Tex.
Gov't Code Section 533.0027
Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan
(b)
The office of contract management shall use the utilization review process to review each fiscal year:(1)
every managed care organization participating in the STAR + PLUS Medicaid managed care program; or(2)
only the managed care organizations that, using a risk-based assessment process, the office determines have a higher likelihood of inappropriate client placement in the STAR + PLUS home and community-based services and supports (HCBS) program.(c)
Expired.(d)
In conjunction with the commission’s office of contract management, the commission shall provide a report to the standing committees of the senate and house of representatives with jurisdiction over Medicaid not later than December 1 of each year. The report must:(1)
summarize the results of the utilization reviews conducted under this section during the preceding fiscal year;(2)
provide analysis of errors committed by each reviewed managed care organization; and(3)
extrapolate those findings and make recommendations for improving the efficiency of the program.(e)
If a utilization review conducted under this section results in a determination to recoup money from a managed care organization, a service provider who contracts with the managed care organization may not be held liable for the good faith provision of services based on an authorization from the managed care organization.
Source:
Section 533.0027 — Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.533.htm#533.0027 (accessed Jun. 5, 2024).
