Tex. Gov't Code Section 533.0075
Recipient Enrollment


The commission shall:

(1)

encourage recipients to choose appropriate managed care plans and primary health care providers by:

(A)

providing initial information to recipients and providers in a region about the need for recipients to choose plans and providers not later than the 90th day before the date on which a managed care organization plans to begin to provide health care services to recipients in that region through managed care;

(B)

providing follow-up information before assignment of plans and providers and after assignment, if necessary, to recipients who delay in choosing plans and providers; and

(C)

allowing plans and providers to provide information to recipients or engage in marketing activities under marketing guidelines established by the commission under Section 533.008 (Marketing Guidelines) after the commission approves the information or activities;

(2)

consider the following factors in assigning managed care plans and primary health care providers to recipients who fail to choose plans and providers:

(A)

the importance of maintaining existing provider-patient and physician-patient relationships, including relationships with specialists, public health clinics, and community health centers;

(B)

to the extent possible, the need to assign family members to the same providers and plans; and

(C)

geographic convenience of plans and providers for recipients;

(3)

retain responsibility for enrollment and disenrollment of recipients in managed care plans, except that the commission may delegate the responsibility to an independent contractor who receives no form of payment from, and has no financial ties to, any managed care organization;

(4)

develop and implement an expedited process for determining eligibility for and enrolling pregnant women and newborn infants in managed care plans; and

(5)

ensure immediate access to prenatal services and newborn care for pregnant women and newborn infants enrolled in managed care plans, including ensuring that a pregnant woman may obtain an appointment with an obstetrical care provider for an initial maternity evaluation not later than the 30th day after the date the woman applies for Medicaid.
Added by Acts 1997, 75th Leg., ch. 1262, Sec. 2, eff. June 20, 1997. Amended by Acts 1999, 76th Leg., ch. 1447, Sec. 7, eff. June 19, 1999; Acts 1999, 76th Leg., ch. 1460, Sec. 9.07, eff. Sept. 1, 1999.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 945 (H.B. 3231), Sec. 2, eff. June 19, 2009.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.227, eff. April 2, 2015.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.

Source: Section 533.0075 — Recipient Enrollment, https://statutes.­capitol.­texas.­gov/Docs/GV/htm/GV.­533.­htm#533.­0075 (accessed Jun. 5, 2024).

521
General Provisions
522
Provisions Applicable to All Health and Human Services Agencies and Certain Other State Entities
523
Health and Human Services Commission
524
Authority over Health and Human Services System
525
General Powers and Duties of Commission and Executive Commissioner
526
Additional Powers and Duties of Commission and Executive Commissioner
531
Health and Human Services Commission
532
Medicaid Administration and Operation in General
533.001
Definitions
533.002
Purpose
533.003
Considerations in Awarding Contracts
533.004
Mandatory Contracts
533.005
Required Contract Provisions
533.006
Provider Networks
533.007
Contract Compliance
533.008
Marketing Guidelines
533.009
Special Disease Management
533.010
Special Protocols
533.011
Public Notice
533.012
Information for Fraud Control
533.013
Premium Payment Rate Determination
533.014
Profit Sharing
533.015
Coordination of External Oversight Activities
533.016
Provider Reporting of Encounter Data
533.017
Qualifications of Certifier of Encounter Data
533.018
Certification of Encounter Data
533.019
Value-added Services
533.020
Managed Care Organizations: Fiscal Solvency and Complaint System Guidelines
533.021
Community Health Workers
533.0025
Delivery of Services
533.0026
Direct Access to Eye Health Care Services Under Medicaid Managed Care Model or Arrangement
533.0027
Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan
533.0029
Promotion and Principles of Patient-centered Medical Homes for Recipients
533.0031
Medicaid Managed Care Plan Accreditation
533.0035
Certification by Commission
533.038
Coordination of Benefits
533.039
Delivery of Benefits Using Telecommunications and Information Technology
533.0051
Performance Measures and Incentives for Value-based Contracts
533.051
Definitions
533.0052
Star Health Program: Trauma-informed Care Training
533.052
Applicability and Construction of Subchapter
533.0053
Compliance with Texas Health Steps
533.053
Overall Strategy for Managing Audit Resources
533.0054
Health Screening Requirements for Enrollee Under Star Health Program
533.054
Performance Audit Selection Process and Follow-up
533.0055
Provider Protection Plan
533.055
Agreed-upon Procedures Engagements and Corrective Action Plans
533.0056
Star Health Program: Notification of Placement Change
533.056
Audits of Pharmacy Benefit Managers
533.057
Collection of Costs for Audit-related Services
533.058
Collection Activities Related to Profit Sharing
533.059
Use of Information from External Quality Reviews
533.060
Security and Processing Controls over Information Technology Systems
533.0061
Provider Access Standards
533.0062
Penalties and Other Remedies for Failure to Comply with Provider Access Standards
533.0063
Provider Network Directories
533.0064
Expedited Credentialing Process for Certain Providers
533.0065
Frequency of Provider Credentialing
533.0066
Provider Incentives
533.0067
Eye Health Care Service Providers
533.0071
Administration of Contracts
533.071
Preferred Drug List Exceptions
533.0072
Internet Posting of Sanctions Imposed for Contractual Violations
533.0073
Medical Director Qualifications
533.0075
Recipient Enrollment
533.0076
Limitations on Recipient Disenrollment
533.0077
Statewide Effort to Promote Maintenance of Eligibility
533.083
Assessment and Implementation of Pilot Program Findings
533.0091
Sickle Cell Disease Treatment
533.0131
Use of Encounter Data in Determining Premium Payment Rates
533.0132
State Taxes
533.0161
Monitoring of Psychotropic Drug Prescriptions for Certain Children
533.00253
Star Kids Medicaid Managed Care Program
533.00254
Star Kids Managed Care Advisory Committee
533.00255
Behavioral Health and Physical Health Services Network
533.00256
Managed Care Clinical Improvement Program
533.00257
Delivery of Medical Transportation Program Services Through Managed Transportation Organization
533.00258
Nonmedical Transportation Services Under Medicaid Managed Care Program
533.00282
Utilization Review and Prior Authorization Procedures
533.00283
Annual Review of Prior Authorization Requirements
533.00284
Reconsideration Following Adverse Determinations on Certain Prior Authorization Requests
533.00511
Quality-based Enrollment Incentive Program for Managed Care Organizations
533.00515
Medication Therapy Management
533.00521
Star Health Program: Health Care for Foster Children
533.00522
Star Health Program: Mental Health Providers
533.00531
Medicaid Benefits for Certain Children Formerly in Foster Care
533.00751
Recipient Directory
533.01315
Reimbursement for Services Provided Outside of Regular Business Hours
533.002551
Monitoring of Compliance with Behavioral Health Integration
533.002552
Targeted Case Management and Psychiatric Rehabilitative Services for Children, Adolescents, and Families
533.002553
Behavioral Health Services Provided Through Third Party or Subsidiary
533.002555
Transition of Case Management for Children and Pregnant Women Program Recipients to Managed Care Program
533.002571
Delivery of Nonemergency Transportation Services to Certain Medicaid Recipients Through Medicaid Managed Care Organization
533.002581
Delivery of Nonmedical Transportation Services Under Medicaid Managed Care Program
533.002821
Prior Authorization Procedures for Hospitalized Recipient
533.002841
Maximum Period for Prior Authorization Decision
534
System Redesign for Delivery of Medicaid Acute Care Services and Long-term Services and Supports to Persons with an Intellectual or Developmental Disability
535
Provision of Human Services and Other
536
Medicaid and the Child Health Plan Program: Quality-based Outcomes and Payments
537
Medicaid Reform Waiver
538
Medicaid Quality Improvement Process for Clinical Initiatives
539.001
Definition
539.002
Grants for Establishment and Expansion of Community Collaboratives
539.003
Acceptable Uses of Grant Money
539.004
Elements of Community Collaboratives
539.005
Outcome Measures for Community Collaboratives
539.006
Annual Review of Outcome Measures
539.007
Reduction and Cessation of Funding
539.008
Rules
539.009
Administrative Costs
539.010
Biennial Report
539.0051
Plan Required for Certain Community Collaboratives
540
Medicaid Managed Care Program
540A
Medicaid Managed Transportation Services
541
Pediatric Tele-connectivity Resource Program for Rural Texas
542
System Redesign for Delivery of Medicaid Acute Care Services and Long-term Services and Supports to Individuals with an Intellectual or Developmental Disability
543
Clinical Initiatives to Improve Medicaid Quality of Care and Cost-effectiveness
543A
Quality-based Outcomes and Payments Under Medicaid and Child Health Plan Program
544
Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services
545
Certain Public Assistance Benefits
546
Long-term Care and Support Options for Individuals with Disabilities and Elderly Individuals
547
Mental Health and Substance Use Services
547A
Community Collaboratives
548
Health Care Services Provided Through Tele-connective Means
549
Provision of Drugs and Drug Information
550
Human Services and Other Social Services Provided Through Faith- and Community-based Organizations

Accessed:
Jun. 5, 2024

§ 533.0075’s source at texas​.gov