Tex. Gov't Code Section 542.0116
Recipient Enrollment, Participation, and Eligibility


(a)

The commission, in collaboration with the advisory committee and pilot program work group, shall develop pilot program participant eligibility criteria. The criteria must ensure that pilot program participants:

(1)

include individuals with an intellectual or developmental disability or a cognitive disability, including:

(A)

individuals with autism;

(B)

individuals with significant complex behavioral, medical, and physical needs who are receiving home and community-based services through the STAR+PLUS Medicaid managed care program;

(C)

individuals enrolled in the STAR+PLUS Medicaid managed care program who:
(i)
are on a Medicaid waiver program interest list;
(ii)
meet the criteria for an intellectual or developmental disability; or
(iii)
have a traumatic brain injury that occurred after the age of 21; and

(D)

other individuals with disabilities who have similar functional needs without regard to the age of onset or diagnosis; and

(2)

do not include individuals who are receiving only acute care services under the STAR+PLUS Medicaid managed care program and are enrolled in the community-based ICF-IID program or another Medicaid waiver program.

(b)

An individual who is eligible to participate in the pilot program will be enrolled automatically. The decision to opt out of participating may be made only by the individual or the individual’s legally authorized representative.

(c)

Before implementing the pilot program, the commission, in collaboration with the advisory committee and pilot program work group, shall develop and implement a process to ensure that pilot program participants remain eligible for Medicaid for 12 consecutive months during the pilot program.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.

Source: Section 542.0116 — Recipient Enrollment, Participation, and Eligibility, https://statutes.­capitol.­texas.­gov/Docs/GV/htm/GV.­542.­htm#542.­0116 (accessed Jun. 5, 2024).

542.0001
Definitions
542.0002
Conflict with Other Law
542.0003
Delayed Implementation Authorized
542.0051
Redesign of Acute Care Services and Long-term Services and Supports System for Individuals with an Intellectual or Developmental Disability
542.0052
Intellectual and Developmental Disability System Redesign Advisory Committee
542.0053
Implementation of System Redesign
542.0054
Annual Report on Implementation
542.0101
Definitions
542.0102
Pilot Program to Test Person-centered Managed Care Strategies and Improvements Based on Capitation
542.0103
Alternative Payment Rate or Methodology
542.0104
Pilot Program Work Group
542.0105
Stakeholder Input
542.0106
Measurable Goals
542.0107
Managed Care Organization Selection
542.0108
Managed Care Organization Participation Requirements
542.0109
Required Benefits
542.0110
Provider Participation
542.0111
Care Coordination
542.0112
Person-centered Planning
542.0113
Use of Innovative Technology
542.0114
Informational Materials
542.0115
Implementation, Location, and Duration
542.0116
Recipient Enrollment, Participation, and Eligibility
542.0117
Pilot Program Information Collection and Analysis
542.0118
Pilot Program Conclusion
542.0119
Evaluations and Reports
542.0120
Transition Between Programs
542.0121
Service Transition Requirements
542.0151
Delivery of Acute Care Services to Individuals with an Intellectual or Developmental Disability
542.0201
Transition of Icf-iid Program Recipients and Certain Other Medicaid Waiver Program Recipients to Managed Care Program
542.0202
Recipient Choice of Delivery Model
542.0203
Required Contract Provisions
542.0204
Responsibilities of Commission Under Subchapter

Accessed:
Jun. 5, 2024

§ 542.0116’s source at texas​.gov