Text of section effective on April 01, 2025
Sec. 540.0402.  CERTIFIER OF ENCOUNTER DATA QUALIFICATIONS.  (a)  The state Medicaid director shall appoint a person as the certifier of encounter data.
(b)  The certifier of encounter data must have:
(1)  demonstrated expertise in estimating premium payment rates paid to a managed care organization under a managed care plan; and
(2)  access to actuarial expertise, including expertise in estimating premium payment rates paid to a managed care organization under a managed care plan.
(c)  A person may not be appointed as the certifier of encounter data if the person participated with the commission in developing premium payment rates for managed care organizations under managed care plans in this state during the three-year period before the date the certifier is appointed.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.