Tex. Gov't Code Section 531.076
Review of Prior Authorization and Utilization Review Processes

531.001
Definitions 531.003
Goals 531.004
Sunset Provision 531.005
Executive Commissioner 531.006
Eligibility for Appointment as Executive Commissioner 531.007
Term 531.008
Divisions of Commission 531.009
Personnel 531.010
Merit System 531.0011
References in Law Meaning Commission or Appropriate Division 531.011
Public Input Information and Complaints 531.0012
References in Law Meaning Executive Commissioner or Designee 531.012
Advisory Committees 531.013
Electronic Availability of Technical Assistance 531.014
Consolidation of Reports 531.015
New Facilities in Certain Counties 531.017
Purchasing Unit 531.018
Certain Contracts for Health Care Purposes 531.019
Administrative and Judicial Review of Certain Decisions 531.020
Office of Community Access and Services 531.021
Administration of Medicaid 531.023
Submission of Plans and Updates by Agencies 531.024
Planning and Delivery of Health and Human Services 531.0025
Restrictions on Awards to Family Planning Service Providers 531.025
Statewide Needs Appraisal Project 531.027
Appropriations Request by Agencies 531.028
Monitoring and Effective Management of Funds 531.031
Management Information and Cost Accounting System 531.032
Application of Other Laws 531.033
Rules 531.035
Dispute Arbitration 531.036
Public Hearings 531.037
Notice of Public Hearings 531.038
Gifts and Grants 531.039
Contracts 531.040
Reference Guide 531.041
General Powers and Duties 531.042
Information and Assistance Regarding Care and Support Options 531.043
Long-term Care Vision 531.044
Financial Assistance Recipients Eligible for Federal Programs 531.0045
Limit on Sunset Review 531.047
Substitute Care Provider Outcome Standards 531.048
Caseload Standards 531.050
Minimum Collection Goal 531.0051
Health and Human Services Commission Executive Council 531.051
Consumer Direction of Certain Services for Persons with Disabilities and Elderly Persons 531.053
Leases and Subleases of Certain Office Space 531.054
Assumption of Leases for Implementations of Integrated Enrollment Services Initiative 531.0055
Executive Commissioner: General Responsibility for Health and Human Services System 531.055
Memorandum of Understanding on Services for Persons Needing Multiagency Services 531.0056
Appointment of Agency Director by Executive Commissioner 531.056
Review of Survey Process in Certain Institutions and Facilities 531.0057
Medical Transportation Services 531.057
Volunteer Advocate Program for the Elderly 531.058
Informal Dispute Resolution for Certain Long-term Care Facilities 531.059
Voucher Program for Transitional Living Assistance for Persons with Disabilities 531.060
Family-based Alternatives for Children 531.061
Participation by Fathers 531.062
Pilot Projects Relating to Technology Applications 531.063
Call Centers 531.064
Vaccines for Children Program Provider Enrollment and Reimbursement 531.066
Participation of Diagnostic Laboratory Service Providers in Certain Programs 531.067
Program to Improve and Monitor Certain Outcomes of Recipients Under Child Health Plan Program and Medicaid 531.069
Periodic Review of Vendor Drug Program 531.070
Supplemental Rebates 531.071
Confidentiality of Information Regarding Drug Rebates, Pricing, and Negotiations 531.072
Preferred Drug Lists 531.073
Prior Authorization for Certain Prescription Drugs 531.075
Prior Authorization for High-cost Medical Services 531.076
Review of Prior Authorization and Utilization Review Processes 531.077
Recovery of Certain Assistance 531.078
Quality Assurance Fees on Certain Waiver Program Services 531.079
Waiver Program Quality Assurance Fee Account 531.080
Reimbursement of Waiver Programs 531.081
Invalidity 531.082
Expiration of Quality Assurance Fee on Waiver Programs 531.0082
Data Analysis Unit 531.0083
Office of Policy and Performance 531.083
Medicaid Long-term Care System 531.0084
Investigation Unit for Illegally Operating Child-care Facilities 531.084
Medicaid Long-term Care Cost Containment Strategies 531.085
Hospital Emergency Room Use Reduction Initiatives 531.087
Distribution of Earned Income Tax Credit Information 531.088
Pooled Funding for Foster Care Preventive Services 531.089
Certain Medication for Sex Offenders Prohibited 531.090
Joint Purchasing of Prescription Drugs and Other Medications 531.091
Integrated Benefits Issuance 531.092
Transfer of Money for Community-based Services 531.093
Services for Military Personnel 531.097
Tailored Benefit Packages for Certain Categories of the Medicaid Population 531.099
Alignment of Medicaid Diabetic Equipment and Supplies Written Order Procedures with Medicare Diabetic Equipment and Supplies Written Order Procedures 531.101
Award for Reporting Medicaid Fraud, Abuse, or Overcharges 531.102
Office of Inspector General 531.103
Interagency Coordination 531.104
Assisting Investigations by Attorney General 531.105
Fraud Detection Training 531.106
Learning, Neural Network, or Other Technology 531.108
Fraud Prevention 531.109
Selection and Review of Claims 531.110
Electronic Data Matching Program 531.111
Fraud Detection Technology 531.112
Expunction of Information Related to Certain Chemical Dependency Diagnoses in Certain Records 531.113
Managed Care Organizations: Special Investigative Units or Contracts 531.114
Financial Assistance Fraud 531.115
Federal Felony Match 531.116
Compliance with Law Prohibiting Solicitation 531.117
Recovery Audit Contractors 531.118
Preliminary Investigations of Allegations of Fraud or Abuse and Fraud Referrals 531.119
Website Posting 531.120
Notice and Informal Resolution of Proposed Recoupment of Overpayment or Debt 531.0121
Public Access to Advisory Committee Meetings 531.121
Definitions 531.124
Commission Duties 531.125
Grants 531.0141
Application Requirement for Colonias Projects 531.151
Definitions 531.152
Policy Statement 531.153
Development of Permanency Plan 531.154
Notification Required 531.155
Offer of Services 531.156
Designation of Advocate 531.157
Community-based Services 531.158
Local Permanency Planning Sites 531.159
Monitoring of Permanency Planning Efforts 531.160
Inspections 531.0161
Negotiated Rulemaking and Alternative Dispute Procedures 531.161
Access to Records 531.0162
Use of Technology 531.162
Permanency Reporting 531.0163
Memorandum of Understanding 531.163
Effect on Other Law 531.0164
Health and Human Services System Internet Website Coordination 531.164
Duties of Certain Institutions 531.165
Search for Parent or Guardian of a Child 531.0165
Internet Broadcast and Archive of Open Meetings 531.166
Transfer of Child Between Institutions 531.167
Collection of Information Regarding Involvement of Certain Parents and Guardians 531.171
Committee Duties 531.0191
Services Provided by Contractor to Persons with Limited English Proficiency 531.191
Integrated Eligibility Determination 531.0192
Health and Human Services System Hotline and Call Center Coordination 531.201
Strategic Plan 531.202
Advisory Committee on Rural Hospitals 531.203
Collaboration with Office of Rural Affairs 531.0211
Managed Care Medicaid Program: Rules 531.0212
Medicaid Bill of Rights and Bill of Responsibilities 531.0214
Medicaid Data Collection System 531.0215
Compilation of Statistics Relating to Fraud 531.0216
Participation and Reimbursement of Telemedicine Medical Service Providers, Teledentistry Dental Service Providers, and Telehealth Service Providers Under Medicaid 531.0217
Reimbursement for Certain Medical Consultations 531.0218
Long-term Care Medicaid Programs 531.0222
Local Mental Health Authority Group Regional Planning 531.0224
Planning and Policy Direction of Temporary Assistance for Needy Families Program 531.0225
Mental Health and Substance Abuse Services 531.0226
Chronic Health Conditions Services Medicaid Waiver Program 531.0227
Person First Respectful Language Promotion 531.0241
Streamlining Delivery of Services 531.0242
Use of Agency Staff 531.0244
Ensuring Appropriate Care Setting for Persons with Disabilities 531.0245
Permanency Planning for Certain Children 531.0246
Regional Management of Health and Human Services Agencies 531.0247
Annual Business Plan 531.0248
Community-based Support Systems 531.251
Texas System of Care Framework 531.255
Evaluation 531.257
Technical Assistance for Projects 531.0271
Health and Human Services Agencies Operating Budgets 531.0273
Information Resources Planning and Management 531.0274
Coordination and Approval of Caseload Estimates 531.281
Definition 531.282
Office 531.283
Goals 531.284
Strategic Plan 531.285
Powers and Duties 531.287
Texas Home Visiting Program Trust Fund 531.301
Development and Implementation of State Program 531.302
Rules 531.303
Generic Equivalent Authorized 531.304
Program Funding Priorities 531.0312
Texas Information and Referral Network 531.0313
Electronic Access to Health and Human Services Referral Information 531.0315
Implementing National Electronic Data Interchange Standards for Health Care Information 531.0317
Health and Human Services Information Made Available Through the Internet 531.0318
Long-term Care Consumer Information Made Available Through the Internet 531.0319
Outreach Campaigns for Aging Adults with Visual Impairments 531.0335
Prohibition on Punitive Action for Failure to Immunize 531.351
Definition 531.352
Providing Information to Commission 531.353
Toll-free Telephone Number 531.0381
Certain Gifts and Grants to Health and Human Services Agencies 531.381
Definitions 531.382
Victim Assistance Program Established 531.383
Grant Program 531.384
Training Programs 531.385
Funding 531.0391
Subrogation and Third-party Reimbursement Collection Contract 531.0392
Recovery of Certain Third-party Reimbursements Under Medicaid 531.0411
Rules Regarding Refugee Resettlement 531.421
Definitions 531.422
Evaluations by Community Resource Coordination Groups 531.423
Summary Report by Commission 531.424
Agency Implementation of Recommendations 531.451
Operational Plan to Coordinate Initiatives 531.452
Revision of Major Initiatives 531.453
Incentives for Initiative Coordination 531.471
Definition 531.472
Purpose 531.473
Composition of Council 531.474
Presiding Officer 531.475
Meetings 531.476
Powers and Duties 531.477
Suicide Prevention Subcommittee 531.491
Definitions 531.492
Purpose 531.493
Composition of Council 531.494
Terms 531.495
Presiding Officer 531.496
Meetings 531.497
Powers and Duties 531.498
Recurring Five-year Strategic Plan and Related Implementation Plans 531.499
Application of Sunset Act 531.0501
Medicaid Waiver Programs: Interest List Management 531.501
Definition 531.502
Direction to Obtain Federal Waiver 531.503
Establishment of Texas Health Opportunity Pool Trust Fund 531.504
Deposits to Fund 531.505
Use of Fund in General 531.506
Reimbursements for Uncompensated Health Care Costs 531.507
Increasing Access to Health Benefits Coverage 531.508
Infrastructure Improvements 531.0511
Medically Dependent Children Waiver Program: Consumer Direction of Services 531.0512
Notification Regarding Consumer Direction Model 531.0515
Risk Management Criteria for Certain Waiver Programs 531.00551
Procedures for Adopting Rules and Policies 531.551
Uncompensated Hospital Care Reporting and Analysis 531.00552
Consolidated Internal Audit Program 531.00553
Administrative Support Services 531.00554
Criminal Background Checks 531.00561
Appointment and Qualifications of Division Directors 531.00562
Division Director Duties 531.0581
Long-term Care Facilities Council 531.0585
Issuance of Materials to Certain Long-term Care Facilities 531.0601
Long-term Care Services Waiver Program Interest Lists 531.0604
Medically Dependent Children Program Eligibility Requirements 531.0605
Advancing Care for Exceptional Kids Pilot Program 531.651
Definitions 531.652
Medicaid Managed Care Organization Service Coordination Benefits Not Affected 531.653
Case Management for Children and Pregnant Women Program: Provider Qualifications 531.654
Case Management for Children and Pregnant Women Program: Provider Training 531.655
Initial Medical and Nonmedical Health-related Screenings of Certain Recipients 531.656
Screening and Program Services Optional 531.0691
Vendor Drug Program Inclusion 531.0693
Prescription Drug Use and Expenditure Patterns 531.0694
Period of Validity for Prescription 531.0696
Considerations in Awarding Certain Contracts 531.0697
Prior Approval and Provider Access to Certain Communications with Certain Recipients 531.0701
Value-based Arrangements 531.0735
Medicaid Drug Utilization Review Program: Drug Use Reviews and Annual Report 531.0736
Drug Utilization Review Board 531.0737
Drug Utilization Review Board: Conflicts of Interest 531.0741
Publication of Information Regarding Commission Decisions on Preferred Drug List Placement 531.751
Definitions 531.752
Establishment of Community-based Navigator Program 531.753
Program Standards 531.754
Training Program 531.755
Publication of Navigator List 531.0841
Long-term Care Insurance Awareness and Education Campaign 531.0843
Durable Medical Equipment Reuse Program 531.851
Mortality Review 531.852
Access to Information 531.853
Mortality Review Report 531.854
Use and Publication Restrictions 531.855
Limitation on Liability 531.0861
Physician Incentive Program to Reduce Hospital Emergency Room Use for Non-emergent Conditions 531.0862
Continued Implementation of Certain Interventions and Best Practices by Providers 531.901
Definitions 531.903
Electronic Health Information Exchange System 531.906
Electronic Health Information Exchange System Stage One: Electronic Prescribing 531.907
Electronic Health Information Exchange System Stage Two: Expansion 531.908
Electronic Health Information Exchange System Stage Three: Expansion 531.909
Incentives 531.911
Rules 531.912
Common Performance Measurements and Pay-for-performance Incentives for Certain Nursing Facilities 531.0925
Veteran Suicide Prevention Action Plan 531.0931
Interest List or Other Waiting List Rules for Certain Military Members and Their Dependents 531.0932
Instruction Guide for Family Members and Caregivers of Veterans Who Have Mental Health Disorders 531.0941
Medicaid Health Savings Account Pilot Program 531.951
Applicability 531.952
Record of Final Decision 531.953
Denial of Application Based on Adverse Agency Decision 531.954
Required Application Information 531.0971
Tailored Benefit Packages for Non-medicaid Populations 531.0972
Pilot Program to Prevent the Spread of Certain Infectious or Communicable Diseases 531.0973
Deaf-blind with Multiple Disabilities Waiver Program: Career Ladder for Interveners 531.0981
Wellness Screening Program 531.0991
Grant Program for Mental Health Services 531.991
Definitions 531.0992
Grant Program for Mental Health Services for Veterans and Their Families 531.992
Appointment of Ombudsman 531.0993
Grant Program to Reduce Recidivism, Arrest, and Incarceration Among Individuals with Mental Illness and to Reduce Wait Time for Forensic Commitment 531.993
Duties of Ombudsman 531.0994
Study 531.994
Investigation of Unreported Complaints 531.0995
Information for Certain Enrollees in the Healthy Texas Women Program 531.995
Access to Information 531.996
Communication and Confidentiality 531.997
Retaliation Prohibited 531.0998
Memorandum of Understanding Regarding Public Assistance Reporting Information System 531.998
Report 531.0999
Peer Specialists 531.1011
Definitions 531.1021
Subpoenas 531.1022
Peace Officers 531.1023
Compliance with Federal Coding Guidelines 531.1024
Hospital Utilization Reviews and Audits: Provider Education Process 531.1025
Performance Audits and Coordination of Audit Activities 531.1031
Duty to Exchange Information 531.1032
Office of Inspector General: Criminal History Record Information Check 531.1033
Monitoring of Certain Federal Databases 531.1034
Time to Determine Provider Eligibility 531.1061
Fraud Investigation Tracking System 531.1062
Recovery Monitoring System 531.1081
Integrity of Certain Public Assistance Programs 531.1112
Study Concerning Increased Use of Technology to Strengthen Fraud Detection and Deterrence 531.1131
Fraud and Abuse Recovery by Certain Persons 531.1132
Annual Report on Certain Fraud and Abuse Recoveries 531.1135
Managed Care Organizations: Process to Recoup Certain Overpayments 531.1201
Appeal of Determination to Recoup Overpayment or Debt 531.1202
Record and Confidentiality of Informal Resolution Meetings 531.1203
Rights of and Provision of Information to Pharmacies Subject to Certain Audits 531.1521
Preadmission Information 531.1531
Assistance with Permanency Planning Efforts 531.1532
Interference with Permanency Planning Efforts 531.1533
Requirements on Admissions of Children to Certain Institutions 531.1591
Annual Reauthorization of Plans of Care for Certain Children 531.02111
Biennial Medicaid Financial Report 531.02113
Optimization of Medicaid Financing 531.02114
Dental Director 531.02115
Marketing Activities by Providers Participating in Medicaid or Child Health Plan Program 531.02118
Streamlining Medicaid Provider Enrollment and Credentialing Processes 531.02119
Discrimination Based on Immunization Status Prohibited 531.02131
Grievances Related to Medicaid 531.02141
Medicaid Information Collection and Analysis 531.02142
Public Access to Certain Medicaid Data 531.02143
Data Regarding Postnatal Alcohol and Controlled Substance Treatment 531.02161
Provision of Services Through Telecommunications and Information Technology Under Medicaid and Other Public Benefits Programs 531.02162
Medicaid Services Provided Through Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services to Children with Special Health Care Needs 531.02164
Medicaid Services Provided Through Home Telemonitoring Services 531.02171
Reimbursement for Certain Telehealth Services 531.02172
Reimbursement for Teledentistry Dental Services 531.02174
Additional Authority Regarding Telemedicine Medical Services 531.02175
Reimbursement for Online Medical Consultations 531.02191
Public Input 531.02192
Federally Qualified Health Center and Rural Health Clinic Services 531.02193
Certain Conditions on Medicaid Reimbursement of Rural Health Clinics Prohibited 531.02194
Reimbursement Methodology for Rural Hospitals 531.02241
Pilot Program for Self-sufficiency of Certain Persons Receiving Financial Assistance or Supplemental Nutrition Assistance Benefits 531.02253
Telehealth Treatment for Substance Use Disorders 531.02411
Streamlining Administrative Processes 531.02412
Service Delivery Audit Mechanisms 531.02413
Billing Coordination System 531.02414
Nonemergency Transportation Services Under Medical Transportation Program 531.02415
Electronic Eligibility Information Pilot Project 531.02417
Medicaid Nursing Services Assessments 531.02418
Medicaid and Child Health Plan Program Eligibility Determinations for Certain Individuals 531.02442
Community Living Options Information Process for Certain Persons with an Intellectual Disability 531.02443
Implementation of Community Living Options Information Process at State Institutions for Certain Adult Residents 531.02444
Medicaid Buy-in Programs for Certain Persons with Disabilities 531.02445
Transition Services for Youth with Disabilities 531.02447
Employment-first Policy 531.02448
Competitive and Integrated Employment Initiative for Certain Medicaid Recipients 531.02481
Community-based Support and Service Delivery Systems for Long-term Care Services 531.02482
Faith- and Community-based Organization Support for Certain Persons Receiving Public Assistance 531.02485
Required Review of Criminal History Record Information for Certain Residential Caregivers 531.02486
Suspending Employment of Certain Residential Caregivers 531.02491
Joint Training for Certain Caseworkers 531.02492
Delivery of Health and Human Services to Young Texans 531.02731
Report of Information Resources Manager to Commission 531.03131
Electronic Access to Child-care and Education Services Referral Information 531.03132
Electronic Access to Referral Information About Housing Options for Persons with Mental Illness 531.005522
Efficiency Audit 531.06011
Certain Medicaid Waiver Programs: Interest List Management 531.8501
Definition 531.9051
Electronic Health Information Exchange System Stage One: Encounter Data 531.9912
Establishment of Ombudsman Programs 531.09915
Innovation Matching Grant Program for Mental Health Early Intervention and Treatment 531.9915
Office of Ombudsman 531.9921
Conflict of Interest 531.9931
Ombudsman for Children and Youth in Foster Care 531.9932
Ombudsman for Managed Care Assistance 531.9933
Ombudsman for Behavioral Health Access to Care 531.9934
Ombudsman for Individuals with an Intellectual or Developmental Disability 531.09935
Grant Program to Reduce Recidivism, Arrest, and Incarceration Among Individuals with Mental Illness and to Reduce Wait Time for Forensic Commitment in Most Populous County 531.09936
Establishment or Expansion of Regional Behavioral Health Centers or Jail Diversion Centers 531.09991
Plan for the Transition of Care of Certain Individuals 531.021135
Commission’s Authority to Retain Certain Money to Administer Certain Medicaid Programs 531.021182
Use of National Provider Identifier Number 531.021191
Medicaid Enrollment of Certain Eye Health Care Providers 531.024115
Service Delivery Area Alignment 531.024131
Expansion of Billing Coordination and Information Collection Activities 531.024161
Reimbursement Claims for Certain Medicaid or Child Health Plan Services Involving Supervised Providers 531.024162
Notice Requirements Regarding Medicaid Coverage or Prior Authorization Denial and Incomplete Requests 531.024163
Accessibility of Information Regarding Medicaid Prior Authorization Requirements 531.024164
External Medical Review 531.024171
Therapy Services Assessments 531.024172
Electronic Visit Verification System 531.024181
Verification of Immigration Status of Applicants for Certain Benefits Who Are Qualified Aliens 531.024182
Verification of Sponsorship Information for Certain Benefits Recipients 531.024183
Standardized Screening Questions for Assessing Nonmedical Health-related Needs of Certain Pregnant Women