Text of section effective on April 01, 2025
Sec. 532.0202.  INFORMATION COLLECTION AND ANALYSIS.  (a)  The commission shall:
(1)  make every effort to improve data analysis and integrate available information associated with Medicaid;
(2)  use the decision support system in the commission's center for analytics and decision support for the purpose described by Subdivision (1);
(3)  modify or redesign the decision support system to allow for the data collected by Medicaid to be used more systematically and effectively for Medicaid evaluation and policy development; and
(4)  develop or redesign the decision support system as necessary to ensure that the system:
(A)  incorporates currently collected Medicaid enrollment, utilization, and provider data;
(B)  allows data manipulation and quick analysis to address a large variety of questions concerning enrollment and utilization patterns and trends within Medicaid;
(C)  is able to obtain consistent and accurate answers to questions;
(D)  allows for analysis of multiple issues within Medicaid to determine whether any programmatic or policy issues overlap or are in conflict;
(E)  includes predefined data reports on utilization of high-cost services that allow Medicaid management to analyze and determine the reasons for an increase or decrease in utilization and immediately proceed with policy changes, if appropriate;
(F)  includes any encounter data with respect to recipients that a Medicaid managed care organization receives from a health care provider in the organization's provider network; and
(G)  links Medicaid and non-Medicaid data sets, including data sets related to:
(i)  Medicaid;
(ii)  the financial assistance program under Chapter 31, Human Resources Code;
(iii)  the special supplemental nutrition program for women, infants, and children authorized by 42 U.S.C. Section 1786;
(iv)  vital statistics; and
(v)  other public health programs.
(b)  The commission shall ensure that all Medicaid data sets the decision support system creates or identifies  are made available on the Internet to the extent not prohibited by federal or state laws regarding medical privacy or security.  If privacy concerns exist or arise with respect to making the data sets available on the Internet, the system and the commission shall make every effort to make the data available on the Internet either by:
(1)  removing individually identifiable information; or
(2)  aggregating the data in a manner to prevent the association of individual records with particular individuals.
(c)  The commission shall regularly evaluate data submitted by Medicaid managed care organizations to determine whether:
(1)  the data continues to serve a useful purpose; and
(2)  additional data is needed to oversee contracts or evaluate the effectiveness of Medicaid.
(d)  The commission shall collect Medicaid managed care data that effectively captures the quality of services recipients receive.
(e)  The commission shall develop a dashboard for agency leadership that is designed to assist leadership with overseeing Medicaid and comparing the performance of Medicaid managed care organizations.  The dashboard must identify a concise number of important Medicaid indicators, including key data, performance measures, trends, and problems.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.