall require each health and human services agency to provide to each patient or client of the agency and...
- Texas Section 531.043 - Long-term Care Vision
(a) In conjunction with the appropriate state agencies, the executive commissioner shall develop a plan for access to individualized long-term care services for persons with...
- Texas Section 531.044 - Financial Assistance Recipients Eligible For Federal Programs
The commission shall assist recipients of financial assistance under Chapter 31, Human Resources Code, who are eligible for assistance under federal programs to apply for...
- Texas Section 531.047 - Substitute Care Provider Outcome Standards
(a) The executive commissioner, after consulting with representatives from the Department of Family and Protective Services, the Texas Juvenile Justice Department, the Department of Aging...
- Texas Section 531.048 - Caseload Standards
(a) The executive commissioner may establish caseload standards and other standards relating to caseloads for each category of caseworker employed by the Department of Family...
- Texas Section 531.050 - Minimum Collection Goal
(a) Before August 31 of each year, the executive commissioner by rule shall set a minimum goal for the commission that specifies the percentage of...
- Texas Section 531.051 - Consumer Direction Of Certain Services For Persons With Disabilities And Elderly Persons
(a) In this section: (1) "Consumer" means a person who receives services through a consumer direction model established by the commission under this section. (2)...
- Texas Section 531.0515 - Risk Management Criteria For Certain Waiver Programs
(a) In this section, "legally authorized representative" has the meaning assigned by Section 531.051. (b) The commission shall consider developing risk management criteria under home...
- Texas Section 531.053 - Leases And Subleases Of Certain Office Space
(a) A health and human services agency, with the approval of the commission, or the Texas Workforce Commission or any other state agency that administers...
- Texas Section 531.054 - Assumption Of Leases For Implementations Of Integrated Enrollment Services Initiative
(a) A health and human services agency, with the approval of the commission, or the Texas Workforce Commission or any other state agency that administers...
- Texas Section 531.055 - Memorandum Of Understanding On Services For Persons Needing Multiagency Services
(a) Each health and human services agency, the Texas Correctional Office on Offenders with Medical or Mental Impairments, the Texas Department of Criminal Justice, the...
- Texas Section 531.056 - Review Of Survey Process In Certain Institutions And Facilities
(a) The commission shall adopt procedures to review: (1) citations or penalties assessed for a violation of a rule or law against an institution or...
- Texas Section 531.057 - Volunteer Advocate Program For The Elderly
(a) In this section: (1) "Designated caregiver" means: (A) a person designated as a caregiver by an elderly individual receiving services from or under the...
- Texas Section 531.058 - Informal Dispute Resolution For Certain Long-term Care Facilities
(a) The executive commissioner by rule shall establish an informal dispute resolution process in accordance with this section. The process must provide for adjudication by...
- Texas Section 531.059 - Voucher Program For Transitional Living Assistance For Persons With Disabilities
(a) In this section: (1) "Institutional housing" means: (A) an ICF-IID, as defined by Section 531.002, Health and Safety Code; (B) a nursing facility; (C)...
- Texas Section 531.060 - Family-based Alternatives For Children
(a) The purpose of the system of family-based alternatives required by this section is to further the state's policy of providing for a child's basic...
- Texas Section 531.061 - Participation By Fathers
(a) The commission and each health and human services agency shall periodically examine commission or agency policies and procedures to determine if the policies and...
- Texas Section 531.062 - Pilot Projects Relating To Technology Applications
(a) Notwithstanding any other law, the commission may establish one or more pilot projects through which reimbursement under Medicaid is made to demonstrate the applications...
- Texas Section 531.063 - Call Centers
(a) The executive commissioner by rule shall establish at least one but not more than four call centers for purposes of determining and certifying or...
- Texas Section 531.064 - Vaccines For Children Program Provider Enrollment And Reimbursement
(a) In this section, "vaccines for children program" means the program operated by the Department of State Health Services under authority of 42 U.S.C. Section...
- Texas Section 531.066 - Participation Of Diagnostic Laboratory Service Providers In Certain Programs
Notwithstanding any other law, a diagnostic laboratory may participate as an in-state provider under any program administered by a health and human services agency or...
- Texas Section 531.067 - Program To Improve And Monitor Certain Outcomes Of Recipients Under Child Health Plan Program And Medicaid
The commission may design and implement a program to improve and monitor clinical and functional outcomes of a recipient of services under Medicaid or the...
- Texas Section 531.069 - Periodic Review Of Vendor Drug Program
(a) The commission shall periodically review all purchases made under the vendor drug program to determine the cost-effectiveness of including a component for prescription drug...
- Texas Section 531.0693 - Prescription Drug Use And Expenditure Patterns
(a) The commission shall monitor and analyze prescription drug use and expenditure patterns in Medicaid. The commission shall identify the therapeutic prescription drug classes and...
- Texas Section 531.0694 - Period Of Validity For Prescription
In the rules and standards governing the vendor drug program, the executive commissioner, to the extent allowed by federal law and laws regulating the writing...
- Texas Section 531.0696 - Considerations In Awarding Certain Contracts
The commission may not contract with a managed care organization, including a health maintenance organization, or a pharmacy benefit manager if, in the preceding three...
- Texas Section 531.0697 - Prior Approval And Provider Access To Certain Communications With Certain Recipients
(a) This section applies to: (1) the vendor drug program for Medicaid and the child health plan program; (2) the kidney health care program; (3)...
- Texas Section 531.070 - Supplemental Rebates
(a) In this section: (1) "Labeler" means a person that: (A) has a labeler code from the United States Food and Drug Administration under 21...
- Texas Section 531.071 - Confidentiality Of Information Regarding Drug Rebates, Pricing, And Negotiations
(a) Notwithstanding any other state law, information obtained or maintained by the commission regarding prescription drug rebate negotiations or a supplemental Medicaid or other rebate...
- Texas Section 531.072 - Preferred Drug Lists
(a) In a manner that complies with applicable state and federal law, the commission shall adopt preferred drug lists for the Medicaid vendor drug program...
- Texas Section 531.073 - Prior Authorization For Certain Prescription Drugs
(a) The executive commissioner, in the rules and standards governing the Medicaid vendor drug program and the child health plan program, shall require prior authorization...
- Texas Section 531.0735 - Medicaid Drug Utilization Review Program: Drug Use Reviews And Annual Report
(a) In this section: (1) "Medicaid Drug Utilization Review Program" means the program operated by the vendor drug program to improve the quality of pharmaceutical...
- Texas Section 531.0736 - Drug Utilization Review Board
(a) In this section, "board" means the Drug Utilization Review Board. (b) In addition to performing any other duties required by federal law, the board...
- Texas Section 531.0737 - Drug Utilization Review Board: Conflicts Of Interest
(a) A voting member of the Drug Utilization Review Board may not have a contractual relationship, ownership interest, or other conflict of interest with a...
- Texas Section 531.0741 - Publication Of Information Regarding Commission Decisions On Preferred Drug List Placement
The commission shall publish on the commission's Internet website any decisions on preferred drug list placement, including: (1) a list of drugs reviewed and the...
- Texas Section 531.075 - Prior Authorization For High-cost Medical Services
The commission may evaluate and implement, as appropriate, procedures, policies, and methodologies to require prior authorization for high-cost medical services and procedures and may contract...
- Texas Section 531.076 - Review Of Prior Authorization And Utilization Review Processes
(a) The commission shall periodically review in accordance with an established schedule the prior authorization and utilization review processes within the Medicaid fee-for-service delivery model...
- Texas Section 531.077 - Recovery Of Certain Assistance
(a) The executive commissioner shall ensure that Medicaid implements 42 U.S.C. Section 1396p(b)(1). (b) The Medicaid account is an account in the general revenue fund....
- Texas Section 531.078 - Quality Assurance Fees On Certain Waiver Program Services
(a) In this section, "gross receipts" means money received as compensation for services under an intermediate care facility for individuals with an intellectual disability waiver...
- Texas Section 531.079 - Waiver Program Quality Assurance Fee Account
(a) The waiver program quality assurance fee account is a dedicated account in the general revenue fund. The account is exempt from the application of...
- Texas Section 531.080 - Reimbursement Of Waiver Programs
Subject to legislative appropriation and state and federal law, the Department of Aging and Disability Services shall use money from the waiver program quality assurance...
- Texas Section 531.081 - Invalidity; Federal Funds
If any portion of Sections 531.078-531.080 is held invalid by a final order of a court that is not subject to appeal, or if the...
- Texas Section 531.082 - Expiration Of Quality Assurance Fee On Waiver Programs
If Subchapter H, Chapter 252, Health and Safety Code, expires, this section and Sections 531.078-531.081 expire on the same date. Added by Acts 2005, 79th...
- Texas Section 531.083 - Medicaid Long-term Care System
The commission shall ensure that the Medicaid long-term care system provides the broadest array of choices possible for recipients while ensuring that the services are...
- Texas Section 531.084 - Medicaid Long-term Care Cost Containment Strategies
(a) The commission shall make every effort to achieve cost efficiencies within the Medicaid long-term care program. To achieve those efficiencies, the commission shall: (1)...
- Texas Section 531.0841 - Long-term Care Insurance Awareness And Education Campaign
(a) The commission, in consultation with the Department of Aging and Disability Services and the Texas Department of Insurance, shall develop and implement a public...
- Texas Section 531.0843 - Durable Medical Equipment Reuse Program
(a) In this section: (1) "Complex rehabilitation technology equipment" means equipment that is classified as durable medical equipment under the Medicare program on January 1,...
- Texas Section 531.085 - Hospital Emergency Room Use Reduction Initiatives
The commission shall develop and implement a comprehensive plan to reduce the use of hospital emergency room services by recipients under Medicaid. The plan may...
- Texas Section 531.0861 - Physician Incentive Program To Reduce Hospital Emergency Room Use For Non-emergent Conditions
(a) If cost-effective, the executive commissioner by rule shall establish a physician incentive program designed to reduce the use of hospital emergency room services for...
- Texas Section 531.087 - Distribution Of Earned Income Tax Credit Information
(a) The commission shall ensure that educational materials relating to the federal earned income tax credit are provided in accordance with this section to each...
- Texas Section 531.088 - Pooled Funding For Foster Care Preventive Services
(a) The commission and the Department of Family and Protective Services shall develop and implement a plan to combine, to the extent and in the...
- Texas Section 531.089 - Certain Medication For Sex Offenders Prohibited
(a) To the maximum extent allowable under federal law, the commission may not provide sexual performance enhancing medication under the Medicaid vendor drug program or...
- Texas Section 531.090 - Joint Purchasing Of Prescription Drugs And Other Medications
(a) Subject to Subsection (b), the commission and each health and human services agency authorized by the executive commissioner may enter into an agreement with...
- Texas Section 531.091 - Integrated Benefits Issuance
(a) The commission may develop and implement a method to consolidate, to the extent possible, recipient identification and benefits issuance for the commission and health...
- Texas Section 531.092 - Transfer Of Money For Community-based Services
(a) The commission shall quantify the amount of money appropriated by the legislature that would have been spent during the remainder of a state fiscal...
- Texas Section 531.093 - Services For Military Personnel
(a) In this section, "servicemember" has the meaning assigned by Section 161.551, Health and Safety Code. (b) The executive commissioner shall ensure that each health...
- Texas Section 531.0931 - Interest List Or Other Waiting List Rules For Certain Military Members And Their Dependents
(a) In this section, "military member" means a member of the United States military serving in the army, navy, air force, marine corps, or coast...
- Texas Section 531.0941 - Medicaid Health Savings Account Pilot Program
(a) If the commission determines that it is cost-effective and feasible, the commission shall develop and implement a Medicaid health savings account pilot program that...
- Texas Section 531.097 - Tailored Benefit Packages For Certain Categories Of The Medicaid Population
(a) The executive commissioner may seek a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) to develop and, subject...
- Texas Section 531.0971 - Tailored Benefit Packages For Non-medicaid Populations
(a) The commission shall identify state or federal non-Medicaid programs that provide health care services to persons whose health care needs could be met by...
- Texas Section 531.0972 - Pilot Program To Prevent The Spread Of Certain Infectious Or Communicable Diseases
The commission may provide guidance to the local health authority of Bexar County in establishing a pilot program funded by the county to prevent the...
- Texas Section 531.0973 - Deaf-blind With Multiple Disabilities Waiver Program: Career Ladder For Interveners
(a) In this section, "deaf-blind-related course work" means educational courses designed to improve a student's: (1) knowledge of deaf-blindness and its effect on learning; (2)...
- Texas Section 531.0981 - Wellness Screening Program
If cost-effective, the commission may implement a wellness screening program for Medicaid recipients designed to evaluate a recipient's risk for having certain diseases and medical...
- Texas Section 531.099 - Alignment Of Medicaid Diabetic Equipment And Supplies Written Order Procedures With Medicare Diabetic Equipment And Supplies Written Order Procedures
(a) The commission shall review forms and requirements under Medicaid regarding written orders for diabetic equipment and supplies to identify variations between permissible ordering procedures...
- Texas Section 531.0992 - Grant Program For Mental Health Services For Veterans And Their Families
(a) To the extent funds are appropriated to the commission for that purpose, the commission shall establish a grant program for the purpose of supporting...
- Texas Section 531.0994 - Study; Annual Report
(a) The commission, in consultation with the Department of State Health Services, the Texas Medical Board, and the Texas Department of Insurance, shall explore and...
- Texas Section 531.0996 - Pregnancy Medical Home Pilot Program
(a) The commission shall develop and implement a pilot program in Harris County to create pregnancy medical homes that provide coordinated evidence-based maternity care management...
SUBCHAPTER C MEDICAID AND OTHER HEALTH AND HUMAN SERVICES FRAUD, ABUSE, OR OVERCHARGES
- Texas Section 531.0998 - Memorandum Of Understanding Regarding Public Assistance Reporting Information System; Maximization Of Benefits
(a) In this section, "system" means the Public Assistance Reporting Information System (PARIS) operated by the Administration for Children and Families of the United States...
- Texas Section 531.101 - Award For Reporting Medicaid Fraud, Abuse, Or Overcharges
(a) The commission may grant an award to an individual who reports activity that constitutes fraud or abuse of funds in Medicaid or reports overcharges...
- Texas Section 531.1011 - Definitions
For purposes of this subchapter: (1) "Abuse" means: (A) a practice by a provider that is inconsistent with sound fiscal, business, or medical practices and...
- Texas Section 531.102 - Office Of Inspector General
(a) The commission's office of inspector general is responsible for the prevention, detection, audit, inspection, review, and investigation of fraud, waste, and abuse in the...
- Texas Section 531.1021 - Subpoenas
(a) The office of inspector general may issue a subpoena in connection with an investigation conducted by the office. A subpoena may be issued under...
- Texas Section 531.1022 - Peace Officers
(a) The commission's office of inspector general shall employ and commission not more than five peace officers at any given time for the purpose of...
- Texas Section 531.1023 - Compliance With Federal Coding Guidelines
The commission's office of inspector general, including office staff and any third party with which the office contracts to perform coding services, shall comply with...
- Texas Section 531.1024 - Hospital Utilization Reviews And Audits: Provider Education Process
The executive commissioner, in consultation with the office, shall by rule develop a process for the commission's office of inspector general, including office staff and...
- Texas Section 531.1025 - Performance Audits And Coordination Of Audit Activities
(a) Notwithstanding any other law, the commission's office of inspector general may conduct a performance audit of any program or project administered or agreement entered...
- Texas Section 531.103 - Interagency Coordination
(a) The commission, acting through the commission's office of inspector general, and the office of the attorney general shall enter into a memorandum of understanding...
- Texas Section 531.1031 - Duty To Exchange Information
(a) In this section and Sections 531.1032, 531.1033, and 531.1034: (1) "Health care professional" means a person issued a license to engage in a health...
- Texas Section 531.1032 - Office Of Inspector General: Criminal History Record Information Check
(a) The office and each licensing authority that requires the submission of fingerprints for the purpose of conducting a criminal history record information check of...
- Texas Section 531.1033 - Monitoring Of Certain Federal Databases
The office shall routinely check appropriate federal databases, including databases referenced in 42 C.F.R. Section 455.436, to ensure that a person who is excluded from...
- Texas Section 531.1034 - Time To Determine Provider Eligibility; Performance Metrics
(a) Not later than the 10th day after the date the office receives the complete application of a health care professional seeking to participate in...
- Texas Section 531.104 - Assisting Investigations By Attorney General
(a) The commission and the attorney general shall execute a memorandum of understanding under which the commission shall provide investigative support as required to the...
- Texas Section 531.105 - Fraud Detection Training
(a) The commission shall develop and implement a program to provide annual training to contractors who process Medicaid claims and to appropriate staff of the...
- Texas Section 531.106 - Learning Or Neural Network Technology
(a) The commission shall use learning or neural network technology to identify and deter fraud in Medicaid throughout this state. (b) The commission shall contract...
- Texas Section 531.1061 - Fraud Investigation Tracking System
(a) The commission shall use an automated fraud investigation tracking system through the commission's office of inspector general to monitor the progress of an investigation...
- Texas Section 531.1062 - Recovery Monitoring System
(a) The commission shall use an automated recovery monitoring system to monitor the collections process for a settled case of fraud, abuse, or insufficient quality...
- Texas Section 531.108 - Fraud Prevention
(a) The commission's office of inspector general shall compile and disseminate accurate information and statistics relating to: (1) fraud prevention; and (2) post-fraud referrals received...
- Texas Section 531.109 - Selection And Review Of Claims
(a) The commission shall annually select and review a random, statistically valid sample of all claims for reimbursement under Medicaid, including under the vendor drug...
- Texas Section 531.110 - Electronic Data Matching Program
(a) The commission shall conduct electronic data matches for a Medicaid recipient at least quarterly to verify the identity, income, employment status, and other factors...
- Texas Section 531.111 - Fraud Detection Technology
The commission may contract with a contractor who specializes in developing technology capable of identifying patterns of fraud exhibited by Medicaid recipients to: (1) develop...
- Texas Section 531.1112 - Study Concerning Increased Use Of Technology To Strengthen Fraud Detection And Deterrence; Implementation
(a) The commission and the commission's office of inspector general shall jointly study the feasibility of increasing the use of technology to strengthen the detection...
- Texas Section 531.112 - Expunction Of Information Related To Certain Chemical Dependency Diagnoses In Certain Records
(a) In this section: (1) "Chemical dependency" has the meaning assigned by Section 461A.002, Health and Safety Code. (2) "Child" means a person 13 years...
- Texas Section 531.113 - Managed Care Organizations: Special Investigative Units Or Contracts
(a) Each managed care organization that provides or arranges for the provision of health care services to an individual under a government-funded program, including Medicaid...
- Texas Section 531.1131 - Fraud And Abuse Recovery By Certain Persons; Retention Of Recovered Amounts
(a) If a managed care organization's special investigative unit under Section 531.113(a)(1) or the entity with which the managed care organization contracts under Section 531.113(a)(2)...
- Texas Section 531.1132 - Annual Report On Certain Fraud And Abuse Recoveries
Not later than December 1 of each year, the commission shall prepare and submit a report to the legislature relating to the amount of money...
- Texas Section 531.114 - Financial Assistance Fraud
(a) For purposes of establishing or maintaining the eligibility of a person and the person's family for financial assistance under Chapter 31, Human Resources Code,...
- Texas Section 531.115 - Federal Felony Match
The commission shall develop and implement a system to cross-reference data collected for the programs listed under Section 531.008(c) with the list of fugitive felons...
- Texas Section 531.116 - Compliance With Law Prohibiting Solicitation
A provider who furnishes services under Medicaid or the child health plan program is subject to Chapter 102, Occupations Code, and the provider's compliance with...
- Texas Section 531.117 - Recovery Audit Contractors
To the extent required under Section 1902(a)(42), Social Security Act (42 U.S.C. Section 1396a(a)(42)), the commission shall establish a program under which the commission contracts...
- Texas Section 531.118 - Preliminary Investigations Of Allegations Of Fraud Or Abuse And Fraud Referrals
(a) The commission shall maintain a record of all allegations of fraud or abuse against a provider containing the date each allegation was received or...
- Texas Section 531.119 - Website Posting
The commission's office of inspector general shall post on its publicly available website a description in plain English of, and a video explaining, the processes...
- Texas Section 531.120 - Notice And Informal Resolution Of Proposed Recoupment Of Overpayment Or Debt
(a) The commission or the commission's office of inspector general shall provide a provider with written notice of any proposed recoupment of an overpayment or...
- Texas Section 531.1201 - Appeal Of Determination To Recoup Overpayment Or Debt
(a) A provider must request an appeal under this section not later than the 30th day after the date the provider is notified that the...
- Texas Section 531.1202 - Record And Confidentiality Of Informal Resolution Meetings
(a) On the written request of the provider, the commission shall, at no expense to the provider who requested the meeting, provide for an informal...
SUBCHAPTER D PLAN TO SUPPORT GUARDIANSHIPS
- Texas Section 531.1203 - Rights Of And Provision Of Information To Pharmacies Subject To Certain Audits
(a) A pharmacy has a right to request an informal hearing before the commission's appeals division to contest the findings of an audit conducted by...
- Texas Section 531.121 - Definitions
In this subchapter: (1) Repealed by Acts 2015, 84th Leg., R.S., Ch. 837 , Sec. 3.40(a)(7), and Ch. 946 , Sec. 2.37(b)(7), eff. January 1,...
- Texas Section 531.124 - Commission Duties
The commission shall develop and, subject to appropriations, implement a plan to: (1) ensure that each incapacitated individual in this state who needs a guardianship...
SUBCHAPTER D-1 PERMANENCY PLANNING
- Texas Section 531.125 - Grants
(a) The commission in accordance with commission rules may award grants to: (1) a local guardianship program, subject to the requirements of this section; and...
- Texas Section 531.151 - Definitions
In this subchapter: (1) "Child" means a person with a developmental disability who is younger than 22 years of age. (2) "Community resource coordination group"...
- Texas Section 531.152 - Policy Statement
It is the policy of the state to strive to ensure that the basic needs for safety, security, and stability are met for each child...
- Texas Section 531.1521 - Preadmission Information
(a) The executive commissioner by rule shall develop and implement a system by which the Department of Aging and Disability Services ensures that, for each...
- Texas Section 531.153 - Development Of Permanency Plan
(a) To further the policy stated in Section 531.152 and except as provided by Subsection (b), the commission and each appropriate health and human services...
- Texas Section 531.1531 - Assistance With Permanency Planning Efforts
An institution in which a child resides shall assist with providing effective permanency planning for the child by: (1) cooperating with the health and human...
- Texas Section 531.1532 - Interference With Permanency Planning Efforts
An entity that provides information to a child's parent or guardian relating to permanency planning shall refrain from providing the child's parent or guardian with...
- Texas Section 531.1533 - Requirements On Admissions Of Children To Certain Institutions
On the admission of a child to an institution described by Section 531.151(3)(A), (B), or (D), the Department of Aging and Disability Services shall require...
- Texas Section 531.154 - Notification Required
(a) Not later than the third day after the date a child is initially placed in an institution, the institution shall notify: (1) the Department...
- Texas Section 531.155 - Offer Of Services
Each entity receiving notice of the initial placement of a child in an institution under Section 531.154 may contact the child's parent or guardian to...
- Texas Section 531.156 - Designation Of Advocate
(a) The Department of Aging and Disability Services shall designate a person, including a member of a community-based organization, to serve as a volunteer advocate...
- Texas Section 531.157 - Community-based Services
A state agency that receives notice of a child's placement in an institution shall ensure that, on or before the third day after the date...
- Texas Section 531.158 - Local Permanency Planning Sites
The commission shall develop an implementation system that consists initially of four or more local sites and that is designed to coordinate planning for a...
- Texas Section 531.159 - Monitoring Of Permanency Planning Efforts
(a) The commission and each appropriate health and human services agency shall require a person who develops a permanency plan for a child residing in...
- Texas Section 531.1591 - Annual Reauthorization Of Plans Of Care For Certain Children
(a) The executive commissioner shall adopt rules under which the Department of Aging and Disability Services requires a nursing facility in which a child resides...
- Texas Section 531.160 - Inspections
As part of each inspection, survey, or investigation of an institution, including a nursing facility, general residential operation for children with an intellectual disability that...
- Texas Section 531.161 - Access To Records
Each institution in which a child resides shall allow the following to have access to the child's records to assist in complying with the requirements...
- Texas Section 531.162 - Permanency Reporting
(a) For each of the local permanency planning sites, the commission shall develop a reporting system under which each appropriate health and human services agency...
- Texas Section 531.163 - Effect On Other Law
This subchapter does not affect responsibilities imposed by federal or other state law on a physician or other professional. Added by Acts 2001, 77th Leg.,...
- Texas Section 531.164 - Duties Of Certain Institutions
(a) This section applies only to an institution described by Section 531.151(3)(A), (B), or (D). (b) An institution described by Section 531.151(3)(A) or (B) shall...
- Texas Section 531.165 - Search For Parent Or Guardian Of A Child
(a) The Department of Aging and Disability Services shall develop and implement a process by which the department, on receipt of notification under Section 531.164(h)...
- Texas Section 531.166 - Transfer Of Child Between Institutions
(a) This section applies only to an institution described by Section 531.151(3)(A), (B), or (D) in which a child resides. (b) Before transferring a child...
SUBCHAPTER E HEALTH AND HUMAN SERVICES LEGISLATIVE OVERSIGHT
- Texas Section 531.167 - Collection Of Information Regarding Involvement Of Certain Parents And Guardians
(a) The Department of Aging and Disability Services shall collect and maintain aggregate information regarding the involvement of parents and guardians of children residing in...
SUBCHAPTER F TEXAS INTEGRATED ENROLLMENT SERVICES
- Texas Section 531.171 - Committee Duties
(a) The standing or other committees of the house of representatives and the senate that have jurisdiction over the commission and other agencies relating to...
SUBCHAPTER G-1 DEVELOPING LOCAL MENTAL HEALTH SYSTEMS OF CARE FOR CERTAIN CHILDREN
- Texas Section 531.191 - Integrated Eligibility Determination
(a) The commission, subject to the approval of the governor and the Legislative Budget Board, shall develop and implement a plan for the integration of...
- Texas Section 531.251 - Texas System Of Care Framework
(a) In this section: (1) "Minor" means an individual younger than 18 years of age. (2) "Serious emotional disturbance" means a mental, behavioral, or emotional...
- Texas Section 531.255 - Evaluation
The commission shall monitor the implementation of a system of care framework under Section 531.251 and adopt rules as necessary to facilitate or adjust that...
SUBCHAPTER H OFFICE OF HEALTH COORDINATION AND CONSUMER SERVICES
- Texas Section 531.257 - Technical Assistance For Projects
The commission may provide technical assistance to a community that implements a local system of care. Added by Acts 1999, 76th Leg., ch. 446, Sec....
- Texas Section 531.281 - Definition
In this chapter, "office" means the Office of Health Coordination and Consumer Services. Added by Acts 2001, 77th Leg., ch. 103, Sec. 1, eff. Sept....
- Texas Section 531.282 - Office; Staff
(a) The Office of Health Coordination and Consumer Services is an office within the commission. (b) The executive commissioner shall employ staff as needed to...
- Texas Section 531.283 - Goals
The goals of the office are to: (1) promote community support for parents of all children younger than six years of age through an integrated...
- Texas Section 531.284 - Strategic Plan
(a) The office shall create and implement a statewide strategic plan for the delivery of health and human services to children younger than six years...
- Texas Section 531.285 - Powers And Duties
(a) The office shall identify: (1) gaps in early childhood services by functional area and geographical area; (2) state policies, rules, and service procedures that...
SUBCHAPTER I STATE PRESCRIPTION DRUG PROGRAM
- Texas Section 531.287 - Texas Home Visiting Program Trust Fund
(a) The Texas Home Visiting Program trust fund is created as a trust fund outside the treasury with the comptroller and shall be administered by...
- Texas Section 531.301 - Development And Implementation Of State Program; Funding
(a) The commission shall develop and implement a state prescription drug program that operates in the same manner as the vendor drug program operates in...
- Texas Section 531.302 - Rules
(a) The executive commissioner shall adopt all rules necessary for implementation of the state prescription drug program. (b) In adopting rules for the state prescription...
- Texas Section 531.303 - Generic Equivalent Authorized
In adopting rules under the state program, the executive commissioner may require that, unless the practitioner's signature on a prescription clearly indicates that the prescription...
SUBCHAPTER J PROVISION OF INFORMATION ABOUT PATIENT ASSISTANCE PROGRAMS
- Texas Section 531.304 - Program Funding Priorities
If money available for the state prescription drug program is insufficient to provide prescription drug benefits to all persons who are eligible under Section 531.301(b),...
- Texas Section 531.351 - Definition
In this subchapter, "patient assistance program" means a program offered by a pharmaceutical company under which the company provides a drug to persons in need...
- Texas Section 531.352 - Providing Information To Commission
Each pharmaceutical company that does business in this state and that offers a patient assistance program shall inform the commission of the existence of the...
SUBCHAPTER J-1 ASSISTANCE PROGRAM FOR DOMESTIC VICTIMS OF TRAFFICKING
- Texas Section 531.353 - Toll-free Telephone Number
(a) The commission shall establish a system under which members of the public can call a toll-free telephone number to obtain information about available patient...
- Texas Section 531.381 - Definitions
In this subchapter: (1) "Domestic victim" means a victim of trafficking who is a permanent legal resident or citizen of the United States. (2) "Victim...
- Texas Section 531.382 - Victim Assistance Program Established
The commission shall develop and implement a program designed to assist domestic victims, including victims who are children, in accessing necessary services. The program must...
- Texas Section 531.383 - Grant Program
(a) Subject to available funds, the commission shall establish a grant program to award grants to public and nonprofit organizations that provide assistance to domestic...
- Texas Section 531.384 - Training Programs
The commission, with assistance from the Office of Court Administration of the Texas Judicial System, the Department of Public Safety, and local law enforcement agencies,...
SUBCHAPTER K HEALTH AND HUMAN SERVICES COUNCIL
- Texas Section 531.385 - Funding
(a) The commission may use appropriated funds and may accept gifts, grants, and donations from any sources for purposes of the victim assistance program established...
- Texas Section 531.401 - Definition
In this subchapter, "council" means the Health and Human Services Council. Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.08, eff. Sept. 1, 2003....
- Texas Section 531.402 - Health And Human Services Council
(a) The Health and Human Services Council is created to assist the executive commissioner in developing rules and policies for the commission. (b) The council...
- Texas Section 531.403 - Appointments
(a) Appointments to the council shall be made without regard to the race, color, disability, sex, religion, age, or national origin of the appointees. (b)...
- Texas Section 531.404 - Training Program For Council Members
(a) A person who is appointed as a member of the council may not vote, deliberate, or be counted as a member in attendance at...
- Texas Section 531.405 - Terms
(a) Council members serve for staggered six-year terms with the terms of three members expiring February 1 of each odd-numbered year. (b) A member of...
- Texas Section 531.406 - Vacancy
The governor by appointment shall fill the unexpired term of a vacancy on the council. Added by Acts 2003, 78th Leg., ch. 198, Sec. 1.08,...
- Texas Section 531.407 - Presiding Officer; Other Officers; Meetings
(a) The governor shall designate a member of the council as the presiding officer to serve in that capacity at the pleasure of the governor....
- Texas Section 531.408 - Reimbursement For Expenses
A council member may not receive compensation for service as a member of the council but is entitled to reimbursement for travel expenses incurred by...
- Texas Section 531.409 - Public Interest Information And Complaints
(a) The executive commissioner, with the advice of the council, shall prepare information of public interest describing the functions of the commission and the procedures...
- Texas Section 531.410 - Public Access And Testimony
The executive commissioner shall develop and implement policies that provide the public with a reasonable opportunity to appear before the council or executive commissioner and...
SUBCHAPTER L PROVISION OF SERVICES FOR CERTAIN CHILDREN WITH MULTIAGENCY NEEDS
- Texas Section 531.411 - Policymaking And Management Responsibilities
The executive commissioner, with the advice of the council, shall develop and the commission shall implement policies that clearly delineate the policymaking responsibilities of the...
- Texas Section 531.421 - Definitions
In this subchapter: (1) "Children with severe emotional disturbances" includes: (A) children who are at risk of incarceration or placement in a residential mental health...
- Texas Section 531.422 - Evaluations By Community Resource Coordination Groups
(a) Each community resource coordination group shall evaluate the provision of systems of care services in the community that the group serves. Each evaluation must:...
- Texas Section 531.423 - Summary Report By Consortium
(a) The consortium shall create a summary report based on the evaluations in the reports submitted to the consortium by community resource coordination groups under...
SUBCHAPTER M COORDINATION OF QUALITY INITIATIVES
- Texas Section 531.424 - Agency Implementation Of Recommendations
As appropriate, the person or entity responsible for adopting rules for an agency described by Section 531.423(a) shall adopt rules, and the agency shall implement...
- Texas Section 531.451 - Operational Plan To Coordinate Initiatives
(a) The commission shall develop and implement a comprehensive, coordinated operational plan to ensure a consistent approach across the major quality initiatives of the health...
- Texas Section 531.452 - Revision Of Major Initiatives
Notwithstanding any other law, the commission shall revise major quality initiatives of the health and human services system in accordance with the operational plan and...
- Texas Section 531.453 - Incentives For Initiative Coordination
The commission shall consider and, if the commission determines it appropriate, develop incentives that promote coordination among the various major quality initiatives in accordance with...
SUBCHAPTER N TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
- Texas Section 531.454 - Renewal Of Federal Authorization For Medicaid Reform
(a) When the commission seeks to renew the Texas Health Care Transformation and Quality Improvement Program waiver issued under Section 1115 of the federal Social...
- Texas Section 531.501 - Definition
In this subchapter, "fund" means the Texas health opportunity pool trust fund established under Section 531.503. Added by Acts 2007, 80th Leg., R.S., Ch. 268...
- Texas Section 531.502 - Direction To Obtain Federal Waiver
(a) The executive commissioner may seek a waiver under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315) to the state Medicaid...
- Texas Section 531.503 - Establishment Of Texas Health Opportunity Pool Trust Fund
Subject to approval of the waiver authorized by Section 531.502, the Texas health opportunity pool trust fund is created as a trust fund outside the...
- Texas Section 531.504 - Deposits To Fund
(a) The comptroller shall deposit in the fund: (1) federal money provided to this state under the disproportionate share hospitals supplemental payment program or the...
- Texas Section 531.505 - Use Of Fund In General; Rules For Allocation
(a) Except as otherwise provided by the terms of a waiver authorized by Section 531.502, money in the fund may be used: (1) subject to...
- Texas Section 531.506 - Reimbursements For Uncompensated Health Care Costs
(a) Except as otherwise provided by the terms of a waiver authorized by Section 531.502 and subject to Subsections (b) and (c), money in the...
- Texas Section 531.507 - Increasing Access To Health Benefits Coverage
(a) Except as otherwise provided by the terms of a waiver authorized by Section 531.502, money in the fund that is available to reduce the...
SUBCHAPTER O UNCOMPENSATED HOSPITAL CARE
- Texas Section 531.508 - Infrastructure Improvements
(a) Except as otherwise provided by the terms of a waiver authorized by Section 531.502 and subject to Subsection (c), money in the fund may...
SUBCHAPTER S COMMUNITY-BASED NAVIGATOR PROGRAM
- Texas Section 531.551 - Uncompensated Hospital Care Reporting And Analysis
(a) The executive commissioner shall adopt rules providing for: (1) a standard definition of "uncompensated hospital care"; (2) a methodology to be used by hospitals...
- Texas Section 531.751 - Definitions
In this subchapter: (1) "Community-based organization" and "faith-based organization" have the meanings assigned by Section 535.001. (2) "Navigator" means a person who is: (A) a...
- Texas Section 531.752 - Establishment Of Community-based Navigator Program
If the executive commissioner determines that a statewide community-based navigator program can be established and operated using existing resources and without disrupting other commission functions,...
- Texas Section 531.753 - Program Standards
The executive commissioner shall adopt standards to implement this subchapter, including standards: (1) subject to Section 531.754, regarding the qualifications and training required for certification...
- Texas Section 531.754 - Training Program
The commission shall develop and administer a training program for navigators. The program must include training on: (1) how to complete an online application for...
SUBCHAPTER U MORTALITY REVIEW FOR CERTAIN INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY
- Texas Section 531.755 - Publication Of Navigator List
The commission shall maintain and publish on the commission's Internet website a list of certified navigators. Added by Acts 2011, 82nd Leg., R.S., Ch. 537...
- Texas Section 531.8501 - Definition
In this subchapter, "contracted organization" means an entity that contracts with the commission for the provision of services as described by Section 531.851(c). Added by...
- Texas Section 531.851 - Mortality Review
(a) The executive commissioner shall establish an independent mortality review system to review the death of a person with an intellectual or developmental disability who,...
- Texas Section 531.852 - Access To Information
(a) A contracted organization may request information and records regarding a deceased person as necessary to carry out the contracted organization's duties. Records and information...
- Texas Section 531.853 - Mortality Review Report
Subject to Section 531.854, a contracted organization shall submit: (1) to the Department of Aging and Disability Services, the Department of Family and Protective Services,...
- Texas Section 531.854 - Use And Publication Restrictions; Confidentiality
(a) The commission may use or publish information under this subchapter only to advance statewide practices regarding the treatment and care of individuals with an...
SUBCHAPTER V HEALTH INFORMATION EXCHANGE SYSTEMS
- Texas Section 531.855 - Limitation On Liability
A health care provider or other person is not civilly or criminally liable for furnishing information to the contracted organization or to the commission for...
- Texas Section 531.901 - Definitions
In this subchapter: (1) "Electronic health record" means an electronic record of aggregated health-related information concerning a person that conforms to nationally recognized interoperability standards...
- Texas Section 531.903 - Electronic Health Information Exchange System
(a) The commission shall develop an electronic health information exchange system to improve the quality, safety, and efficiency of health care services provided under the...
- Texas Section 531.9051 - Electronic Health Information Exchange System Stage One: Encounter Data
In stage one of implementing the health information exchange system, the commission shall require for purposes of the implementation each managed care organization with which...
- Texas Section 531.906 - Electronic Health Information Exchange System Stage One: Electronic Prescribing
(a) In stage one of implementing the health information exchange system, the commission shall support and coordinate electronic prescribing tools used by health care providers...
- Texas Section 531.907 - Electronic Health Information Exchange System Stage Two: Expansion
(a) Based on feedback provided by interested parties, the commission in stage two of implementing the health information exchange system may expand the system by:...
- Texas Section 531.908 - Electronic Health Information Exchange System Stage Three: Expansion
In stage three of implementing the health information exchange system, the commission may expand the system by: (1) developing evidence-based benchmarking tools that can be...
- Texas Section 531.909 - Incentives
The commission shall develop strategies to encourage health care providers to use the health information exchange system, including incentives, education, and outreach tools to increase...
- Texas Section 531.911 - Rules
The executive commissioner may adopt rules to implement Sections 531.903 through 531.909. Added by Acts 2009, 81st Leg., R.S., Ch. 1120 (H.B. 1218), Sec. 1,...
SUBCHAPTER W ADVERSE LICENSING, LISTING, OR REGISTRATION DECISIONS
- Texas Section 531.912 - Common Performance Measurements And Pay-for-performance Incentives For Certain Nursing Facilities
(a) In this section, "nursing facility" means a convalescent or nursing home or related institution licensed under Chapter 242, Health and Safety Code, that provides...
- Texas Section 531.951 - Applicability
(a) This subchapter applies only to the final licensing, listing, or registration decisions of a health and human services agency with respect to a person...
- Texas Section 531.952 - Record Of Final Decision
(a) Each health and human services agency that regulates a person described by Section 531.951 shall in accordance with this section and executive commissioner rule...
- Texas Section 531.953 - Denial Of Application Based On Adverse Agency Decision
A health and human services agency that regulates a person described by Section 531.951 may deny an application for a license, including a renewal license...
SUBCHAPTER X TEXAS HOME VISITING PROGRAM
- Texas Section 531.954 - Required Application Information
An applicant submitting an initial or renewal application for a license, including a renewal license or a license that does not expire, a listing, or...
- Texas Section 531.981 - Definitions
In this subchapter: (1) "Home visiting program" means a voluntary-enrollment program in which early childhood and health professionals such as nurses, social workers, or trained...
- Texas Section 531.982 - Implementation Of Texas Home Visiting Program
(a) The commission shall maintain a strategic plan to serve at-risk pregnant women and families with children under the age of six through home visiting...
- Texas Section 531.983 - Types Of Home Visiting Programs
(a) A home visiting program is classified as either an evidence-based program or a promising practice program. (b) An evidence-based program is a home visiting...
- Texas Section 531.984 - Funding
(a) The commission shall ensure that at least 75 percent of funds appropriated for home visiting programs are used in evidence-based programs, with any remaining...
- Texas Section 531.985 - Outcomes
The commission shall ensure that a home visiting program achieves favorable outcomes in at least two of the following areas: (1) improved maternal or child...
- Texas Section 531.986 - Evaluation Of Home Visiting Program
(a) The commission shall adopt outcome indicators to measure the effectiveness of a home visiting program in achieving desired outcomes. (b) The commission may work...
- Texas Section 531.9871 - Reports To Legislature
(a) Not later than December 1 of each even-numbered year, the commission shall prepare and submit a report on state-funded home visiting programs to the...
SUBCHAPTER Y OMBUDSMAN FOR CHILDREN AND YOUTH IN FOSTER CARE
- Texas Section 531.988 - Rules
The executive commissioner may adopt rules as necessary to implement this subchapter. Added by Acts 2013, 83rd Leg., R.S., Ch. 421 (S.B. 426), Sec. 1,...
- Texas Section 531.991 - Definitions
In this subchapter: (1) "Department" means the Department of Family and Protective Services. (2) "Ombudsman" means the individual appointed as the ombudsman for children and...
- Texas Section 531.992 - Ombudsman For Children And Youth In Foster Care
(a) The executive commissioner shall appoint an ombudsman for children and youth in foster care to serve at the will of the executive commissioner. (b)...
- Texas Section 531.993 - Duties Of Ombudsman
(a) The ombudsman serves as a neutral party in assisting children and youth in the conservatorship of the department with complaints regarding issues within the...
- Texas Section 531.994 - Investigation Of Unreported Complaints
If, during the investigation of a complaint, the ombudsman discovers unreported violations of the department's or a health and human services agency's rules and policies,...
- Texas Section 531.995 - Access To Information
The department and each health and human services agency shall provide the ombudsman access to the department's or agency's records that relate to a complaint...
- Texas Section 531.996 - Communication And Confidentiality
(a) A person may communicate with the ombudsman relating to a complaint by telephone, by mail, by electronic mail, or by any other means the...
- Texas Section 531.997 - Retaliation Prohibited
The department or another health and human services agency may not retaliate against a child or youth in the conservatorship of the department who in...
- Texas Section 531.998 - Report
(a) The ombudsman shall prepare an annual report that contains: (1) a description of the ombudsman's work; (2) any change made by the department or...