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Texas Statutes
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Government Code
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Title 4. Executive Branch
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Subtitle I. Health and Human Services text of Chapter Effective Until April 1, 2025
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Chapter 533. Medicaid Managed Care Program
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Subchapter A. General Provisions
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Sec. 533.001. Definitions.
Sec. 533.002. Purpose.
Sec. 533.0025. Delivery of Services.
Sec. 533.00251. Delivery of Certain Benefits, Including Nursing Facility Benefits, Through Star + Plus Medicaid Managed Care Program.
Sec. 533.00253. Star Kids Medicaid Managed Care Program.
Sec. 533.00254. Star Kids Managed Care Advisory Committee.
Sec. 533.00255. Behavioral Health and Physical Health Services Network.
Sec. 533.002551. Monitoring of Compliance with Behavioral Health Integration.
Sec. 533.002552. Targeted Case Management and Psychiatric Rehabilitative Services for Children, Adolescents, and Families.
Sec. 533.002553. Behavioral Health Services Provided Through Third Party Or Subsidiary.
Sec. 533.002555. Transition of Case Management for Children and Pregnant Women Program Recipients to Managed Care Program.
Sec. 533.00256. Managed Care Clinical Improvement Program.
Sec. 533.00257. Delivery of Medical Transportation Program Services Through Managed Transportation Organization.
Sec. 533.002571. Delivery of Nonemergency Transportation Services to Certain Medicaid Recipients Through Medicaid Managed Care Organization.
Sec. 533.00258. Nonmedical Transportation Services Under Medicaid Managed Care Program.
Sec. 533.002581. Delivery of Nonmedical Transportation Services Under Medicaid Managed Care Program.
Sec. 533.0026. Direct Access to Eye Health Care Services Under Medicaid Managed Care Model Or Arrangement.
Sec. 533.0027. Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan.
Sec. 533.0028. Evaluation of Certain Star + Plus Medicaid Managed Care Program Services.
Sec. 533.00281. Utilization Review for Star + Plus Medicaid Managed Care Organizations.
Sec. 533.00282. Utilization Review and Prior Authorization Procedures.
Sec. 533.002821. Prior Authorization Procedures for Hospitalized Recipient.
Sec. 533.00283. Annual Review of Prior Authorization Requirements.
Sec. 533.00284. Reconsideration Following Adverse Determinations On Certain Prior Authorization Requests.
Sec. 533.002841. Maximum Period for Prior Authorization Decision; Access to Care.
Sec. 533.0029. Promotion and Principles of Patient-centered Medical Homes for Recipients.
Sec. 533.003. Considerations in Awarding Contracts.
Sec. 533.0031. Medicaid Managed Care Plan Accreditation.
Sec. 533.0035. Certification by Commission.
Sec. 533.004. Mandatory Contracts.
Sec. 533.005. Required Contract Provisions.
Sec. 533.0051. Performance Measures and Incentives for Value-based Contracts.
Sec. 533.00511. Quality-based Enrollment Incentive Program for Managed Care Organizations.
Sec. 533.00515. Medication Therapy Management.
Sec. 533.0052. Star Health Program: Trauma-informed Care Training.
Sec. 533.00521. Star Health Program: Health Care for Foster Children.
Sec. 533.00522. Star Health Program: Mental Health Providers.
Sec. 533.0053. Compliance with Texas Health Steps.
Sec. 533.00531. Medicaid Benefits for Certain Children Formerly in Foster Care.
Sec. 533.0054. Health Screening Requirements for Enrollee Under Star Health Program.
Sec. 533.0055. Provider Protection Plan.
Sec. 533.0056. Star Health Program: Notification of Placement Change.
Sec. 533.006. Provider Networks.
Sec. 533.0061. Provider Access Standards; Report.
Sec. 533.0062. Penalties and Other Remedies for Failure to Comply with Provider Access Standards.
Sec. 533.0063. Provider Network Directories.
Sec. 533.0064. Expedited Credentialing Process for Certain Providers.
Sec. 533.0065. Frequency of Provider Credentialing.
Sec. 533.0066. Provider Incentives.
Sec. 533.0067. Eye Health Care Service Providers.
Sec. 533.007. Contract Compliance.
Sec. 533.0071. Administration of Contracts.
Sec. 533.0072. Internet Posting of Sanctions Imposed for Contractual Violations.
Sec. 533.0073. Medical Director Qualifications.
Sec. 533.0075. Recipient Enrollment.
Sec. 533.00751. Recipient Directory.
Sec. 533.0076. Limitations On Recipient Disenrollment.
Sec. 533.0077. Statewide Effort to Promote Maintenance of Eligibility.
Sec. 533.008. Marketing Guidelines.
Sec. 533.009. Special Disease Management.
Sec. 533.0091. Sickle Cell Disease Treatment.
Sec. 533.010. Special Protocols.
Sec. 533.011. Public Notice.
Sec. 533.012. Information for Fraud Control.
Sec. 533.013. Premium Payment Rate Determination; Review and Comment.
Sec. 533.0131. Use of Encounter Data in Determining Premium Payment Rates.
Sec. 533.01315. Reimbursement for Services Provided Outside of Regular Business Hours.
Sec. 533.0132. State Taxes.
Sec. 533.014. Profit Sharing.
Sec. 533.015. Coordination of External Oversight Activities.
Sec. 533.016. Provider Reporting of Encounter Data.
Sec. 533.0161. Monitoring of Psychotropic Drug Prescriptions for Certain Children.
Sec. 533.017. Qualifications of Certifier of Encounter Data.
Sec. 533.018. Certification of Encounter Data.
Sec. 533.019. Value-added Services.
Sec. 533.020. Managed Care Organizations: Fiscal Solvency and Complaint System Guidelines.
Sec. 533.021. Community Health Workers.
Sec. 533.038. Coordination of Benefits; Continuity of Specialty Care for Certain Recipients.
Sec. 533.039. Delivery of Benefits Using Telecommunications and Information Technology.