Text of section effective on April 01, 2025
Sec. 532.0053.  GRIEVANCES.  (a)  The commission shall:
(1)  adopt a definition of "grievance" related to Medicaid and ensure the definition is consistent among divisions within the commission to ensure all grievances are managed consistently;
(2)  standardize Medicaid grievance data reporting and tracking among divisions within the commission;
(3)  implement a no-wrong-door system for Medicaid grievances reported to the commission; and
(4)  verify grievance data a Medicaid managed care organization reports.
(b)  The commission shall establish a procedure for expedited resolution of a grievance related to Medicaid that allows the commission to:
(1)  identify a grievance related to a Medicaid access-to-care issue that is urgent and requires an expedited resolution; and
(2)  resolve the grievance within a specified period.
(c)  The commission shall:
(1)  aggregate recipient and Medicaid provider grievance data to provide a comprehensive data set of grievances; and
(2)  make the aggregated data available to the legislature and the public in a manner that does not allow for the identification of a particular recipient or provider.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.