Text of section effective on April 01, 2025
Sec. 540.0159.  USING INFORMATION FROM EXTERNAL QUALITY REVIEWS.  (a)  To enhance the commission's monitoring of managed care organizations, the commission shall use the information provided by the external quality review organization, including:
(1)  detailed data from results of surveys of:
(A)  recipients and, if applicable, child health plan program enrollees;
(B)  caregivers of those recipients and enrollees; and
(C)  Medicaid and, as applicable, child health plan program providers; and
(2)  the validation results of matching paid claims data with medical records.
(b)  The commission shall document how the commission uses the information described by Subsection (a) to monitor managed care organizations.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.