Tex.
Ins. Code Section 4201.053
Medicaid and Other State Health or Mental Health Programs
(a)
Except as provided by Section 4201.057 (Health Maintenance Organizations), this chapter does not apply to:(1)
the state Medicaid program;(2)
the services program for children with special health care needs under Chapter 35 (Children with Special Health Care Needs), Health and Safety Code;(3)
a program administered under Title 2, Human Resources Code;(4)
a program of the Department of State Health Services relating to mental health services;(5)
a program of the Department of Aging and Disability Services relating to intellectual disability services; or(6)
a program of the Texas Department of Criminal Justice.(b)
Sections 4201.303 (Adverse Determination: Contents of Notice)(c), 4201.304 (Time for Notice of Adverse Determination)(b), 4201.357 (Expedited Appeal for Denial of Emergency Care, Continued Hospitalization, Prescription Drugs or Intravenous Infusions)(a-1), and 4201.3601 (Immediate Appeal to Independent Review Organization for Denial of Prescription Drugs or Intravenous Infusions) do not apply to:(1)
the child health program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, or the health benefits plan for children under Chapter 63 (Health Benefits Plan for Certain Children), Health and Safety Code;(2)
the Employees Retirement System of Texas or another entity issuing or administering a coverage plan under Chapter 1551 (Texas Employees Group Benefits Act);(3)
the Teacher Retirement System of Texas or another entity issuing or administering a plan under Chapter 1575 (Texas Public School Employees Group Benefits Program) or 1579 (Texas School Employees Uniform Group Health Coverage);(4)
The Texas A&M University System or The University of Texas System or another entity issuing or administering coverage under Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System); and(5)
a managed care organization providing a Medicaid managed care plan under Chapter 533, Government Code.(b)
Sections 4201.303 (Adverse Determination: Contents of Notice)(c), 4201.304 (Time for Notice of Adverse Determination)(b), 4201.357 (Expedited Appeal for Denial of Emergency Care, Continued Hospitalization, Prescription Drugs or Intravenous Infusions)(a-1), and 4201.3601 (Immediate Appeal to Independent Review Organization for Denial of Prescription Drugs or Intravenous Infusions) do not apply to:(1)
the child health program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, or the health benefits plan for children under Chapter 63 (Health Benefits Plan for Certain Children), Health and Safety Code;(2)
the Employees Retirement System of Texas or another entity issuing or administering a coverage plan under Chapter 1551 (Texas Employees Group Benefits Act);(3)
the Teacher Retirement System of Texas or another entity issuing or administering a plan under Chapter 1575 (Texas Public School Employees Group Benefits Program) or 1579 (Texas School Employees Uniform Group Health Coverage);(4)
The Texas A&M University System or The University of Texas System or another entity issuing or administering coverage under Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System); and(5)
a managed care organization providing a Medicaid managed care plan under Chapter 540 (Medicaid Managed Care Program) or 540A (Medicaid Managed Transportation Services), Government Code, as applicable.
Source:
Section 4201.053 — Medicaid and Other State Health or Mental Health Programs, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.4201.htm#4201.053 (accessed Jun. 5, 2024).
