Text of section effective on April 01, 2025

Sec. 540.0264.  PROVIDER REIMBURSEMENT RATE REDUCTION.  (a) A contract to which this subchapter applies must require that the contracting Medicaid managed care organization not implement a significant, nonnegotiated, across-the-board provider reimbursement rate reduction unless:
(1)  subject to Subsection (b), the organization has the commission's prior approval to implement the reduction; or
(2)  the rate reduction is based on changes to the Medicaid fee schedule or cost containment initiatives the commission implements.
(b)  A provider reimbursement rate reduction a Medicaid managed care organization proposes is considered to have received the commission's prior approval unless the commission issues a written statement of disapproval not later than the 45th day after the date the commission receives notice of the proposed rate reduction from the organization.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.