§ 540.0260 — COMPLIANCE WITH PROVIDER ACCESS STANDARDS; REPORT.

Texas § 540.0260

• Jurisdiction: Texas
• Code GV: Government Code

Text

Sec. 540.0260. COMPLIANCE WITH PROVIDER ACCESS STANDARDS; REPORT. A contract to which this subchapter applies must require the contracting Medicaid managed care organization to:
(1) develop and submit to the commission, before the organization begins providing health care services to recipients, a comprehensive plan that describes how the organization's provider network complies with the provider access standards the commission establishes under Section 540.0652 ;
(2) as a condition of contract retention and renewal:
(A) continue to comply with the provider access standards; and
(B) make substantial efforts, as the commission determines, to mitigate or remedy any noncompliance with the provider access standards;
(3) pay liquidated damages for each failure, as the commission determines, to comply with the provider access standards in amounts that are reasonably related to the noncompliance; and
(4) regularly, as the commission determines, submit to the commission and make available to the public a report containing:
(A) data on the organization's provider network sufficiency with regard to providing the care and services described by Section 540.0652 (a); and
(B) specific data with respect to access to primary care, specialty care, long-term services and supports, nursing services, and therapy services on the average length of time between:
(i) the date a provider requests prior authorization for the care or service and the date the organization approves or denies the request; and
(ii) the date the organization approves a request for prior authorization for the care or service and the date the care or service is initiated.

Legislative History

Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.