Texas § 540.0264 PROVIDER REIMBURSEMENT RATE REDUCTION.

Texas Statutes

§ 540.0264 — PROVIDER REIMBURSEMENT RATE REDUCTION.

Texas § 540.0264

Code GVGovernment Code

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Bluebook

Tex. Government Code Code Ann. § 540.0264 (2026).

Text

Sec. 540.0264. PROVIDER REIMBURSEMENT RATE REDUCTION.

(a)A contract to which this subchapter applies must require that the contracting Medicaid managed care organization not implement a significant, nonnegotiated, across-the-board provider reimbursement rate reduction unless:

(1)subject to Subsection (b), the organization has the commission's prior approval to implement the reduction; or

(2)the rate reduction is based on changes to the Medicaid fee schedule or cost containment initiatives the commission implements.

(b)A provider reimbursement rate reduction a Medicaid managed care organization proposes is considered to have received the commission's prior approval unless the commission issues a written statement of disapproval not later than the 45th day after the date the commission r

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Sec. 540.0264. PROVIDER REIMBURSEMENT RATE REDUCTION. (a) A contract to which this subchapter applies must require that the contracting Medicaid managed care organization not implement a significant, nonnegotiated, across-the-board provider reimbursement rate reduction unless:
(1) subject to Subsection (b), the organization has the commission's prior approval to implement the reduction; or
(2) the rate reduction is based on changes to the Medicaid fee schedule or cost containment initiatives the commission implements.
(b) A provider reimbursement rate reduction a Medicaid managed care organization proposes is considered to have received the commission's prior approval unless the commission issues a written statement of disapproval not later than the 45th day after the date the commission receives notice of the proposed rate reduction from the organization.