Sec. 43.006. SERVICE PROVIDERS. (a) The executive commissioner may adopt substantive and procedural rules relating to:
(1) the selection of dentists, physicians, facilities, and other providers to furnish program services, including criteria for the emergency selection of providers; and
(2) the denial, modification, suspension, or termination of a provider's program participation.
(b) The department shall approve providers to participate in the program according to the criteria, rules, and procedures adopted by the executive commissioner.
(c) The department may pay only for program services furnished by approved providers, except in an emergency.
(d) The department shall provide a due process hearing procedure in accordance with department rules for the resolution of conflicts between the department and a provider. Chapter 2001, Government Code, does not apply to conflict resolution procedures adopted under this section.
(e) The department shall render the final administrative decision in a due process hearing to modify, suspend, or terminate the approval of a provider.
(f) The department may not terminate a contract while a due process hearing is pending under this section. The department may withhold payments while the hearing is pending, but shall pay the withheld payments and resume contract payments if the final determination is favorable to the provider.
(g) Subsections (d)-(f) do not apply if a contract:
(1) is canceled by the department because of the exhaustion of funds;
(2) expires according to its terms; or
(3) is canceled because program services are restricted to conform to budgetary limitations as prescribed by Section 43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff. Sept. 1, 1995.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0162, eff. April 2, 2015.
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