Sec. 62.052. AUTHORITY OF COMMISSION RELATING TO HEALTH PLAN PROVIDER CONTRACTS. The commission may:
(1) implement contracts with health plan providers under Section 62.155;
(2) monitor the health plan providers, through reporting requirements and other means, to ensure performance under the contracts and quality delivery of services;
(3) monitor the quality of services delivered to enrollees through outcome measurements including:
(A) rate of hospitalization for ambulatory sensitive conditions, including asthma, diabetes, epilepsy, dehydration, gastroenteritis, pneumonia, and UTI/kidney infection;
(B) rate of hospitalization for injuries;
(C) percent of enrolled adolescents reporting risky health behavior such as injuries, tobacco use, alcohol/drug use, dietary behavior, physical activity, or other health related behaviors; and
(D) percent of adolescents reporting attempted suicide; and
(4) provide payment under the contracts to the health plan providers.
Added by Acts 1999, 76th Leg., ch. 235, Sec. 1, eff. Aug. 30, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0192, eff. April 2, 2015.
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