H.B. No. 4611
 
 
 
 
AN ACT
  relating to the nonsubstantive revision of the health and human
  services laws governing the Health and Human Services Commission,
  Medicaid, and other social services.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1.  NONSUBSTANTIVE REVISION OF
  SUBTITLE I, TITLE 4, GOVERNMENT CODE
         SECTION 1.01.  Subtitle I, Title 4, Government Code, is
  amended by adding Chapters 521, 522, 523, 524, 525, 526, 532, 540,
  540A, 542, 543, 543A, 544, 545, 546, 547, 547A, 548, 549, and 550 to read as follows:
 
  CHAPTER 521. GENERAL PROVISIONS
  Sec. 521.0001.  DEFINITIONS
  Sec. 521.0002.  REFERENCES IN LAW MEANING COMMISSION OR
                   COMMISSION DIVISION
  Sec. 521.0003.  REFERENCES IN LAW MEANING EXECUTIVE
                   COMMISSIONER, EXECUTIVE
                   COMMISSIONER'S DESIGNEE, OR DIVISION
                   DIRECTOR
  Sec. 521.0004.  REFERENCES IN LAW TO PROVISIONS DERIVED
                   FROM FORMER CHAPTER 531
  CHAPTER 521. GENERAL PROVISIONS
         Sec. 521.0001.  DEFINITIONS. In this subtitle:
               (1)  "Child health plan program" means the programs
  established under Chapters 62 and 63, Health and Safety Code.
               (2)  "Commission" means the Health and Human Services
  Commission.
               (3)  "Executive commissioner" means the executive
  commissioner of the commission.
               (4)  "Executive council" means the council established
  under Subchapter C, Chapter 523.
               (5)  "Health and human services agencies" includes the
  Department of State Health Services.
               (6)  "Health and human services system" means the
  system for providing or otherwise administering health and human
  services in this state by the commission, including through:
                     (A)  an office or division of the commission; or
                     (B)  another entity under the administrative and
  operational control of the executive commissioner.
               (7)  "Home telemonitoring service" means a health
  service that requires scheduled remote monitoring of data related
  to a patient's health and transmission of the data to a licensed
  home and community support services agency or hospital, as those
  terms are defined by Section 548.0251.
               (8)  "Medicaid" means the medical assistance program
  established under Chapter 32, Human Resources Code.
               (9)  "Medicaid managed care organization" means a
  managed care organization as defined by Section 540.0001 that
  contracts with the commission under Chapter 540 or 540A to provide
  health care services to Medicaid recipients.
               (10)  "Platform" means the technology, system,
  software, application, modality, or other method through which a
  health professional remotely interfaces with a patient when
  providing a health care service or procedure as a telemedicine
  medical service, teledentistry dental service, or telehealth
  service.
               (11)  "Section 1915(c) waiver program" means a
  federally funded state Medicaid program authorized under Section
  1915(c) of the Social Security Act (42 U.S.C. Section 1396n(c)).
               (12)  "Teledentistry dental service," "telehealth
  service," and "telemedicine medical service" have the meanings
  assigned by Section 111.001, Occupations Code. (Gov. Code, Secs.
  531.001(1-a), (2), (3), (3-a), (4), (4-a), (4-b), (4-c), (4-d),
  (6), (6-a), (7), (8); New.)
         Sec. 521.0002.  REFERENCES IN LAW MEANING COMMISSION OR
  COMMISSION DIVISION. (a) This section applies notwithstanding
  Section 521.0001(5).
         (b)  A reference in any law to any of the following state
  agencies or entities in relation to a function transferred to the
  commission under Section 531.0201, 531.02011, or 531.02012, as
  those sections existed immediately before their expiration on
  September 1, 2023, means the commission or the division of the
  commission performing the function previously performed by the
  state agency or entity before the transfer, as appropriate:
               (1)  health and human services agency;
               (2)  the Department of State Health Services;
               (3)  the Department of Aging and Disability Services;
               (4)  subject to Chapter 316 (H.B. 5), Acts of the 85th
  Legislature, Regular Session, 2017, the Department of Family and
  Protective Services; or
               (5)  the Department of Assistive and Rehabilitative
  Services.
         (c)  Notwithstanding any other law, a reference in any law to
  any of the following state agencies or entities in relation to a
  function transferred to the commission under Section 531.0201,
  531.02011, or 531.02012, as those sections existed immediately
  before their expiration on September 1, 2023, from the state agency
  that assumed the relevant function in accordance with Chapter 198
  (H.B. 2292), Acts of the 78th Legislature, Regular Session, 2003,
  means the commission or the division of the commission performing
  the function previously performed by the agency that assumed the
  function before the transfer, as appropriate:
               (1)  the Texas Department on Aging;
               (2)  the Texas Commission on Alcohol and Drug Abuse;
               (3)  the Texas Commission for the Blind;
               (4)  the Texas Commission for the Deaf and Hard of
  Hearing;
               (5)  the Texas Department of Health;
               (6)  the Texas Department of Human Services;
               (7)  the Texas Department of Mental Health and Mental
  Retardation;
               (8)  the Texas Rehabilitation Commission;
               (9)  the Texas Health Care Information Council; or
               (10)  the Interagency Council on Early Childhood
  Intervention.
         (d)  Notwithstanding any other law and subject to Chapter 316
  (H.B. 5), Acts of the 85th Legislature, Regular Session, 2017, a
  reference in any law to the Department of Protective and Regulatory
  Services in relation to a function transferred under Section
  531.0201, 531.02011, or 531.02012, as those sections existed
  immediately before their expiration on September 1, 2023, from the
  Department of Family and Protective Services means the commission
  or the division of the commission performing the function
  previously performed by the Department of Family and Protective
  Services before the transfer. (Gov. Code, Sec. 531.0011.)
         Sec. 521.0003.  REFERENCES IN LAW MEANING EXECUTIVE
  COMMISSIONER, EXECUTIVE COMMISSIONER'S DESIGNEE, OR DIVISION
  DIRECTOR. (a) A reference in any law to any of the following
  persons in relation to a function transferred to the commission
  under Section 531.0201, 531.02011, or 531.02012, as those sections
  existed immediately before their expiration on September 1, 2023,
  means the executive commissioner, the executive commissioner's
  designee, or the director of the commission division performing the
  function previously performed by the state agency from which the
  function was transferred and that the person represented, as
  appropriate:
               (1)  the commissioner of aging and disability services;
               (2)  the commissioner of assistive and rehabilitative
  services;
               (3)  the commissioner of state health services; or
               (4)  subject to Chapter 316 (H.B. 5), Acts of the 85th
  Legislature, Regular Session, 2017, the commissioner of the
  Department of Family and Protective Services.
         (b)  Notwithstanding any other law and subject to Chapter 316
  (H.B. 5), Acts of the 85th Legislature, Regular Session, 2017, a
  reference in any law to any of the following persons or entities in
  relation to a function transferred to the commission under Section
  531.0201, 531.02011, or 531.02012, as those sections existed
  immediately before their expiration on September 1, 2023, from the
  state agency that assumed or continued to perform the function in
  accordance with Chapter 198 (H.B. 2292), Acts of the 78th
  Legislature, Regular Session, 2003, means the executive
  commissioner or the director of the commission division performing
  the function performed before the enactment of Chapter 198 (H.B.
  2292) by the state agency that was abolished or renamed by Chapter
  198 (H.B. 2292) and that the person or entity represented:
               (1)  an executive director or other chief
  administrative officer of a state agency listed in Section
  521.0002(c) or of the Department of Protective and Regulatory
  Services; or
               (2)  the governing body of a state agency listed in
  Section 521.0002(c) or of the Department of Protective and
  Regulatory Services.
         (c)  A reference to any of the following councils means the
  executive commissioner or the executive commissioner's designee,
  as appropriate, and a function of any of the following councils is a
  function of that appropriate person:
               (1)  the Health and Human Services Council;
               (2)  the Aging and Disability Services Council;
               (3)  the Assistive and Rehabilitative Services
  Council;
               (4)  subject to Chapter 316 (H.B. 5), Acts of the 85th
  Legislature, Regular Session, 2017, the Family and Protective
  Services Council; or
               (5)  the State Health Services Council. (Gov. Code,
  Sec. 531.0012.)
         Sec. 521.0004.  REFERENCES IN LAW TO PROVISIONS DERIVED FROM
  FORMER CHAPTER 531. A reference in any law to "revised provisions
  derived from Chapter 531, as that chapter existed on March 31,
  2025," is a reference to the following:
               (1)  Sections 532.0051, 532.0052, 532.0053, 532.0054,
  532.0055, 532.0057, 532.0058, 532.0059, 532.0060, 532.0061, and
  540.0051;
               (2)  Subchapters B, C, D, E, F, G, H, I, and J, Chapter
  532, Subchapters A, B, C, D, E, F, G, H, and I, Chapter 548, and
  Subchapters D, D-1, and E, Chapter 550; and
               (3)  this chapter and Chapters 522, 523, 524, 525, 526,
  544, 545, 546, 547, and 549. (New.)
  CHAPTER 522. PROVISIONS APPLICABLE TO ALL HEALTH AND HUMAN
  SERVICES AGENCIES AND CERTAIN OTHER STATE ENTITIES
  SUBCHAPTER A. FISCAL PROVISIONS
  Sec. 522.0001.  LEGISLATIVE APPROPRIATIONS REQUEST BY
                   HEALTH AND HUMAN SERVICES AGENCY
  Sec. 522.0002.  ACCEPTANCE OF CERTAIN GIFTS AND GRANTS
                   BY HEALTH AND HUMAN SERVICES AGENCY
  SUBCHAPTER B. CONTRACTS
  Sec. 522.0051.  NEGOTIATION AND REVIEW OF CERTAIN
                   CONTRACTS FOR HEALTH CARE PURPOSES
  Sec. 522.0052.  PERFORMANCE STANDARDS FOR CONTRACTED
                   SERVICES PROVIDED TO INDIVIDUALS WITH
                   LIMITED ENGLISH PROFICIENCY
  SUBCHAPTER C. DATA SHARING
  Sec. 522.0101.  SHARING OF DATA RELATED TO CERTAIN
                   GENERAL REVENUE FUNDED PROGRAMS
  SUBCHAPTER D. COORDINATION OF MULTIAGENCY SERVICES
  Sec. 522.0151.  DEFINITION
  Sec. 522.0152.  APPLICABILITY OF SUBCHAPTER TO CERTAIN
                   STATE ENTITIES
  Sec. 522.0153.  MEMORANDUM OF UNDERSTANDING REQUIRED
  Sec. 522.0154.  DEVELOPMENT AND IMPLEMENTATION OF
                   MEMORANDUM OF UNDERSTANDING
  Sec. 522.0155.  CONTENTS OF MEMORANDUM OF UNDERSTANDING
  Sec. 522.0156.  ADOPTION OF MEMORANDUM OF
                   UNDERSTANDING; REVISIONS
  Sec. 522.0157.  STATE-LEVEL INTERAGENCY STAFFING GROUP
                   DUTIES; BIENNIAL REPORT
  SUBCHAPTER E. PUBLIC ACCESS TO MEETINGS
  Sec. 522.0201.  DEFINITION
  Sec. 522.0202.  ADDITIONAL APPLICABILITY TO CERTAIN
                   ADVISORY BODIES
  Sec. 522.0203.  INTERNET BROADCAST AND ARCHIVE OF OPEN
                   MEETING
  Sec. 522.0204.  INTERNET NOTICE OF OPEN MEETING
  Sec. 522.0205.  EXEMPTION UNDER CERTAIN CIRCUMSTANCES
  Sec. 522.0206.  CONTRACTING AUTHORIZED
  SUBCHAPTER F.  FACILITIES
  Sec. 522.0251.  LEASE OR SUBLEASE OF CERTAIN OFFICE
                   SPACE
  Sec. 522.0252.  ASSUMPTION OF LEASE FOR IMPLEMENTATION
                   OF INTEGRATED ENROLLMENT SERVICES
                   INITIATIVE
  Sec. 522.0253.  PREREQUISITES FOR ESTABLISHING NEW
                   HEALTH AND HUMAN SERVICES FACILITY IN
                   CERTAIN COUNTIES
  CHAPTER 522. PROVISIONS APPLICABLE TO ALL HEALTH AND HUMAN
  SERVICES AGENCIES AND CERTAIN OTHER STATE ENTITIES
  SUBCHAPTER A. FISCAL PROVISIONS
         Sec. 522.0001.  LEGISLATIVE APPROPRIATIONS REQUEST BY
  HEALTH AND HUMAN SERVICES AGENCY. (a) Each health and human
  services agency shall submit to the commission a biennial agency
  legislative appropriations request on a date determined by
  commission rule.
         (b)  A health and human services agency may not submit the
  agency's legislative appropriations request to the legislature or
  the governor until the commission reviews and comments on the
  request. (Gov. Code, Sec. 531.027.)
         Sec. 522.0002.  ACCEPTANCE OF CERTAIN GIFTS AND GRANTS BY
  HEALTH AND HUMAN SERVICES AGENCY. (a) Subject to the executive
  commissioner's written approval, a health and human services agency
  may accept a gift or grant of money, drugs, equipment, or any other
  item of value from a pharmaceutical manufacturer, distributor,
  provider, or other entity engaged in a pharmaceutical-related
  business.
         (b)  Chapter 575 does not apply to a gift or grant under this
  section.
         (c)  The executive commissioner may adopt rules and
  procedures to implement this section. The rules must ensure that
  acceptance of a gift or grant under this section:
               (1)  is consistent with federal laws and regulations;
  and
               (2)  does not adversely affect federal financial
  participation in any state program, including Medicaid.
         (d)  This section does not affect the commission's or a
  health and human services agency's authority under other law to
  accept a gift or grant from a person other than a pharmaceutical
  manufacturer, distributor, provider, or other entity engaged in a
  pharmaceutical-related business. (Gov. Code, Sec. 531.0381.)
  SUBCHAPTER B. CONTRACTS
         Sec. 522.0051.  NEGOTIATION AND REVIEW OF CERTAIN CONTRACTS
  FOR HEALTH CARE PURPOSES. (a) This section applies to a contract
  with a contract amount of $250 million or more:
               (1)  under which a person will provide goods or
  services in connection with the provision of medical or health care
  services, coverage, or benefits; and
               (2)  that will be entered into by the person and:
                     (A)  the commission;
                     (B)  a health and human services agency; or
                     (C)  any other state agency under the commission's
  jurisdiction.
         (b)  An agency described by Subsection (a)(2) must notify the
  office of the attorney general at the time the agency initiates the
  planning phase of the contracting process for a contract described
  by Subsection (a). A representative of the office of the attorney
  general or another attorney advising the agency as provided by
  Subsection (d) may:
               (1)  participate in negotiations or discussions with
  proposed contractors; and
               (2)  be physically present during those negotiations or
  discussions.
         (c)  Notwithstanding any other law, before an agency
  described by Subsection (a)(2) may enter into a contract described
  by Subsection (a), a representative of the office of the attorney
  general shall review the form and terms of the contract and may make
  recommendations to the agency for changes to the contract if the
  attorney general determines that the office of the attorney general
  has sufficient subject matter expertise and resources available to
  provide this service.
         (d)  If the attorney general determines that the office of
  the attorney general does not have sufficient subject matter
  expertise or resources available to provide the services described
  by this section, the office of the attorney general may require the
  agency described by Subsection (a)(2) to enter into an interagency
  agreement or obtain outside legal services under Section 402.0212
  for the provision of services described by this section.
         (e)  The agency described by Subsection (a)(2) shall provide
  to the office of the attorney general any information the office of
  the attorney general determines is necessary to administer this
  section. (Gov. Code, Sec. 531.018.)
         Sec. 522.0052.  PERFORMANCE STANDARDS FOR CONTRACTED
  SERVICES PROVIDED TO INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY.
  (a) This section does not apply to 2-1-1 services provided by the
  Texas Information and Referral Network.
         (b)  Each contract with the commission or a health and human
  services agency that requires the provision of call center services
  or written communications related to call center services must
  include performance standards that measure the effectiveness,
  promptness, and accuracy of the contractor's oral and written
  communications with individuals with limited English proficiency.
         (c)  A person who seeks to enter into a contract described by
  Subsection (b) must include in the bid or other applicable
  expression of interest for the contract a proposal for providing
  call center services or written communications related to call
  center services to individuals with limited English proficiency.
  The proposal must include a language access plan that describes how
  the contractor will:
               (1)  achieve any performance standards described in the
  request for bids or other applicable expressions of interest;
               (2)  identify individuals who need language
  assistance;
               (3)  provide language assistance measures, including
  the translation of forms into languages other than English and the
  provision of translators and interpreters;
               (4)  inform individuals with limited English
  proficiency of the language services available to them and how to
  obtain those services;
               (5)  develop and implement qualifications for
  bilingual staff; and
               (6)  monitor compliance with the plan.
         (d)  In determining which bid or other applicable expression
  of interest offers the best value, the commission or a health and
  human services agency, as applicable, shall evaluate the extent to
  which the proposal for providing call center services or written
  communications related to call center services in languages other
  than English will provide meaningful access to the services for
  individuals with limited English proficiency.
         (e)  In determining the extent to which a proposal will
  provide meaningful access under Subsection (d), the commission or
  health and human services agency, as applicable, shall consider:
               (1)  the language access plan described by Subsection
  (c);
               (2)  the number or proportion of individuals with
  limited English proficiency in the commission's or agency's
  eligible service population;
               (3)  the frequency with which individuals with limited
  English proficiency seek information regarding the commission's or
  agency's programs;
               (4)  the importance of the services provided by the
  commission's or agency's programs; and
               (5)  the resources available to the commission or
  agency.
         (f)  The commission or health and human services agency, as
  applicable, shall avoid selecting a contractor that the commission
  or agency reasonably believes will:
               (1)  provide information in languages other than
  English that is limited in scope;
               (2)  unreasonably delay the provision of information in
  languages other than English; or
               (3)  provide program information, including forms,
  notices, and correspondence, in English only. (Gov. Code, Sec.
  531.0191.)
  SUBCHAPTER C. DATA SHARING
         Sec. 522.0101.  SHARING OF DATA RELATED TO CERTAIN GENERAL
  REVENUE FUNDED PROGRAMS. To the extent permitted under federal law
  and notwithstanding any provision of Chapter 191 or 192, Health and
  Safety Code, the commission and other health and human services
  agencies shall share data to facilitate patient care coordination,
  quality improvement, and cost savings in Medicaid, the child health
  plan program, and other health and human services programs funded
  using money appropriated from the general revenue fund. (Gov. Code,
  Sec. 531.024(a-1).)
  SUBCHAPTER D. COORDINATION OF MULTIAGENCY SERVICES
         Sec. 522.0151.  DEFINITION. In this subchapter, "least
  restrictive setting" means a service setting for an individual
  that, in comparison to other available service settings:
               (1)  is most able to meet the individual's identified
  needs;
               (2)  prioritizes a home and community-based care
  setting; and
               (3)  engages the strengths of the family. (Gov. Code,
  Sec. 531.055(f).)
         Sec. 522.0152.  APPLICABILITY OF SUBCHAPTER TO CERTAIN STATE
  ENTITIES. This subchapter applies to the following state entities:
               (1)  the commission;
               (2)  the Department of Family and Protective Services;
               (3)  the Department of State Health Services;
               (4)  the Texas Education Agency;
               (5)  the Texas Correctional Office on Offenders with
  Medical or Mental Impairments;
               (6)  the Texas Department of Criminal Justice;
               (7)  the Texas Department of Housing and Community
  Affairs;
               (8)  the Texas Workforce Commission; and
               (9)  the Texas Juvenile Justice Department. (Gov. Code,
  Sec. 531.055(a) (part).)
         Sec. 522.0153.  MEMORANDUM OF UNDERSTANDING REQUIRED. The
  state entities to which this subchapter applies shall enter into a
  joint memorandum of understanding to promote a system of
  local-level interagency staffing groups for the identification and
  coordination of services for individuals needing multiagency
  services that:
               (1)  are to be provided in the least restrictive
  setting appropriate; and
               (2)  use residential, institutional, or congregate
  care settings only as a last resort. (Gov. Code, Sec. 531.055(a)
  (part).)
         Sec. 522.0154.  DEVELOPMENT AND IMPLEMENTATION OF
  MEMORANDUM OF UNDERSTANDING. (a)  The division within the
  commission that coordinates the policy for and delivery of mental
  health services shall oversee the development and implementation of
  the memorandum of understanding required by this subchapter.
         (b)  The state entities that participate in developing the
  memorandum of understanding shall consult with and solicit input
  from advocacy and consumer groups. (Gov. Code, Secs. 531.055(a)
  (part), (c).)
         Sec. 522.0155.  CONTENTS OF MEMORANDUM OF UNDERSTANDING.
  The memorandum of understanding required by this subchapter must:
               (1)  clarify the statutory responsibilities of each
  state entity to which this subchapter applies in relation to
  individuals needing multiagency services, including subcategories
  for different services such as:
                     (A)  family preservation and strengthening;
                     (B)  physical and behavioral health care;
                     (C)  prevention and early intervention services,
  including services designed to prevent:
                           (i)  child abuse;
                           (ii)  neglect; or
                           (iii)  delinquency, truancy, or school
  dropout;
                     (D)  diversion from juvenile or criminal justice
  involvement;
                     (E)  housing;
                     (F)  aging in place;
                     (G)  emergency shelter;
                     (H)  residential care;
                     (I)  after-care;
                     (J)  information and referral; and
                     (K)  investigation services;
               (2)  include a functional definition of "individuals
  needing multiagency services";
               (3)  outline membership, officers, and necessary
  standing committees of local-level interagency staffing groups;
               (4)  define procedures aimed at eliminating
  duplication of services relating to assessment and diagnosis,
  treatment, residential placement and care, and case management of
  individuals needing multiagency services;
               (5)  define procedures for addressing disputes between
  the state entities that relate to the entities' areas of service
  responsibilities;
               (6)  provide that each local-level interagency
  staffing group includes:
                     (A)  a local representative of each state entity;
                     (B)  representatives of local private sector
  agencies; and
                     (C)  family members or caregivers of individuals
  needing multiagency services or other current or previous consumers
  of multiagency services acting as general consumer advocates;
               (7)  provide that the local representative of each
  state entity has authority to contribute entity resources to
  solving problems identified by the local-level interagency
  staffing group;
               (8)  provide that if an individual's needs exceed the
  resources of a state entity, the entity may, with the consent of the
  individual's legal guardian, if applicable, submit a referral on
  behalf of the individual to the local-level interagency staffing
  group for consideration;
               (9)  provide that a local-level interagency staffing
  group may be called together by a representative of any member state
  entity;
               (10)  provide that a state entity representative may be
  excused from attending a meeting if the staffing group determines
  that the age or needs of the individual to be considered are clearly
  not within the entity's service responsibilities, provided that
  each entity representative is encouraged to attend all meetings to
  contribute to the collective ability of the staffing group to solve
  an individual's need for multiagency services;
               (11)  define the relationship between state-level
  interagency staffing groups and local-level interagency staffing
  groups in a manner that defines, supports, and maintains local
  autonomy;
               (12)  provide that records used or developed by a
  local-level interagency staffing group or the group's members that
  relate to a particular individual are confidential and may not be
  released to any other person or agency except as provided by this
  subchapter or other law; and
               (13)  provide a procedure that permits the state
  entities to share confidential information while preserving the
  confidential nature of the information. (Gov. Code, Sec.
  531.055(b).)
         Sec. 522.0156.  ADOPTION OF MEMORANDUM OF UNDERSTANDING;
  REVISIONS. Each state entity to which this subchapter applies
  shall adopt the memorandum of understanding required by this
  subchapter and all revisions to the memorandum. The entities shall
  develop revisions as necessary to reflect major reorganizations or
  statutory changes affecting the entities. (Gov. Code, Sec.
  531.055(d).)
         Sec. 522.0157.  STATE-LEVEL INTERAGENCY STAFFING GROUP
  DUTIES; BIENNIAL REPORT. The state entities to which this
  subchapter applies shall ensure that a state-level interagency
  staffing group provides:
               (1)  information and guidance to local-level
  interagency staffing groups regarding:
                     (A)  the availability of programs and resources in
  the community; and
                     (B)  best practices for addressing the needs of
  individuals with complex needs in the least restrictive setting
  appropriate; and
               (2)  a biennial report to the administrative head of
  each entity, the legislature, and the governor that includes:
                     (A)  the number of individuals served through the
  local-level interagency staffing groups and the outcomes of the
  services provided;
                     (B)  a description of any identified barriers to
  the state's ability to provide effective services to individuals
  needing multiagency services; and
                     (C)  any other information relevant to improving
  the delivery of services to individuals needing multiagency
  services. (Gov. Code, Sec. 531.055(e).)
  SUBCHAPTER E. PUBLIC ACCESS TO MEETINGS
         Sec. 522.0201.  DEFINITION. In this subchapter, "agency"
  means the commission or a health and human services agency. (Gov.
  Code, Sec. 531.0165(a).)
         Sec. 522.0202.  ADDITIONAL APPLICABILITY TO CERTAIN
  ADVISORY BODIES. (a) The requirements of this subchapter also
  apply to the meetings of any advisory body that advises the
  executive commissioner or an agency.
         (b)  The archived video and audio recording of an advisory
  body's meeting must be made available through the Internet website
  of the agency to which the advisory body provides advice. (Gov.
  Code, Sec. 531.0165(h).)
         Sec. 522.0203.  INTERNET BROADCAST AND ARCHIVE OF OPEN
  MEETING. (a) An agency shall:
               (1)  broadcast over the Internet live video and audio
  of each open meeting of the agency;
               (2)  make a video and audio recording of reasonable
  quality of the broadcast; and
               (3)  provide access to the archived video and audio
  recording on the agency's Internet website in accordance with
  Subsection (c).
         (b)  An agency may use for an Internet broadcast of an open
  meeting of the agency a room made available to the agency on request
  in any state building, as that term is defined by Section 2165.301.
         (c)  Not later than the seventh day after the date an open
  meeting is broadcast under this section, the agency shall make
  available through the agency's Internet website the archived video
  and audio recording of the open meeting. The agency shall maintain
  the archived video and audio recording on the agency's Internet
  website until at least the second anniversary of the date the
  recording was first made available on the website. (Gov. Code,
  Secs. 531.0165(b), (c), (e).)
         Sec. 522.0204.  INTERNET NOTICE OF OPEN MEETING. An agency
  shall provide on the agency's Internet website the same notice of an
  open meeting that the agency is required to post under Subchapter C,
  Chapter 551. The notice must be posted within the time required for
  posting notice under Subchapter C, Chapter 551. (Gov. Code, Sec.
  531.0165(d).)
         Sec. 522.0205.  EXEMPTION UNDER CERTAIN CIRCUMSTANCES. An
  agency is exempt from the requirements of this subchapter to the
  extent a catastrophe, as defined by Section 551.0411, or a
  technical breakdown prevents the agency from complying with this
  subchapter. Following the catastrophe or technical breakdown, the
  agency shall make all reasonable efforts to make available in a
  timely manner the required video and audio recording of the open
  meeting. (Gov. Code, Sec. 531.0165(f).)
         Sec. 522.0206.  CONTRACTING AUTHORIZED.  The commission
  shall consider contracting through competitive bidding with a
  private individual or entity to broadcast and archive an open
  meeting subject to this subchapter to minimize the cost of
  complying with this subchapter. (Gov. Code, Sec. 531.0165(g).)
  SUBCHAPTER F.  FACILITIES
         Sec. 522.0251.  LEASE OR SUBLEASE OF CERTAIN OFFICE SPACE.
  (a) A health and human services agency, with the commission's
  approval, or the Texas Workforce Commission or any other state
  agency that administers employment services programs may lease or
  sublease office space to a private service entity or lease or
  sublease office space from a private service entity that provides
  publicly funded health, human, or workforce services to enable
  agency eligibility and enrollment personnel to work with the entity
  if:
               (1)  client access to services would be enhanced; and
               (2)  the colocation of offices would improve the
  efficiency of the administration and delivery of services.
         (b)  Subchapters D and E, Chapter 2165, do not apply to a
  state agency that leases or subleases office space to a private
  service entity under this section.
         (c)  Subchapter B, Chapter 2167, does not apply to a state
  agency that leases or subleases office space from a private service
  entity under this section.
         (d)  A state agency is delegated the authority to enter into
  a lease or sublease under this section and may negotiate the terms
  of the lease or sublease.
         (e)  To the extent authorized by federal law, a state agency
  may share business resources with a private service entity that
  enters into a lease or sublease agreement with the agency under this
  section. (Gov. Code, Sec. 531.053.)
         Sec. 522.0252.  ASSUMPTION OF LEASE FOR IMPLEMENTATION OF
  INTEGRATED ENROLLMENT SERVICES INITIATIVE. (a) A health and human
  services agency, with the commission's approval, or the Texas
  Workforce Commission or any other state agency that administers
  employment services programs may assume a lease from an integrated
  enrollment services initiative contractor or subcontractor to
  implement the initiative at one development center, one mail
  center, or 10 or more call or change centers.
         (b)  Subchapter B, Chapter 2167, does not apply to a state
  agency that assumes a lease from a contractor or subcontractor
  under this section. (Gov. Code, Sec. 531.054.)
         Sec. 522.0253.  PREREQUISITES FOR ESTABLISHING NEW HEALTH
  AND HUMAN SERVICES FACILITY IN CERTAIN COUNTIES. A health and human
  services agency may not establish a new facility in a county with a
  population of less than 200,000 until the agency provides notice
  about the facility and the facility's location and purpose to:
               (1)  each state representative and state senator who
  represents all or part of the county;
               (2)  the county judge who represents the county; and
               (3)  the mayor of any municipality in which the facility would be located. (Gov. Code, Sec. 531.015.)
 
  CHAPTER 523. HEALTH AND HUMAN SERVICES COMMISSION
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 523.0001.  HEALTH AND HUMAN SERVICES COMMISSION;
                   RESPONSIBILITY FOR DELIVERY OF HEALTH
                   AND HUMAN SERVICES
  Sec. 523.0002.  GOALS
  Sec. 523.0003.  SUNSET PROVISION
  Sec. 523.0004.  APPLICABILITY OF OTHER LAW
  SUBCHAPTER B. EXECUTIVE COMMISSIONER; PERSONNEL
  Sec. 523.0051.  EXECUTIVE COMMISSIONER
  Sec. 523.0052.  ELIGIBILITY FOR APPOINTMENT AS
                   EXECUTIVE COMMISSIONER OR TO SERVE IN
                   CERTAIN EMPLOYMENT POSITIONS
  Sec. 523.0053.  TERM
  Sec. 523.0054.  MEDICAL DIRECTOR; OTHER PERSONNEL
  Sec. 523.0055.  CAREER LADDER PROGRAM; PERFORMANCE
                   EVALUATIONS
  Sec. 523.0056.  MERIT SYSTEM
  Sec. 523.0057.  QUALIFICATIONS AND STANDARDS OF CONDUCT
                   INFORMATION
  Sec. 523.0058.  EQUAL EMPLOYMENT OPPORTUNITY POLICY
  Sec. 523.0059.  USE OF AGENCY STAFF
  Sec. 523.0060.  CRIMINAL HISTORY BACKGROUND CHECKS
  SUBCHAPTER C. EXECUTIVE COUNCIL
  Sec. 523.0101.  HEALTH AND HUMAN SERVICES COMMISSION
                   EXECUTIVE COUNCIL
  Sec. 523.0102.  POWERS AND DUTIES
  Sec. 523.0103.  COMPOSITION
  Sec. 523.0104.  ELIGIBILITY TO SERVE ON EXECUTIVE
                   COUNCIL
  Sec. 523.0105.  PRESIDING OFFICER; RULES FOR OPERATION
  Sec. 523.0106.  MEETINGS; QUORUM
  Sec. 523.0107.  COMPENSATION; REIMBURSEMENT FOR
                   EXPENSES
  Sec. 523.0108.  PUBLIC COMMENT
  Sec. 523.0109.  CONSTRUCTION OF SUBCHAPTER
  Sec. 523.0110.  INAPPLICABILITY OF CERTAIN OTHER LAW
  SUBCHAPTER D. COMMISSION ORGANIZATION
  Sec. 523.0151.  COMMISSION DIVISIONS
  Sec. 523.0152.  DIVISION DIRECTOR APPOINTMENT AND
                   QUALIFICATIONS
  Sec. 523.0153.  DIVISION DIRECTOR DUTIES
  Sec. 523.0154.  DATA ANALYSIS UNIT; QUARTERLY UPDATE
  Sec. 523.0155.  OFFICE OF POLICY AND PERFORMANCE
  Sec. 523.0156.  PURCHASING UNIT
  SUBCHAPTER E. ADVISORY COMMITTEES
  Sec. 523.0201.  ESTABLISHMENT OF ADVISORY COMMITTEES
  Sec. 523.0202.  APPLICABILITY OF OTHER LAW
  Sec. 523.0203.  RULES FOR ADVISORY COMMITTEES
  Sec. 523.0204.  PUBLIC ACCESS TO ADVISORY COMMITTEE
                   MEETINGS
  Sec. 523.0205.  ADVISORY COMMITTEE REPORTING
  SUBCHAPTER F. PUBLIC INTEREST INFORMATION, INPUT, AND COMPLAINTS
  Sec. 523.0251.  PUBLIC INTEREST INFORMATION AND INPUT
                   GENERALLY
  Sec. 523.0252.  PUBLIC HEARINGS
  Sec. 523.0253.  NOTICE OF PUBLIC HEARING
  Sec. 523.0254.  COMPLAINTS
  Sec. 523.0255.  OFFICE OF OMBUDSMAN
  SUBCHAPTER G. OFFICE OF HEALTH COORDINATION AND CONSUMER SERVICES
  Sec. 523.0301.  DEFINITION
  Sec. 523.0302.  OFFICE; STAFF
  Sec. 523.0303.  GOALS
  Sec. 523.0304.  STRATEGIC PLAN
  Sec. 523.0305.  POWERS AND DUTIES
  Sec. 523.0306.  TEXAS HOME VISITING PROGRAM TRUST FUND
  CHAPTER 523. HEALTH AND HUMAN SERVICES COMMISSION
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 523.0001.  HEALTH AND HUMAN SERVICES COMMISSION;
  RESPONSIBILITY FOR DELIVERY OF HEALTH AND HUMAN SERVICES. (a) The
  Health and Human Services Commission is an agency of this state.
         (b)  The commission is the state agency with primary
  responsibility for ensuring the delivery of state health and human
  services in a manner that:
               (1)  uses an integrated system to determine client
  eligibility;
               (2)  maximizes the use of federal, state, and local
  funds; and
               (3)  emphasizes coordination, flexibility, and
  decision-making at the local level. (Gov. Code, Sec. 531.002.)
         Sec. 523.0002.  GOALS. The commission's goals are to:
               (1)  maximize federal funds through the efficient use
  of available state and local resources;
               (2)  provide a system that delivers prompt,
  comprehensive, effective services to individuals of this state by:
                     (A)  improving access to health and human services
  at the local level; and
                     (B)  eliminating architectural, communication,
  programmatic, and transportation barriers;
               (3)  promote the health of individuals of this state
  by:
                     (A)  reducing the incidence of disease and
  disabling conditions;
                     (B)  increasing the availability and improving
  the quality of health care services;
                     (C)  addressing the high incidence of certain
  illnesses and conditions in minority populations;
                     (D)  increasing the availability of trained
  health care professionals;
                     (E)  improving knowledge of health care needs;
                     (F)  reducing infant death and disease;
                     (G)  reducing the impacts of mental disorders in
  adults and emotional disturbances in children;
                     (H)  increasing nutritional education and
  participation in nutrition programs; and
                     (I)  reducing substance abuse;
               (4)  foster the development of responsible,
  productive, and self-sufficient citizens by:
                     (A)  improving workforce skills;
                     (B)  increasing employment, earnings, and
  benefits;
                     (C)  increasing housing opportunities;
                     (D)  increasing child-care and other
  dependent-care services;
                     (E)  improving education and vocational training
  to meet specific career goals;
                     (F)  reducing school dropouts and teen pregnancy;
                     (G)  improving parental effectiveness;
                     (H)  increasing support services for individuals
  with disabilities and services to help those individuals maintain
  or increase their independence;
                     (I)  improving access to work sites,
  accommodations, transportation, and other public places and
  activities covered by the Americans with Disabilities Act of 1990
  (42 U.S.C. Section 12101 et seq.); and
                     (J)  improving services for juvenile offenders;
               (5)  provide needed resources and services to
  individuals of this state when they cannot provide or care for
  themselves by:
                     (A)  increasing support services for adults and
  their families during periods of unemployment, financial need, or
  homelessness;
                     (B)  reducing extended dependency on basic
  support services; and
                     (C)  increasing the availability and diversity of
  long-term care provided to support individuals with chronic
  conditions in settings that focus on community-based services, with
  options ranging from their own homes to total-care facilities;
               (6)  protect the physical and emotional safety of all
  individuals of this state by:
                     (A)  reducing abuse, neglect, and exploitation of
  elderly individuals and adults with disabilities;
                     (B)  reducing child abuse and neglect;
                     (C)  reducing family violence;
                     (D)  increasing services to children who are
  truant or who run away, or who are at risk of truancy or running
  away, and their families;
                     (E)  reducing crime and juvenile delinquency;
                     (F)  reducing community health risks; and
                     (G)  improving regulation of human services
  providers; and
               (7)  improve the coordination and delivery of
  children's services. (Gov. Code, Sec. 531.003.)
         Sec. 523.0003.  SUNSET PROVISION. The Health and Human
  Services Commission is subject to Chapter 325 (Texas Sunset Act).
  Unless continued in existence as provided by that chapter, the
  commission is abolished September 1, 2027, and Chapter 531 and
  revised provisions derived from Chapter 531, as that chapter
  existed on March 31, 2025, expire on that date. (Gov. Code, Sec.
  531.004.)
         Sec. 523.0004.  APPLICABILITY OF OTHER LAW. The commission
  is subject to Chapters 2001 and 2002. (Gov. Code, Sec. 531.032.)
  SUBCHAPTER B. EXECUTIVE COMMISSIONER; PERSONNEL
         Sec. 523.0051.  EXECUTIVE COMMISSIONER. (a) The commission
  is governed by an executive commissioner.
         (b)  The governor appoints the executive commissioner with
  the advice and consent of the senate, and shall make the appointment
  without regard to race, color, disability, sex, religion, age, or
  national origin. (Gov. Code, Sec. 531.005.)
         Sec. 523.0052.  ELIGIBILITY FOR APPOINTMENT AS EXECUTIVE
  COMMISSIONER OR TO SERVE IN CERTAIN EMPLOYMENT POSITIONS. (a) In
  this section, "Texas trade association" means a cooperative and
  voluntarily joined statewide association of business or
  professional competitors in this state designed to assist its
  members and its industry or profession in dealing with mutual
  business or professional problems and in promoting their common
  interest.
         (b)  An individual may not be appointed as executive
  commissioner or be a commission employee employed in a "bona fide
  executive, administrative, or professional capacity," as that
  phrase is used for purposes of establishing an exemption to the
  overtime provisions of the Fair Labor Standards Act of 1938 (29
  U.S.C. Section 201 et seq.), if:
               (1)  the individual is an officer, employee, or paid
  consultant of a Texas trade association in the field of health and
  human services; or
               (2)  the individual's spouse is an officer, manager, or
  paid consultant of a Texas trade association in the field of health
  and human services.
         (c)  An individual may not be appointed as executive
  commissioner or act as the commission's general counsel if the
  individual is required to register as a lobbyist under Chapter 305
  because of the individual's activities for compensation on behalf
  of a profession related to the commission's operation.
         (d)  An individual may not be appointed as executive
  commissioner if the individual has a financial interest in a
  corporation, organization, or association under contract with:
               (1)  the commission or a health and human services
  agency;
               (2)  a local mental health or intellectual and
  developmental disability authority; or
               (3)  a community center. (Gov. Code, Secs. 531.006(a),
  (a-1) (part), (b), (c).)
         Sec. 523.0053.  TERM. The executive commissioner serves a
  two-year term expiring February 1 of each odd-numbered year. (Gov.
  Code, Sec. 531.007.)
         Sec. 523.0054.  MEDICAL DIRECTOR; OTHER PERSONNEL. The
  executive commissioner:
               (1)  shall employ a medical director to provide medical
  expertise to the executive commissioner and the commission; and
               (2)  may employ other personnel necessary to administer
  the commission's duties. (Gov. Code, Sec. 531.009(a).)
         Sec. 523.0055.  CAREER LADDER PROGRAM; PERFORMANCE
  EVALUATIONS. (a) The executive commissioner shall develop an
  intra-agency career ladder program. The program must require the
  intra-agency posting of all non-entry-level positions concurrently
  with any public posting.
         (b)  The executive commissioner shall develop a system of
  annual performance evaluations based on measurable job tasks. All
  merit pay for commission employees must be based on the system
  established under this subsection. (Gov. Code, Secs. 531.009(b),
  (c).)
         Sec. 523.0056.  MERIT SYSTEM. (a) The commission may
  establish a merit system for commission employees.
         (b)  The merit system may be maintained in conjunction with
  other state agencies that are required by federal law to operate
  under a merit system. (Gov. Code, Sec. 531.010.)
         Sec. 523.0057.  QUALIFICATIONS AND STANDARDS OF CONDUCT
  INFORMATION. The executive commissioner shall provide to
  commission employees as often as necessary information regarding
  their qualifications under this chapter and their responsibilities
  under applicable laws relating to standards of conduct for state
  employees. (Gov. Code, Sec. 531.009(d).)
         Sec. 523.0058.  EQUAL EMPLOYMENT OPPORTUNITY POLICY. (a)
  The executive commissioner shall prepare and maintain a written
  policy statement that implements a program of equal employment
  opportunity to ensure that all personnel transactions are made
  without regard to race, color, disability, sex, religion, age, or
  national origin.
         (b)  The policy statement must include:
               (1)  personnel policies, including policies relating
  to recruitment, evaluation, selection, training, and promotion of
  personnel, that show the commission's intent to avoid the unlawful
  employment practices described by Chapter 21, Labor Code; and
               (2)  an analysis of the extent to which the composition
  of the commission's personnel is in accordance with state and
  federal law and a description of reasonable methods to achieve
  compliance with state and federal law.
         (c)  The policy statement must be:
               (1)  updated annually;
               (2)  reviewed by the Texas Workforce Commission civil
  rights division for compliance with Subsection (b)(1); and
               (3)  filed with the governor's office. (Gov. Code,
  Secs. 531.009(e), (f), (g).)
         Sec. 523.0059.  USE OF AGENCY STAFF. To the extent the
  commission requests, a health and human services agency shall
  assign existing staff to perform a function imposed under Chapter
  531 or revised provisions derived from Chapter 531, as that chapter
  existed on March 31, 2025. (Gov. Code, Sec. 531.0242.)
         Sec. 523.0060.  CRIMINAL HISTORY BACKGROUND CHECKS. (a) In
  this section, "eligible individual" means an individual whose
  criminal history record information the executive commissioner or
  the executive commissioner's designee is entitled to obtain from
  the Department of Public Safety under Section 411.1106.
         (b)  The executive commissioner may require an eligible
  individual to submit fingerprints in a form and of a quality
  acceptable to the Department of Public Safety and the Federal
  Bureau of Investigation for use in conducting a criminal history
  background check by obtaining criminal history record information
  under Sections 411.087 and 411.1106.
         (c)  Criminal history record information the executive
  commissioner obtains under Sections 411.087 and 411.1106 may be
  used only to evaluate the qualification or suitability for
  employment, including continued employment, of an eligible
  individual.
         (d)  Notwithstanding Subsection (c), the executive
  commissioner or the executive commissioner's designee may release
  or disclose criminal history record information obtained under
  Section 411.087 only to a governmental entity or as otherwise
  authorized by federal law, including federal regulations and
  executive orders. (Gov. Code, Sec. 531.00554.)
  SUBCHAPTER C. EXECUTIVE COUNCIL
         Sec. 523.0101.  HEALTH AND HUMAN SERVICES COMMISSION
  EXECUTIVE COUNCIL. The Health and Human Services Commission
  Executive Council is established to receive public comment and
  advise the executive commissioner regarding the commission's
  operation. (Gov. Code, Sec. 531.0051(a) (part).)
         Sec. 523.0102.  POWERS AND DUTIES. (a) The executive
  council shall seek and receive public comment on:
               (1)  proposed rules;
               (2)  advisory committee recommendations;
               (3)  legislative appropriations requests or other
  documents related to the appropriations process;
               (4)  the operation of health and human services
  programs; and
               (5)  other items the executive commissioner determines
  appropriate.
         (b)  The executive council does not have authority to make
  administrative or policy decisions. (Gov. Code, Secs. 531.0051(a)
  (part), (b).)
         Sec. 523.0103.  COMPOSITION. (a) The executive council is
  composed of:
               (1)  the executive commissioner;
               (2)  the director of each division the executive
  commissioner established under former Section 531.008(c) before
  the expiration of that subsection on September 1, 2023;
               (3)  the commissioner of a health and human services
  agency;
               (4)  the commissioner of the Department of Family and
  Protective Services, regardless of whether that agency continues as
  a state agency separate from the commission; and
               (5)  other individuals the executive commissioner
  appoints as the executive commissioner determines necessary.
         (b)  To the extent the executive commissioner appoints
  members to the executive council under Subsection (a)(5), the
  executive commissioner shall make every effort to ensure that those
  appointments result in the executive council including:
               (1)  a balanced representation of a broad range of
  health and human services industry and consumer interests; and
               (2)  representation from broad geographic regions of
  this state.
         (c)  An executive council member appointed under Subsection
  (a)(5) serves at the executive commissioner's pleasure. (Gov.
  Code, Secs. 531.0051(c), (c-1), (e) (part).)
         Sec. 523.0104.  ELIGIBILITY TO SERVE ON EXECUTIVE COUNCIL.
  (a) In this section, "Texas trade association" has the meaning
  assigned by Section 523.0052.
         (b)  An individual may not serve on the executive council if:
               (1)  the individual is an officer, employee, or paid
  consultant of a Texas trade association in the field of health and
  human services; or
               (2)  the individual's spouse is an officer, manager, or
  paid consultant of a Texas trade association in the field of health
  and human services.  (Gov. Code, Secs. 531.0051(e) (part),
  531.006(a), (a-1) (part).)
         Sec. 523.0105.  PRESIDING OFFICER; RULES FOR OPERATION. The
  executive commissioner serves as the chair of the executive council
  and shall adopt rules for the council's operation. (Gov. Code, Sec.
  531.0051(d).)
         Sec. 523.0106.  MEETINGS; QUORUM. (a) The executive
  council shall meet at the executive commissioner's call at least
  quarterly.  The executive commissioner may call additional meetings
  as the executive commissioner determines necessary.
         (b)  A majority of the executive council members constitutes
  a quorum for the transaction of business.
         (c)  The executive council shall comply with the
  requirements of Subchapter E, Chapter 522. The archived video and
  audio recording of a council meeting must be made available through
  the commission's Internet website.
         (d)  A meeting of individual executive council members that
  occurs in the ordinary course of commission operation is not a
  council meeting, and the requirements of Subsection (c) do not
  apply to the meeting. (Gov. Code, Secs. 531.0051(f), (g), (h),
  (k).)
         Sec. 523.0107.  COMPENSATION; REIMBURSEMENT FOR EXPENSES.
  An executive council member appointed under Section 523.0103(a)(5)
  may not receive compensation for service as a council member but is
  entitled to reimbursement for travel expenses the member incurs
  while conducting council business as provided by the General
  Appropriations Act. (Gov. Code, Sec. 531.0051(i).)
         Sec. 523.0108.  PUBLIC COMMENT. The executive commissioner
  shall develop and implement policies that provide the public with a
  reasonable opportunity to appear before the executive council which
  may include holding meetings in various geographic areas across
  this state or allowing public comment at teleconferencing centers
  in various geographic areas across this state and to speak on any
  issue under the commission's jurisdiction. (Gov. Code, Sec.
  531.0051(j).)
         Sec. 523.0109.  CONSTRUCTION OF SUBCHAPTER. This subchapter
  does not limit the executive commissioner's authority to establish
  additional advisory committees or councils. (Gov. Code, Sec.
  531.0051(l).)
         Sec. 523.0110.  INAPPLICABILITY OF CERTAIN OTHER LAW.
  Except as provided by Section 522.0204, Chapters 551 and 2110 do not
  apply to the executive council. (Gov. Code, Sec. 531.0051(m).)
  SUBCHAPTER D. COMMISSION ORGANIZATION
         Sec. 523.0151.  COMMISSION DIVISIONS. (a) The executive
  commissioner shall establish divisions within the commission along
  functional lines as necessary for effective administration and the
  discharge of the commission's functions.
         (b)  The executive commissioner may allocate and reallocate
  functions among the commission's divisions.  (Gov. Code, Secs.
  531.008(a), (b).)
         Sec. 523.0152.  DIVISION DIRECTOR APPOINTMENT AND
  QUALIFICATIONS. (a) The executive commissioner shall appoint a
  director for each division established within the commission under
  Section 523.0151, except that the director of the office of
  inspector general is appointed in accordance with Section 544.0101.
         (b)  The executive commissioner shall:
               (1)  develop clear qualifications for each director
  appointed under this section to ensure the director has:
                     (A)  demonstrated experience in fields relevant
  to the director position; and
                     (B)  executive-level administrative and
  leadership experience; and
               (2)  ensure the qualifications developed under
  Subdivision (1) are publicly available. (Gov. Code, Sec.
  531.00561.)
         Sec. 523.0153.  DIVISION DIRECTOR DUTIES. (a) The
  executive commissioner shall clearly define the duties and
  responsibilities of a division director.
         (b)  The executive commissioner shall develop clear policies
  for the delegation to division directors of specific
  decision-making authority, including budget authority. The
  delegation should be significant enough to ensure the efficient
  administration of the commission's programs and services. (Gov.
  Code, Sec. 531.00562.)
         Sec. 523.0154.  DATA ANALYSIS UNIT; QUARTERLY UPDATE. (a)
  The executive commissioner shall establish a data analysis unit
  within the commission to establish, employ, and oversee data
  analysis processes designed to:
               (1)  improve contract management;
               (2)  detect data trends; and
               (3)  identify anomalies relating to service
  utilization, providers, payment methodologies, and compliance with
  requirements in Medicaid and child health plan program managed care
  and fee-for-service contracts.
         (b)  The commission shall assign to the data analysis unit
  staff who perform duties only in relation to the unit.
         (c)  The data analysis unit shall use all available data and
  tools for data analysis when establishing, employing, and
  overseeing data analysis processes under this section.
         (d)  Not later than the 30th day following the end of each
  calendar quarter, the data analysis unit shall provide an update on
  the unit's activities and findings to the governor, the lieutenant
  governor, the speaker of the house of representatives, the chair of
  the Senate Finance Committee, the chair of the House Appropriations
  Committee, and the chairs of the standing committees of the senate
  and house of representatives having jurisdiction over Medicaid.
  (Gov. Code, Sec. 531.0082.)
         Sec. 523.0155.  OFFICE OF POLICY AND PERFORMANCE. (a) In
  this section, "office" means the office of policy and performance
  established under this section.
         (b)  The executive commissioner shall establish the office
  of policy and performance as an executive-level office designed to
  coordinate policy and performance efforts across the health and
  human services system. To coordinate those efforts, the office
  shall:
               (1)  develop a performance management system;
               (2)  take the lead in providing support and oversight
  for the implementation of major policy changes and in managing
  organizational changes; and
               (3)  act as a centralized body of experts within the
  commission that offers program evaluation and process improvement
  expertise.
         (c)  In developing a performance management system under
  Subsection (b)(1), the office shall:
               (1)  gather, measure, and evaluate performance
  measures and accountability systems the health and human services
  system uses;
               (2)  develop new and refined performance measures as
  appropriate; and
               (3)  establish targeted, high-level system metrics
  capable of measuring overall performance and achievement of goals
  by the health and human services system and of communicating that
  performance and achievement to both internal and public audiences
  through various mechanisms, including the Internet.
         (d)  In providing support and oversight for the
  implementation of policy or organizational changes within the
  health and human services system under Subsection (b)(2), the
  office shall:
               (1)  ensure individuals receiving services from or
  participating in programs administered through the health and human
  services system do not lose visibility or attention during the
  implementation of any new policy or organizational change by:
                     (A)  establishing timelines and milestones for
  any transition;
                     (B)  supporting health and human services system
  staff in any change between service delivery methods; and
                     (C)  providing feedback to executive management
  on technical assistance and other support needed to achieve a
  successful transition;
               (2)  address cultural differences among health and
  human services system staff; and
               (3)  track and oversee changes in policy or
  organization mandated by legislation or administrative rule.
         (e)  In acting as a centralized body of experts under
  Subsection (b)(3), the office shall:
               (1)  for the health and human services system, provide
  program evaluation and process improvement guidance both generally
  and for specific projects identified with executive or stakeholder
  input or through risk analysis; and
               (2)  identify and monitor cross-functional efforts
  involving different administrative components within the health
  and human services system and the establishment of cross-functional
  teams when necessary to improve the coordination of services
  provided through the system.
         (f)  Except as otherwise provided by this section, the
  executive commissioner may develop the office's structure and
  duties as the executive commissioner determines appropriate. (Gov.
  Code, Sec. 531.0083.)
         Sec. 523.0156.  PURCHASING UNIT. (a) The commission shall
  establish a purchasing unit to manage administrative activities
  related to the purchasing functions within the health and human
  services system.
         (b)  The purchasing unit shall:
               (1)  seek to achieve targeted cost reductions, increase
  process efficiencies, improve technological support and customer
  services, and enhance purchasing support within the health and
  human services system; and
               (2)  if cost-effective, contract with private entities
  to perform purchasing functions for the health and human services
  system. (Gov. Code, Sec. 531.017.)
  SUBCHAPTER E. ADVISORY COMMITTEES
         Sec. 523.0201.  ESTABLISHMENT OF ADVISORY COMMITTEES. The
  executive commissioner shall establish and maintain advisory
  committees to consider issues and solicit public input across all
  major areas of the health and human services system which may be
  from various geographic areas across this state, which may be done
  either in person or through teleconferencing centers, including
  relating to the following issues:
               (1)  Medicaid and other social services programs;
               (2)  managed care under Medicaid and the child health
  plan program;
               (3)  health care quality initiatives;
               (4)  aging;
               (5)  individuals with disabilities, including
  individuals with autism;
               (6)  rehabilitation, including for individuals with
  brain injuries;
               (7)  children;
               (8)  public health;
               (9)  behavioral health;
               (10)  regulatory matters;
               (11)  protective services; and
               (12)  prevention efforts. (Gov. Code, Sec.
  531.012(a).)
         Sec. 523.0202.  APPLICABILITY OF OTHER LAW. Chapter 2110
  applies to an advisory committee established under this subchapter.
  (Gov. Code, Sec. 531.012(b).)
         Sec. 523.0203.  RULES FOR ADVISORY COMMITTEES. The
  executive commissioner shall adopt rules:
               (1)  in compliance with Chapter 2110 to govern the
  purpose, tasks, reporting requirements, and date of abolition of an
  advisory committee established under this subchapter; and
               (2)  related to an advisory committee's:
                     (A)  size and quorum requirements;
                     (B)  membership, including:
                           (i)  member qualifications and any
  experience requirements;
                           (ii)  required geographic representation;
                           (iii)  appointment procedures; and
                           (iv)  members' terms; and
                     (C)  duty to comply with the requirements for open
  meetings under Chapter 551. (Gov. Code, Sec. 531.012(c).)
         Sec. 523.0204.  PUBLIC ACCESS TO ADVISORY COMMITTEE
  MEETINGS. (a) This section applies to an advisory committee
  established under this subchapter.
         (b)  The commission shall create a master calendar that
  includes all advisory committee meetings across the health and
  human services system.
         (c)  The commission shall make available on the commission's
  Internet website:
               (1)  the master calendar;
               (2)  all meeting materials for an advisory committee
  meeting; and
               (3)  streaming live video and audio of each advisory
  committee meeting.
         (d)  The commission shall provide Internet access in each
  room used for a meeting that appears on the master calendar.
         (e)  The commission shall ensure that, to the same extent and
  in the same manner as the broadcast, archiving, and notice of agency
  meetings are required under Subchapter E, Chapter 522, advisory
  committee meetings are:
               (1)  broadcast;
               (2)  archived on the Internet website of the agency to
  which the advisory committee provides advice; and
               (3)  subject to public notice requirements. (Gov.
  Code, Sec. 531.0121.)
         Sec. 523.0205.  ADVISORY COMMITTEE REPORTING. An advisory
  committee established under this subchapter shall:
               (1)  report any recommendations to the executive
  commissioner; and
               (2)  submit a written report to the legislature of any
  policy recommendations the advisory committee made to the executive
  commissioner under Subdivision (1). (Gov. Code, Sec. 531.012(d),
  as added Acts 84th Leg., R.S., Ch. 946.)
  SUBCHAPTER F. PUBLIC INTEREST INFORMATION, INPUT, AND COMPLAINTS
         Sec. 523.0251.  PUBLIC INTEREST INFORMATION AND INPUT
  GENERALLY. (a) The commission shall develop and implement
  policies that provide the public a reasonable opportunity to appear
  before the commission and speak on any issue under the commission's
  jurisdiction.
         (b)  The commission shall develop and implement routine and
  ongoing mechanisms, in accessible formats, to:
               (1)  receive consumer input;
               (2)  involve consumers in the planning, delivery, and
  evaluation of programs and services under the commission's
  jurisdiction; and
               (3)  communicate to the public regarding the input the
  commission receives under this section and actions taken in
  response to that input.
         (c)  The commission shall prepare information of public
  interest describing the commission's functions. The commission
  shall make the information available to the public and appropriate
  state agencies. (Gov. Code, Secs. 531.011(a), (b), (c) (part).)
         Sec. 523.0252.  PUBLIC HEARINGS. (a) The commission
  biennially shall conduct a series of public hearings in diverse
  locations throughout this state to give citizens of this state an
  opportunity to comment on health and human services issues. The
  commission shall conduct a sufficient number of hearings to allow
  reasonable access by citizens in both rural and urban areas, with an
  emphasis on geographic diversity.
         (b)  In conducting a public hearing under this section, the
  commission shall, to the greatest extent possible, encourage
  participation in the hearings process by diverse groups of citizens
  in this state.
         (c)  A public hearing held under this section is subject to
  Chapter 551. (Gov. Code, Sec. 531.036.)
         Sec. 523.0253.  NOTICE OF PUBLIC HEARING. (a) In addition
  to the notice required by Chapter 551, the commission shall:
               (1)  publish notice of a public hearing under Section
  523.0252 in a newspaper of general circulation in the county in
  which the hearing is to be held; and
               (2)  provide written notice of the hearing to public
  officials in the affected area.
         (b)  If the county in which the public hearing is to be held
  does not have a newspaper of general circulation, the commission
  shall publish notice in a newspaper of general circulation in an
  adjacent county or in the nearest county in which a newspaper of
  general circulation is published.
         (c)  Notice must be published once a week for two consecutive
  weeks before the public hearing, with the first publication
  appearing not later than the 15th day before the date set for the
  hearing. (Gov. Code, Sec. 531.037.)
         Sec. 523.0254.  COMPLAINTS. (a) The commission shall
  prepare information of public interest describing the commission's
  procedures by which complaints are filed with and resolved by the
  commission. The commission shall make the information available to
  the public and appropriate state agencies.
         (b)  The executive commissioner by rule shall establish
  methods by which the public, consumers, and service recipients can
  be notified of the mailing addresses and telephone numbers of
  appropriate agency personnel for the purpose of directing
  complaints to the commission. The commission may provide for that
  notice:
               (1)  on each registration form, application, or written
  contract for services of a person the commission regulates;
               (2)  on a sign prominently displayed in the place of
  business of each person the commission regulates; or
               (3)  in a bill for service provided by a person the
  commission regulates.
         (c)  The commission shall:
               (1)  keep an information file about each complaint
  filed with the commission relating to:
                     (A)  a license holder or entity the commission
  regulates; or
                     (B)  a service the commission delivers; and
               (2)  maintain an information file about each complaint
  the commission receives relating to any other matter or agency
  under the commission's jurisdiction.
         (d)  If a written complaint is filed with the commission
  relating to a license holder or entity the commission regulates or
  a service the commission delivers, the commission, at least
  quarterly and until final disposition of the complaint, shall
  notify the parties to the complaint of the status of the complaint
  unless notice would jeopardize an undercover investigation. (Gov.
  Code, Secs. 531.011(c) (part), (d), (e), (f), (g).)
         Sec. 523.0255.  OFFICE OF OMBUDSMAN. (a) The executive
  commissioner shall establish the commission's office of the
  ombudsman with authority and responsibility over the health and
  human services system in performing the following functions:
               (1)  providing dispute resolution services for the
  health and human services system;
               (2)  performing consumer protection and advocacy
  functions related to health and human services, including assisting
  a consumer or other interested person with:
                     (A)  raising a matter within the health and human
  services system that the person feels is being ignored; and
                     (B)  obtaining information regarding a filed
  complaint; and
               (3)  collecting inquiry and complaint data related to
  the health and human services system.
         (b)  The office of the ombudsman does not have the authority
  to provide a separate process for resolving complaints or appeals.
         (c)  The executive commissioner shall develop a standard
  process for tracking and reporting received inquiries and
  complaints within the health and human services system. The
  process must provide for the centralized tracking of inquiries and
  complaints submitted to field, regional, or other local health and
  human services system offices.
         (d)  Using the process developed under Subsection (c), the
  office of the ombudsman shall collect inquiry and complaint data
  from all agencies, divisions, offices, and other entities within
  the health and human services system. To assist with the collection
  of data under this subsection, the office may access any system or
  process for recording inquiries and complaints the health and human
  services system uses or maintains. (Gov. Code, Sec. 531.0171.)
  SUBCHAPTER G. OFFICE OF HEALTH COORDINATION AND CONSUMER SERVICES
         Sec. 523.0301.  DEFINITION. In this subchapter, "office"
  means the Office of Health Coordination and Consumer Services.
  (Gov. Code, Sec. 531.281.)
         Sec. 523.0302.  OFFICE; STAFF. (a) The Office of Health
  Coordination and Consumer Services is an office within the
  commission.
         (b)  The executive commissioner shall employ staff as needed
  to carry out the duties of the office. (Gov. Code, Sec. 531.282.)
         Sec. 523.0303.  GOALS. The goals of the office are to:
               (1)  promote community support for parents of children
  younger than six years of age through an integrated state and
  local-level decision-making process; and
               (2)  provide for the seamless delivery of health and
  human services to children younger than six years of age to ensure
  that children are prepared to succeed in school. (Gov. Code, Sec.
  531.283.)
         Sec. 523.0304.  STRATEGIC PLAN. (a) The office shall create
  and implement a statewide strategic plan for the delivery of health
  and human services to children younger than six years of age.
         (b)  In developing the statewide strategic plan, the office
  shall:
               (1)  consider existing programs and models to serve
  children younger than six years of age, including:
                     (A)  community resource coordination groups;
                     (B)  the Texas System of Care; and
                     (C)  the Texas Information and Referral Network
  and the 2-1-1 telephone number for access to human services;
               (2)  attempt to maximize federal funds and local
  existing infrastructure and funds; and
               (3)  provide for local participation to the greatest
  extent possible.
         (c)  The statewide strategic plan must address the needs of
  children with disabilities who are younger than six years of age.
  (Gov. Code, Sec. 531.284.)
         Sec. 523.0305.  POWERS AND DUTIES. (a) The office shall
  identify:
               (1)  gaps in early childhood services by functional
  area and geographical area;
               (2)  state policies, rules, and service procedures that
  prevent or inhibit children younger than six years of age from
  accessing available services;
               (3)  sources of funds for early childhood services,
  including federal, state, and private-public venture sources;
               (4)  opportunities for collaboration between the Texas
  Education Agency and health and human services agencies to better
  serve the needs of children younger than six years of age;
               (5)  methods for coordinating early childhood services
  provided by the Texas Head Start State Collaboration Office, the
  Texas Education Agency, and the Texas Workforce Commission;
               (6)  quantifiable benchmarks for success within early
  childhood service delivery; and
               (7)  national best practices in early care and
  educational delivery models.
         (b)  The office shall establish community outreach efforts
  and ensure adequate communication lines that provide:
               (1)  the office with information about community-level
  efforts; and
               (2)  communities with information about funds and
  programs available to communities.
         (c)  The office shall make recommendations to the commission
  on strategies to:
               (1)  ensure optimum collaboration and coordination
  between state agencies serving the needs of children younger than
  six years of age and other community stakeholders;
               (2)  fill functional and geographical gaps in early
  childhood services; and
               (3)  amend state policies, rules, and service
  procedures that prevent or inhibit children younger than six years
  of age from accessing services. (Gov. Code, Sec. 531.285.)
         Sec. 523.0306.  TEXAS HOME VISITING PROGRAM TRUST FUND. (a)
  The Texas Home Visiting Program trust fund is a trust fund outside
  the treasury with the comptroller. The fund is administered by the
  office under this section and rules the executive commissioner
  adopts. Money in the fund is not state money and is not subject to
  legislative appropriation.
         (b)  The fund consists of money from voluntary contributions
  under Section 191.0048, Health and Safety Code, and Section
  118.018, Local Government Code.
         (c)  The office may spend money in the fund without
  appropriation and only for the purpose of the Texas Home Visiting
  Program the commission administers.
         (d)  Interest and income from fund assets shall be credited to and deposited in the fund. (Gov. Code, Sec. 531.287.)
 
  CHAPTER 524. AUTHORITY OVER HEALTH AND HUMAN SERVICES SYSTEM
  SUBCHAPTER A. SYSTEM OVERSIGHT AUTHORITY OF COMMISSION
  Sec. 524.0001.  GENERAL RESPONSIBILITY OF COMMISSION
                   FOR HEALTH AND HUMAN SERVICES SYSTEM;
                   PRIORITIZATION OF CERTAIN DUTIES
  Sec. 524.0002.  GENERAL RESPONSIBILITY OF EXECUTIVE
                   COMMISSIONER FOR HEALTH AND HUMAN
                   SERVICES SYSTEM
  Sec. 524.0003.  ADOPTION OR APPROVAL OF PAYMENT RATES
  Sec. 524.0004.  PROGRAM TO EVALUATE AND SUPERVISE DAILY
                   OPERATIONS
  Sec. 524.0005.  RULES
  SUBCHAPTER B. COMMISSIONERS OF HEALTH AND HUMAN SERVICES AGENCIES
  Sec. 524.0051.  APPOINTMENT OF AGENCY COMMISSIONER BY
                   EXECUTIVE COMMISSIONER
  Sec. 524.0052.  EVALUATION OF AGENCY COMMISSIONER
  SUBCHAPTER C.  MEMORANDUM OF UNDERSTANDING FOR OPERATION OF SYSTEM
  Sec. 524.0101.  MEMORANDUM OF UNDERSTANDING BETWEEN
                   EXECUTIVE COMMISSIONER AND HEALTH AND
                   HUMAN SERVICES AGENCY COMMISSIONER
  Sec. 524.0102.  ADOPTION AND AMENDMENT OF MEMORANDUM OF
                   UNDERSTANDING
  SUBCHAPTER D.  RULES AND POLICIES FOR HEALTH AND HUMAN SERVICES
  Sec. 524.0151.  AUTHORITY TO ADOPT RULES AND POLICIES
  Sec. 524.0152.  PROCEDURES FOR ADOPTING RULES AND
                   POLICIES
  Sec. 524.0153.  POLICY FOR NEGOTIATED RULEMAKING AND
                   ALTERNATIVE DISPUTE RESOLUTION
                   PROCEDURES
  Sec. 524.0154.  PERSON FIRST RESPECTFUL LANGUAGE
                   PROMOTION
  SUBCHAPTER E. ADMINISTRATIVE SUPPORT SERVICES
  Sec. 524.0201.  DEFINITION
  Sec. 524.0202.  CENTRALIZED SYSTEM OF ADMINISTRATIVE
                   SUPPORT SERVICES
  Sec. 524.0203.  PRINCIPLES FOR AND REQUIREMENTS OF
                   CENTRALIZED SYSTEM; MEMORANDUM OF
                   UNDERSTANDING
  SUBCHAPTER F.  LEGISLATIVE OVERSIGHT
  Sec. 524.0251.  OVERSIGHT BY LEGISLATIVE COMMITTEES
  Sec. 524.0252.  INFORMATION PROVIDED TO LEGISLATIVE
                   COMMITTEES
  CHAPTER 524. AUTHORITY OVER HEALTH AND HUMAN SERVICES SYSTEM
  SUBCHAPTER A. SYSTEM OVERSIGHT AUTHORITY OF COMMISSION
         Sec. 524.0001.  GENERAL RESPONSIBILITY OF COMMISSION FOR
  HEALTH AND HUMAN SERVICES SYSTEM; PRIORITIZATION OF CERTAIN DUTIES.
  (a) The commission shall:
               (1)  supervise the administration and operation of
  Medicaid, including the administration and operation of the
  Medicaid managed care system in accordance with Sections 532.0051
  and 532.0057;
               (2)  perform information resources planning and
  management for the health and human services system under Section
  525.0251, with:
                     (A)  the provision of information technology
  services for the health and human services system as a centralized
  administrative support service performed either by commission
  personnel or under a contract with the commission; and
                     (B)  an emphasis on research and implementation on
  a demonstration or pilot basis of appropriate and efficient uses of
  new and existing technology to improve the operation of the health
  and human services system and delivery of health and human
  services;
               (3)  monitor and ensure the effective use of all
  federal funds received for the health and human services system in
  accordance with Section 525.0052 and the General Appropriations
  Act;
               (4)  implement Texas Integrated Enrollment Services as
  required by Subchapter A, Chapter 545, except that notwithstanding
  that subchapter, the commission is responsible for determining and
  must centralize benefits eligibility under the following programs:
                     (A)  the child health plan program;
                     (B)  the financial assistance program under
  Chapter 31, Human Resources Code;
                     (C)  Medicaid;
                     (D)  the supplemental nutrition assistance
  program under Chapter 33, Human Resources Code;
                     (E)  long-term care services as defined by Section
  22.0011, Human Resources Code;
                     (F)  community-based support services identified
  or provided in accordance with Subchapter D, Chapter 546; and
                     (G)  other health and human services programs, as
  appropriate; and
               (5)  implement programs intended to prevent family
  violence and provide services to victims of family violence.
         (b)  The commission shall implement the powers and duties
  given to the commission under Sections 525.0002, 525.0153,
  2155.144, and 2167.004.
         (c)  After implementing the commission's duties under
  Subsections (a) and (b), the commission shall implement the powers
  and duties given to the commission under Section 525.0160.
         (d)  Nothing in the priorities established by this section is
  intended to limit the commission's authority to work simultaneously
  to achieve the multiple tasks assigned to the commission in this
  section and Section 524.0202(a)(1) when that approach is beneficial
  in the commission's judgment.  (Gov. Code, Secs. 531.0055(b), (c),
  (d) (part).)
         Sec. 524.0002.  GENERAL RESPONSIBILITY OF EXECUTIVE
  COMMISSIONER FOR HEALTH AND HUMAN SERVICES SYSTEM.  (a)  The
  executive commissioner, as necessary to perform the functions
  described by Section 524.0001 and Subchapter E in implementing
  applicable policies the executive commissioner establishes for a
  health and human services agency or division, shall:
               (1)  manage and direct the operations of each agency or
  division, as applicable;
               (2)  supervise and direct the activities of each agency
  commissioner or division director, as applicable; and
               (3)  be responsible for the administrative supervision
  of the internal audit program for the agencies, including:
                     (A)  selecting the director of internal audit;
                     (B)  ensuring the director of internal audit
  reports directly to the executive commissioner; and
                     (C)  ensuring the independence of the internal
  audit function.
         (b)  The executive commissioner's operational authority and
  responsibility for purposes of Subsection (a) and Section
  524.0151(a)(2) for each health and human services agency or
  division, as applicable, includes authority over and
  responsibility for:
               (1)  daily operations management of the agency or
  division, including the organization, management, and operating
  procedures of the agency or division;
               (2)  resource allocation within the agency or division,
  including the use of federal funds the agency or division receives;
               (3)  personnel and employment policies;
               (4)  contracting, purchasing, and related policies,
  subject to this chapter and other laws relating to contracting and
  purchasing by a state agency;
               (5)  information resources systems the agency or
  division uses;
               (6)  facility location; and
               (7)  the coordination of agency or division activities
  with activities of other components of the health and human
  services system and state agencies.  (Gov. Code, Secs. 531.0055(a)
  (part), (e) (part), (f).)
         Sec. 524.0003.  ADOPTION OR APPROVAL OF PAYMENT RATES.  
  Notwithstanding any other law, the executive commissioner's
  operational authority and responsibility for purposes of Sections
  524.0002(a) and 524.0151(a)(2) for each health and human services
  agency or division, as applicable, include the authority and
  responsibility to adopt or approve, subject to applicable
  limitations, any payment rate or similar provision a health and
  human services agency is required by law to adopt or approve.  (Gov.
  Code, Sec. 531.0055(g).)
         Sec. 524.0004.  PROGRAM TO EVALUATE AND SUPERVISE DAILY
  OPERATIONS.  (a)  For each health and human services agency and
  division, as applicable, the executive commissioner shall
  implement a program to evaluate and supervise daily operations.
         (b)  The program must include:
               (1)  measurable performance objectives for each agency
  commissioner or division director; and
               (2)  adequate reporting requirements to permit the
  executive commissioner to perform the duties assigned to the
  executive commissioner under:
                     (A)  this subchapter;
                     (B)  Sections 524.0101(a), 524.0151(a)(2) and
  (b), and 525.0254(b); and
                     (C)  Section 524.0202 with respect to the health
  and human services system. (Gov. Code, Secs. 531.0055(a) (part),
  (h).)
         Sec. 524.0005.  RULES. The executive commissioner shall
  adopt rules to implement the executive commissioner's authority
  under this subchapter with respect to the health and human services
  system. (Gov. Code, Sec. 531.0055(j).)
  SUBCHAPTER B. COMMISSIONERS OF HEALTH AND HUMAN SERVICES AGENCIES
         Sec. 524.0051.  APPOINTMENT OF AGENCY COMMISSIONER BY
  EXECUTIVE COMMISSIONER. (a) The executive commissioner, with the
  governor's approval, shall appoint a commissioner for each health
  and human services agency.
         (b)  A health and human services agency commissioner serves
  at the executive commissioner's pleasure. (Gov. Code, Secs.
  531.0055(a) (part), 531.0056(a), (b).)
         Sec. 524.0052.  EVALUATION OF AGENCY COMMISSIONER. Based on
  the performance objectives outlined in the memorandum of
  understanding entered into under Section 524.0101(a), the
  executive commissioner shall perform an employment evaluation of
  each health and human services agency commissioner. The executive
  commissioner shall submit the evaluation to the governor not later
  than January 1 of each even-numbered year. (Gov. Code, Secs.
  531.0055(a) (part), 531.0056(c) (part), (e), (f).)
  SUBCHAPTER C.  MEMORANDUM OF UNDERSTANDING FOR OPERATION OF SYSTEM
         Sec. 524.0101.  MEMORANDUM OF UNDERSTANDING BETWEEN
  EXECUTIVE COMMISSIONER AND HEALTH AND HUMAN SERVICES AGENCY
  COMMISSIONER. (a) The executive commissioner and each health and
  human services agency commissioner shall enter into a memorandum of
  understanding in the manner prescribed by Section 524.0102 that:
               (1)  clearly defines the responsibilities of the
  executive commissioner and the commissioner, including:
                     (A)  the responsibility of the commissioner to:
                           (i)  report to the governor; and
                           (ii)  report to and implement policies of
  the executive commissioner; and
                     (B)  the extent to which the commissioner acts as
  a liaison between the health and human services agency the
  commissioner serves and the commission;
               (2)  establishes the program to evaluate and supervise
  daily operations required by Section 524.0004;
               (3)  describes each power or duty delegated to a
  commissioner; and
               (4)  ensures the commission and each health and human
  services agency has access to databases or other information each
  other agency maintains or keeps that is necessary for the operation
  of a function the commission or the health and human services agency
  performs, to the extent not prohibited by other law.
         (b)  The memorandum of understanding must also outline
  specific performance objectives, as the executive commissioner
  defines, to be fulfilled by the health and human services agency
  commissioner with whom the executive commissioner enters into the
  memorandum of understanding, including the performance objectives
  required by Section 524.0004.  (Gov. Code, Secs. 531.0055(a)
  (part), (k), 531.0056(c), (d).)
         Sec. 524.0102.  ADOPTION AND AMENDMENT OF MEMORANDUM OF
  UNDERSTANDING. (a) The executive commissioner by rule shall adopt
  the memorandum of understanding under Section 524.0101 in
  accordance with the procedures prescribed by Subchapter B, Chapter
  2001, for adopting rules, except that the requirements of Sections
  2001.033(a)(1)(A) and (C) do not apply with respect to any part of
  the memorandum of understanding that:
               (1)  concerns only internal management or organization
  within or among health and human services agencies and does not
  affect private rights or procedures; or
               (2)  relates solely to the internal personnel practices
  of health and human services agencies.
         (b)  The memorandum of understanding may be amended only by
  following the procedures prescribed by Subsection (a).  (Gov. Code,
  Sec. 531.0163.)
  SUBCHAPTER D.  RULES AND POLICIES FOR HEALTH AND HUMAN SERVICES
         Sec. 524.0151.  AUTHORITY TO ADOPT RULES AND POLICIES. (a)
  The executive commissioner shall:
               (1)  adopt rules necessary to carry out the
  commission's duties under Chapter 531 and revised provisions
  derived from Chapter 531, as that chapter existed on March 31, 2025;
  and
               (2)  notwithstanding any other law, adopt rules and
  policies for the operation of the health and human services system
  and the provision of health and human services by that system.
         (b)  Notwithstanding any other law, the executive
  commissioner has the authority to adopt rules and policies
  governing:
               (1)  the delivery of services to persons the health and
  human services system serves; and
               (2)  the rights and duties of persons the system serves
  or regulates.  (Gov. Code, Secs. 531.0055(e) (part), (l), 531.033.)
         Sec. 524.0152.  PROCEDURES FOR ADOPTING RULES AND POLICIES.
  (a) The executive commissioner shall develop procedures for
  adopting rules for the health and human services agencies.  The
  procedures must specify the manner in which the agencies may
  participate in the rulemaking process.
         (b)  A health and human services agency shall assist the
  executive commissioner in developing policies and guidelines
  needed for the administration of the agency's functions and shall
  submit any proposed policies and guidelines to the executive
  commissioner.  The agency may implement a proposed policy or
  guideline only if the executive commissioner approves the policy or
  guideline.  (Gov. Code, Sec. 531.00551.)
         Sec. 524.0153.  POLICY FOR NEGOTIATED RULEMAKING AND
  ALTERNATIVE DISPUTE RESOLUTION PROCEDURES. (a) The commission
  shall develop and implement a policy for the commission and each
  health and human services agency to encourage the use of:
               (1)  negotiated rulemaking procedures under Chapter
  2008 for the adoption of rules for the commission and each agency;
  and
               (2)  appropriate alternative dispute resolution
  procedures under Chapter 2009 to assist in the resolution of
  internal and external disputes under the commission's or agency's
  jurisdiction.
         (b)  The procedures relating to alternative dispute
  resolution must conform, to the extent possible, to any model
  guidelines the State Office of Administrative Hearings issues for
  the use of alternative dispute resolution by state agencies.
         (c)  The commission shall:
               (1)  coordinate the implementation of the policy
  developed under Subsection (a);
               (2)  provide training as needed to implement the
  procedures for negotiated rulemaking or alternative dispute
  resolution; and
               (3)  collect data concerning the effectiveness of those
  procedures.  (Gov. Code, Sec. 531.0161.)
         Sec. 524.0154.  PERSON FIRST RESPECTFUL LANGUAGE PROMOTION.
  The executive commissioner shall ensure that the commission and
  each health and human services agency use the terms and phrases
  listed as preferred under the person first respectful language
  initiative in Chapter 392 when proposing, adopting, or amending the
  commission's or agency's rules, reference materials, publications,
  or electronic media. (Gov. Code, Sec. 531.0227.)
  SUBCHAPTER E. ADMINISTRATIVE SUPPORT SERVICES
         Sec. 524.0201.  DEFINITION. In this subchapter,
  "administrative support services" includes strategic planning and
  evaluation, audit, legal, human resources, information resources,
  purchasing, contracting, financial management, and accounting
  services. (Gov. Code, Sec. 531.00553(a).)
         Sec. 524.0202.  CENTRALIZED SYSTEM OF ADMINISTRATIVE
  SUPPORT SERVICES. (a) Subject to Section 524.0203(a), the
  executive commissioner shall plan and implement an efficient and
  effective centralized system of administrative support services
  for:
               (1)  the health and human services system; and
               (2)  the Department of Family and Protective Services.
         (b)  The commission is responsible for the performance of
  administrative support services for the health and human services
  system.  The executive commissioner shall adopt rules to implement
  the executive commissioner's authority under this section with
  respect to that system.  (Gov. Code, Secs. 531.0055(d) (part), (j),
  531.00553(b).)
         Sec. 524.0203.  PRINCIPLES FOR AND REQUIREMENTS OF
  CENTRALIZED SYSTEM; MEMORANDUM OF UNDERSTANDING.  (a)  The
  executive commissioner shall plan and implement the centralized
  system of administrative support services in accordance with the
  following principles and requirements:
               (1)  the executive commissioner shall consult with the
  commissioner of each agency and the director of each division
  within the health and human services system to ensure the
  commission is responsive to and addresses agency or division needs;
               (2)  consolidation of staff providing the support
  services must be done in a manner that ensures each agency or
  division within the health and human services system that loses
  staff as a result of the centralization of support services has
  adequate resources to carry out functions of the agency or
  division, as appropriate; and
               (3)  the commission and each agency or division within
  the health and human services system shall, as appropriate, enter
  into a memorandum of understanding or other written agreement to
  ensure accountability for the provision of support services by
  clearly detailing:
                     (A)  the responsibilities of each agency or
  division and the commission;
                     (B)  the points of contact for each agency or
  division and the commission;
                     (C)  the transfer of personnel among each agency
  or division and the commission;
                     (D)  the agreement's budgetary effect on each
  agency or division and the commission; and
                     (E)  any other item the executive commissioner
  determines is critical for maintaining accountability.
         (b)  A memorandum of understanding or other written
  agreement entered into under Subsection (a)(3) may be combined with
  the memorandum of understanding required under Section
  524.0101(a), if appropriate. (Gov. Code, Secs. 531.00553(c),
  (d).)
  SUBCHAPTER F.  LEGISLATIVE OVERSIGHT
         Sec. 524.0251.  OVERSIGHT BY LEGISLATIVE COMMITTEES. The
  standing or other committees of the house of representatives and
  the senate that have jurisdiction over the commission and other
  agencies relating to implementation of Chapter 531 and revised
  provisions derived from Chapter 531, as that chapter existed on
  March 31, 2025, as identified by the speaker of the house of
  representatives and the lieutenant governor, shall:
               (1)  to ensure implementation consistent with law,
  monitor the commission's:
                     (A)  implementation of Subchapter A, Sections
  524.0101(a), 524.0151(a)(2) and (b), and 525.0254(b), and Section
  524.0202 with respect to the health and human services system; and
                     (B)  other duties in consolidating and
  integrating health and human services;
               (2)  recommend any needed adjustments to the
  implementation of the provisions listed in Subdivision (1)(A) and
  the commission's other duties in consolidating and integrating
  health and human services; and
               (3)  review the commission's rulemaking process,
  including the commission's plan for obtaining public input.
  (Gov. Code, Sec. 531.171(a).)
         Sec. 524.0252.  INFORMATION PROVIDED TO LEGISLATIVE
  COMMITTEES. The commission shall provide the committees described
  by Section 524.0251 with copies of all required reports and
  proposed rules.  Copies of the proposed rules must be provided to
  the committees before the rules are published in the Texas
  Register. At the request of a committee or the executive
  commissioner, a health and human services agency shall:
               (1)  provide other information to the committee,
  including information relating to the health and human services
  system; and
               (2)  report on agency progress in implementing
  statutory directives the committee identifies and the commission's directives. (Gov. Code, Sec. 531.171(b).)
 
  CHAPTER 525.  GENERAL POWERS AND DUTIES OF COMMISSION AND EXECUTIVE
  COMMISSIONER
  SUBCHAPTER A. HEALTH AND HUMAN SERVICES ADMINISTRATION GENERALLY
  Sec. 525.0001.  POWERS AND DUTIES RELATING TO HEALTH
                   AND HUMAN SERVICES ADMINISTRATION
  Sec. 525.0002.  LOCATION OF AND CONSOLIDATION OF
                   CERTAIN SERVICES AMONG HEALTH AND
                   HUMAN SERVICES AGENCIES
  Sec. 525.0003.  CONSOLIDATED INTERNAL AUDIT PROGRAM
  Sec. 525.0004.  INTERAGENCY DISPUTE ARBITRATION
  SUBCHAPTER B. ACCOUNTING AND FISCAL PROVISIONS
  Sec. 525.0051.  MANAGEMENT INFORMATION AND COST
                   ACCOUNTING SYSTEMS
  Sec. 525.0052.  FEDERAL FUNDS: PLANNING AND MANAGEMENT;
                   ANNUAL REPORT
  Sec. 525.0053.  AUTHORITY TO TRANSFER CERTAIN
                   APPROPRIATED AMOUNTS AMONG HEALTH AND
                   HUMAN SERVICES AGENCIES
  Sec. 525.0054.  EFFICIENCY AUDIT OF CERTAIN ASSISTANCE
                   PROGRAMS
  Sec. 525.0055.  GIFTS AND GRANTS
  SUBCHAPTER C. CONTRACTS
  Sec. 525.0101.  GENERAL CONTRACT AUTHORITY
  Sec. 525.0102.  SUBROGATION AND THIRD-PARTY
                   REIMBURSEMENT CONTRACTS
  SUBCHAPTER D. PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
  Sec. 525.0151.  PLANNING AND DELIVERY OF HEALTH AND
                   HUMAN SERVICES GENERALLY
  Sec. 525.0152.  PLANNING AND POLICY DIRECTION OF
                   TEMPORARY ASSISTANCE FOR NEEDY
                   FAMILIES PROGRAM
  Sec. 525.0153.  ANNUAL BUSINESS SERVICES PLANS
  Sec. 525.0154.  COORDINATED STRATEGIC PLAN AND BIENNIAL
                   PLAN UPDATES FOR HEALTH AND HUMAN
                   SERVICES
  Sec. 525.0155.  COORDINATION WITH LOCAL GOVERNMENTAL
                   ENTITIES
  Sec. 525.0156.  SUBMISSION AND REVIEW OF AGENCY
                   STRATEGIC PLANS AND BIENNIAL PLAN
                   UPDATES
  Sec. 525.0157.  STATEWIDE NEEDS APPRAISAL PROJECT
  Sec. 525.0158.  STREAMLINING SERVICE DELIVERY
  Sec. 525.0159.  HOTLINE AND CALL CENTER COORDINATION
  Sec. 525.0160.  COMMUNITY-BASED SUPPORT SYSTEMS
  SUBCHAPTER E.  HEALTH INFORMATION EXCHANGE SYSTEM
  Sec. 525.0201.  DEFINITIONS
  Sec. 525.0202.  HEALTH INFORMATION EXCHANGE SYSTEM
                   DEVELOPMENT
  Sec. 525.0203.  HEALTH INFORMATION EXCHANGE SYSTEM
                   IMPLEMENTATION IN STAGES
  Sec. 525.0204.  HEALTH INFORMATION EXCHANGE SYSTEM
                   STAGE ONE: ENCOUNTER DATA
  Sec. 525.0205.  HEALTH INFORMATION EXCHANGE SYSTEM
                   STAGE ONE: ELECTRONIC PRESCRIBING
  Sec. 525.0206.  HEALTH INFORMATION EXCHANGE SYSTEM
                   STAGE TWO: EXPANSION
  Sec. 525.0207.  HEALTH INFORMATION EXCHANGE SYSTEM
                   STAGE THREE: EXPANSION
  Sec. 525.0208.  STRATEGIES TO ENCOURAGE HEALTH
                   INFORMATION EXCHANGE SYSTEM USE
  Sec. 525.0209.  RULES
  SUBCHAPTER F. INFORMATION RESOURCES AND TECHNOLOGY
  Sec. 525.0251.  INFORMATION RESOURCES STRATEGIC
                   PLANNING AND MANAGEMENT
  Sec. 525.0252.  TECHNOLOGICAL SOLUTIONS POLICIES
  Sec. 525.0253.  TECHNOLOGY USE FOR ADULT PROTECTIVE
                   SERVICES PROGRAM
  Sec. 525.0254.  ELECTRONIC SIGNATURES
  Sec. 525.0255.  HEALTH AND HUMAN SERVICES SYSTEM
                   INTERNET WEBSITES
  Sec. 525.0256.  AUTOMATION STANDARDS FOR DATA SHARING
  Sec. 525.0257.  ELECTRONIC EXCHANGE OF HEALTH
                   INFORMATION; BIENNIAL REPORT
  SUBCHAPTER G.  STUDIES, REPORTS, AND PUBLICATIONS
  Sec. 525.0301.  BIENNIAL REFERENCE GUIDE
  Sec. 525.0302.  CONSOLIDATION OF REPORTS
  Sec. 525.0303.  ANNUAL REPORT ON SAFEGUARDING PROTECTED
                   HEALTH INFORMATION
  CHAPTER 525.  GENERAL POWERS AND DUTIES OF COMMISSION AND EXECUTIVE
  COMMISSIONER
  SUBCHAPTER A. HEALTH AND HUMAN SERVICES ADMINISTRATION GENERALLY
         Sec. 525.0001.  POWERS AND DUTIES RELATING TO HEALTH AND
  HUMAN SERVICES ADMINISTRATION. The commission and the executive
  commissioner have all the powers and duties necessary to administer
  Chapter 531 and revised provisions derived from Chapter 531, as
  that chapter existed March 31, 2025. (Gov. Code, Sec. 531.041.)
         Sec. 525.0002.  LOCATION OF AND CONSOLIDATION OF CERTAIN
  SERVICES AMONG HEALTH AND HUMAN SERVICES AGENCIES. (a) The
  commission may require a health and human services agency, under
  the commission's direction, to:
               (1)  ensure that the agency's location is accessible
  to:
                     (A)  employees with disabilities; and
                     (B)  agency clients with disabilities; and
               (2)  consolidate agency support services, including
  clerical, administrative, and information resources support
  services, with support services provided to or by another health
  and human services agency.
         (b)  The executive commissioner may require a health and
  human services agency, under the executive commissioner's
  direction, to locate all or a portion of the agency's employees and
  programs:
               (1)  in the same building as another health and human
  services agency; or
               (2)  at a location near or adjacent to another health
  and human services agency's location. (Gov. Code, Sec. 531.0246.)
         Sec. 525.0003.  CONSOLIDATED INTERNAL AUDIT PROGRAM. (a)
  Notwithstanding Section 2102.005, the commission shall operate the
  internal audit program required under Chapter 2102 for the
  commission and each health and human services agency as a
  consolidated internal audit program.
         (b)  For purposes of this section, a reference in Chapter
  2102 to the administrator of a state agency with respect to a health
  and human services agency means the executive commissioner.  (Gov.
  Code, Sec. 531.00552.)
         Sec. 525.0004.  INTERAGENCY DISPUTE ARBITRATION. The
  executive commissioner shall arbitrate and render the final
  decision on interagency disputes.  (Gov. Code, Sec. 531.035.)
  SUBCHAPTER B. ACCOUNTING AND FISCAL PROVISIONS
         Sec. 525.0051.  MANAGEMENT INFORMATION AND COST ACCOUNTING
  SYSTEMS. The executive commissioner shall establish a management
  information system and a cost accounting system for all health and
  human services that is compatible with and meets the requirements
  of the uniform statewide accounting project. (Gov. Code, Sec.
  531.031.)
         Sec. 525.0052.  FEDERAL FUNDS: PLANNING AND MANAGEMENT;
  ANNUAL REPORT. (a) The commission, subject to the General
  Appropriations Act, is responsible for planning for and managing
  the use of federal funds in a manner that maximizes the federal
  funding available to this state while promoting the delivery of
  services.
         (b)  The executive commissioner shall:
               (1)  establish a federal money management system to
  coordinate and monitor the use of federal money health and human
  services agencies receive to ensure that the money is spent in the
  most efficient manner;
               (2)  establish priorities for health and human services
  agencies' use of federal money in coordination with the coordinated
  strategic plan the executive commissioner develops under Section
  525.0154;
               (3)  coordinate and monitor the use of federal money
  for health and human services to ensure that the money is spent in
  the most cost-effective manner throughout the health and human
  services system;
               (4)  review and approve all federal funding plans for
  health and human services in this state;
               (5)  estimate available federal money, including
  earned federal money, and monitor unspent money;
               (6)  ensure that the state meets federal requirements
  relating to receipt of federal money for health and human services,
  including requirements relating to state matching money and
  maintenance of effort;
               (7)  transfer appropriated amounts as described by
  Section 525.0053; and
               (8)  ensure that each governmental entity the executive
  commissioner identifies under Section 525.0155 has access to
  complete and timely information about all sources of federal money
  for health and human services programs and that technical
  assistance is available to governmental entities seeking grants of
  federal money to provide health and human services.
         (c)  The commission shall prepare an annual report regarding
  the results of implementing this section. The report must identify
  strategies to:
               (1)  maximize the receipt and use of federal funds; and
               (2)  improve federal funds management.
         (d)  Not later than December 15 of each year, the commission
  shall file the report the commission prepares under Subsection (c)
  with the governor, the lieutenant governor, and the speaker of the
  house of representatives. (Gov. Code, Sec. 531.028.)
         Sec. 525.0053.  AUTHORITY TO TRANSFER CERTAIN APPROPRIATED
  AMOUNTS AMONG HEALTH AND HUMAN SERVICES AGENCIES. The commission
  may, subject to the General Appropriations Act, transfer amounts
  appropriated to health and human services agencies among the
  agencies to:
               (1)  enhance the receipt of federal money under the
  federal money management system the executive commissioner
  establishes under Section 525.0052;
               (2)  achieve efficiencies in the agencies' 
  administrative support functions; and
               (3)  perform the functions assigned to the executive
  commissioner under:
                     (A)  Subchapter A, Chapter 524; and
                     (B)  Sections 524.0101, 524.0151, 524.0202, and
  525.0254. (Gov. Code, Sec. 531.0271.)
         Sec. 525.0054.  EFFICIENCY AUDIT OF CERTAIN ASSISTANCE
  PROGRAMS. (a)  For purposes of this section, "efficiency audit"
  means an investigation of the implementation and administration of
  the federal Temporary Assistance for Needy Families program
  operated under Chapter 31, Human Resources Code, and the state
  temporary assistance and support services program operated under
  Chapter 34, Human Resources Code, to examine fiscal management, the
  efficiency of the use of resources, and the effectiveness of state
  efforts in achieving the goals of the Temporary Assistance for
  Needy Families program described under 42 U.S.C. Section 601(a).
         (b)  In 2022 and every sixth year after that year, an
  external auditor selected under Subsection (c) shall conduct an
  efficiency audit.  The commission shall pay the costs associated
  with the audit using existing resources.
         (c)  The state auditor shall:
               (1)  not later than March 1 of the year in which an
  efficiency audit is required under this section, select an external
  auditor to conduct the audit; and
               (2)  ensure that the external auditor conducts the
  audit in accordance with this section.
         (d)  The external auditor shall be independent and not
  subject to direction from:
               (1)  the commission; or
               (2)  any other state agency that:
                     (A)  is subject to evaluation by the auditor for
  purposes of this section; or
                     (B)  receives or spends money under the programs
  described by Subsection (a).
         (e)  The external auditor shall complete the efficiency
  audit not later than the 90th day after the date the state auditor
  selects the external auditor.
         (f)  The Legislative Budget Board shall establish the scope
  of the efficiency audit and determine the areas of investigation
  for the audit, including:
               (1)  reviewing the resources dedicated to a program
  described by Subsection (a) to determine whether those resources:
                     (A)  are used effectively and efficiently to
  achieve desired outcomes for individuals receiving benefits under
  the program; and
                     (B)  are not used for purposes other than the
  intended goals of the program;
               (2)  identifying cost savings or reallocations of
  resources; and
               (3)  identifying opportunities to improve services
  through consolidation of essential functions, outsourcing, and
  elimination of duplicative efforts.
         (g)  Not later than November 1 of the year an efficiency
  audit is conducted, the external auditor shall prepare and submit a
  report of the audit and recommendations for efficiency improvements
  to:
               (1)  the governor;
               (2)  the Legislative Budget Board;
               (3)  the state auditor;
               (4)  the executive commissioner; and
               (5)  the chairs of the House Human Services Committee
  and the Senate Health and Human Services Committee.
         (h)  The executive commissioner and the state auditor shall
  publish the report, recommendations, and full efficiency audit on
  the commission's and the state auditor's Internet websites.  (Gov.
  Code, Sec. 531.005522.)
         Sec. 525.0055.  GIFTS AND GRANTS. The commission may accept
  a gift or grant from a public or private source to perform any of the
  commission's powers or duties. (Gov. Code, Sec. 531.038.)
  SUBCHAPTER C. CONTRACTS
         Sec. 525.0101.  GENERAL CONTRACT AUTHORITY. The commission
  may enter into contracts as necessary to perform any of the
  commission's powers or duties. (Gov. Code, Sec. 531.039.)
         Sec. 525.0102.  SUBROGATION AND THIRD-PARTY REIMBURSEMENT
  CONTRACTS. (a) Except as provided by Subsection (d), the
  commission shall enter into a contract under which the contractor
  is authorized on behalf of the commission or a health and human
  services agency to recover money under a subrogation or third-party
  reimbursement right the commission or agency holds that arises from
  payment of medical expenses. The contract must provide that:
               (1)  the commission or agency, as appropriate, shall
  compensate the contractor based on a percentage of the amount of
  money the contractor recovers for the commission or agency; and
               (2)  the contractor may represent the commission or
  agency in a court proceeding to recover money under a subrogation or
  third-party reimbursement right if:
                     (A)  the attorney required by other law to
  represent the commission or agency in court approves; and
                     (B)  the representation is cost-effective and
  specifically authorized by the commission.
         (b)  The commission shall develop a process to:
               (1)  identify claims for the recovery of money under a
  subrogation or third-party reimbursement right described by this
  section; and
               (2)  refer the identified claims to a contractor
  authorized under this section.
         (c)  A health and human services agency shall cooperate with
  a contractor authorized under this section on a claim the agency
  refers to the contractor for recovery.
         (d)  If the commission cannot identify a contractor who is
  willing to contract with the commission under this section on
  reasonable terms, the commission:
               (1)  is not required to enter into a contract under
  Subsection (a); and
               (2)  shall develop and implement alternative policies
  to ensure the recovery of money under a subrogation or third-party
  reimbursement right.
         (e)  The commission may allow a state agency other than a
  health and human services agency to be a party to the contract
  required by Subsection (a).  If the commission allows an additional
  state agency to be a party to the contract, the commission shall
  modify the contract as necessary to reflect the services the
  contractor is to provide to that agency. (Gov. Code, Sec.
  531.0391.)
  SUBCHAPTER D. PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
         Sec. 525.0151.  PLANNING AND DELIVERY OF HEALTH AND HUMAN
  SERVICES GENERALLY. The executive commissioner shall:
               (1)  facilitate and enforce coordinated planning and
  delivery of health and human services, including:
                     (A)  compliance with the coordinated strategic
  plan;
                     (B)  colocation of services;
                     (C)  integrated intake; and
                     (D)  coordinated referral and case management;
               (2)  establish and enforce uniform regional boundaries
  for all health and human services agencies;
               (3)  carry out statewide health and human services
  needs surveys and forecasting;
               (4)  perform independent special-outcome evaluations
  of health and human services programs and activities; and
               (5)  on request of a governmental entity the executive
  commissioner identifies under Section 525.0155, assist the entity
  in implementing a coordinated plan that:
                     (A)  may include colocation of services,
  integrated intake, and coordinated referral and case management;
  and
                     (B)  is tailored to the entity's needs and
  priorities.  (Gov. Code, Sec. 531.024(a) (part).)
         Sec. 525.0152.  PLANNING AND POLICY DIRECTION OF TEMPORARY
  ASSISTANCE FOR NEEDY FAMILIES PROGRAM. (a) In this section,
  "financial assistance program" means the financial assistance
  program operated under Chapter 31, Human Resources Code.
         (b)  The commission shall:
               (1)  plan and direct the financial assistance program,
  including the procurement, management, and monitoring of contracts
  necessary to implement the program; and
               (2)  establish requirements for and define the scope of
  the ongoing evaluation of the financial assistance program.
         (c)  The executive commissioner shall adopt rules and
  standards governing the financial assistance program. (Gov. Code,
  Sec. 531.0224; New.)
         Sec. 525.0153.  ANNUAL BUSINESS SERVICES PLANS. The
  commission shall develop and implement an annual business services
  plan for each health and human services region that:
               (1)  establishes performance objectives for all health
  and human services agencies providing services in the region; and
               (2)  measures agency effectiveness and efficiency in
  achieving those objectives. (Gov. Code, Sec. 531.0247.)
         Sec. 525.0154.  COORDINATED STRATEGIC PLAN AND BIENNIAL PLAN
  UPDATES FOR HEALTH AND HUMAN SERVICES. (a) The executive
  commissioner shall:
               (1)  develop a coordinated, six-year strategic plan for
  health and human services in this state; and
               (2)  submit a biennial update of the plan to the
  governor, the lieutenant governor, and the speaker of the house of
  representatives not later than October 1 of each even-numbered
  year.
         (b)  The coordinated strategic plan must include the
  following goals:
               (1)  developing a comprehensive, statewide approach to
  the planning of health and human services;
               (2)  creating a continuum of care for families and
  individuals in need of health and human services;
               (3)  integrating health and human services to provide
  for the efficient and timely delivery of those services;
               (4)  maximizing existing resources through effective
  funds management and the sharing of administrative functions;
               (5)  effectively using management information systems
  to continually improve service delivery;
               (6)  providing systemwide accountability through
  effective monitoring mechanisms;
               (7)  promoting teamwork among the health and human
  services agencies and providing incentives for creativity;
               (8)  fostering innovation at the local level; and
               (9)  encouraging full participation of fathers in
  programs and services relating to children.
         (c)  In developing the coordinated strategic plan and plan
  updates under this section, the executive commissioner shall
  consider:
               (1)  existing strategic plans of health and human
  services agencies;
               (2)  health and human services priorities and plans
  governmental entities submit under Section 525.0155;
               (3)  facilitation of pending reorganizations or
  consolidations of health and human services agencies and programs;
               (4)  public comment, including comment documented
  through public hearings conducted under Section 523.0252; and
               (5)  budgetary issues, including projected agency
  needs and projected availability of funds.  (Gov. Code, Secs.
  531.022(a), (b), (c), (d).)
         Sec. 525.0155.  COORDINATION WITH LOCAL GOVERNMENTAL
  ENTITIES. The executive commissioner shall:
               (1)  identify the governmental entities that
  coordinate the delivery of health and human services in regions,
  counties, and municipalities; and
               (2)  request that each identified governmental entity:
                     (A)  identify the health and human services
  priorities in the entity's jurisdiction and the most effective ways
  to deliver and coordinate services in that jurisdiction;
                     (B)  develop a coordinated plan for delivering
  health and human services in the jurisdiction, including transition
  services that prepare special education students for adulthood; and
                     (C)  make available to the commission the
  information requested under Paragraphs (A) and (B). (Gov. Code,
  Sec. 531.022(e).)
         Sec. 525.0156.  SUBMISSION AND REVIEW OF AGENCY STRATEGIC
  PLANS AND BIENNIAL PLAN UPDATES. (a) Each health and human
  services agency shall submit to the commission a strategic plan and
  biennial updates of the plan on a date determined by commission
  rule.
         (b)  The commission shall:
               (1)  review and comment on each strategic plan and
  biennial update a health and human services agency submits to the
  commission under this section; and
               (2)  not later than January 1 of each even-numbered
  year, begin formal discussions with each health and human services
  agency regarding that agency's strategic plan or biennial update,
  as appropriate. (Gov. Code, Sec. 531.023.)
         Sec. 525.0157.  STATEWIDE NEEDS APPRAISAL PROJECT. (a) The
  commission may implement the Statewide Needs Appraisal Project to
  obtain county-specific demographic data concerning health and
  human services needs in this state.
         (b)  Any collected data must be made available for use in
  planning and budgeting for health and human services programs by
  state agencies.
         (c)  The commission shall coordinate the commission's
  activities with the appropriate health and human services agencies.
  (Gov. Code, Sec. 531.025.)
         Sec. 525.0158.  STREAMLINING SERVICE DELIVERY. To integrate
  and streamline service delivery and facilitate access to services,
  the executive commissioner may:
               (1)  request a health and human services agency to take
  a specific action; and
               (2)  recommend the manner for accomplishing the
  streamlining, including requesting each agency to:
                     (A)  simplify or automate agency procedures;
                     (B)  coordinate service planning and management
  tasks between and among health and human services agencies;
                     (C)  reallocate staff resources;
                     (D)  waive existing rules; or
                     (E)  take other necessary actions. (Gov. Code,
  Sec. 531.0241.)
         Sec. 525.0159.  HOTLINE AND CALL CENTER COORDINATION. (a)
  The commission shall establish a process to ensure all health and
  human services system hotlines and call centers are necessary and
  appropriate.  Under the process, the commission shall:
               (1)  develop criteria for use in assessing whether a
  hotline or call center serves an ongoing purpose;
               (2)  develop and maintain an inventory of all system
  hotlines and call centers;
               (3)  use the inventory and assessment criteria the
  commission develops under this subsection to periodically
  consolidate hotlines and call centers along appropriate functional
  lines;
               (4)  develop an approval process designed to ensure
  that a newly established hotline or call center, including the
  telephone system and contract terms for the hotline or call center,
  meets policies and standards the commission establishes; and
               (5)  develop policies and standards for hotlines and
  call centers that:
                     (A)  include quality and quantity performance
  measures and benchmarks; and
                     (B)  may include policies and standards for:
                           (i)  client satisfaction with call
  resolution;
                           (ii)  accuracy of information provided;
                           (iii)  the percentage of received calls that
  are answered;
                           (iv)  the amount of time a caller spends on
  hold; and
                           (v)  call abandonment rates.
         (b)  In consolidating hotlines and call centers under
  Subsection (a)(3), the commission shall seek to maximize the use
  and effectiveness of the commission's 2-1-1 telephone number.
         (c)  In developing policies and standards under Subsection
  (a)(5), the commission may allow varied performance measures and
  benchmarks for a hotline or call center based on factors affecting
  the capacity of the hotline or call center, including factors such
  as staffing levels and funding. (Gov. Code, Sec. 531.0192.)
         Sec. 525.0160.  COMMUNITY-BASED SUPPORT SYSTEMS. (a)
  Subject to Sections 524.0001(c) and (d) and 524.0202(a)(1), the
  commission shall assist communities in this state in developing
  comprehensive, community-based support systems for health and
  human services. At a community's request, the commission shall
  provide to the community resources and assistance to enable the
  community to:
               (1)  identify and overcome institutional barriers to
  developing more comprehensive community support systems, including
  barriers resulting from the policies and procedures of state health
  and human services agencies; and
               (2)  develop a system of blended funds to allow the
  community to customize services to fit individual community needs.
         (b)  At the commission's request, a health and human services
  agency shall provide to a community resources and assistance as
  necessary to perform the commission's duties under Subsection (a).
         (c)  A health and human services agency that receives or
  develops a proposal for a community initiative shall submit the
  proposal to the commission for review and approval. The commission
  shall review the proposal to ensure that the proposed initiative:
               (1)  is consistent with other similar programs offered
  in communities; and
               (2)  does not duplicate other services provided in the
  community.
         (d)  In implementing this section, the commission shall
  consider models used in other service delivery systems, including
  the mental health and intellectual disability service delivery
  systems. (Gov. Code, Sec. 531.0248.)
  SUBCHAPTER E.  HEALTH INFORMATION EXCHANGE SYSTEM
         Sec. 525.0201.  DEFINITIONS.  In this subchapter:
               (1)  "Electronic health record" means an electronic
  record of an individual's aggregated health-related information
  that conforms to nationally recognized interoperability standards
  and that can be created, managed, and consulted by authorized
  health care providers across two or more health care organizations.
               (2)  "Electronic medical record" means an electronic
  record of an individual's health-related information that can be
  created, gathered, managed, and consulted by authorized clinicians
  and staff within a single health care organization.
               (3)  "Health information exchange system" means an
  electronic health information exchange system created under this
  subchapter that moves health-related information among entities
  according to nationally recognized standards. (Gov. Code, Secs.
  531.901(1), (2), (3).)
         Sec. 525.0202.  HEALTH INFORMATION EXCHANGE SYSTEM
  DEVELOPMENT. (a) The commission shall develop an electronic
  health information exchange system to improve the quality, safety,
  and efficiency of health care services provided under Medicaid and
  the child health plan program. In developing the system, the
  commission shall ensure that:
               (1)  the confidentiality of patients' health
  information is protected and patient privacy is maintained in
  accordance with federal and state law, including:
                     (A)  Section 1902(a)(7), Social Security Act (42
  U.S.C. Section 1396a(a)(7));
                     (B)  the Health Insurance Portability and
  Accountability Act of 1996 (Pub. L. No. 104-191);
                     (C)  Chapter 552;
                     (D)  Subchapter G, Chapter 241, Health and Safety
  Code;
                     (E)  Section 12.003, Human Resources Code; and
                     (F)  federal and state rules, including:
                           (i)  42 C.F.R. Part 431, Subpart F; and
                           (ii)  45 C.F.R. Part 164;
               (2)  appropriate information technology systems the
  commission and health and human services agencies use are
  interoperable;
               (3)  the system and external information technology
  systems are interoperable in receiving and exchanging appropriate
  electronic health information as necessary to enhance:
                     (A)  the comprehensive nature of information
  contained in electronic health records; and
                     (B)  health care provider efficiency by
  supporting integration of the information into the electronic
  health record health care providers use;
               (4)  the system and other health information systems
  not described by Subdivision (3) and data warehousing initiatives
  are interoperable; and
               (5)  the system includes the elements described by
  Subsection (b).
         (b)  The health information exchange system must include the
  following elements:
               (1)  an authentication process that uses multiple forms
  of identity verification before allowing access to information
  systems and data;
               (2)  a formal process for establishing data-sharing
  agreements within the community of participating providers in
  accordance with the Health Insurance Portability and
  Accountability Act of 1996 (Pub. L. No. 104-191) and the American
  Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5);
               (3)  a method by which the commission may open or
  restrict access to the system during a declared state emergency;
               (4)  the capability of appropriately and securely
  sharing health information with state and federal emergency
  responders;
               (5)  compatibility with the Nationwide Health
  Information Network (NHIN) and other national health information
  technology initiatives coordinated by the Office of the National
  Coordinator for Health Information Technology;
               (6)  technology that allows for patient identification
  across multiple systems; and
               (7)  the capability of allowing a health care provider
  with technology that meets current national standards to access the
  system.
         (c)  The health information exchange system must be
  developed in accordance with the Medicaid Information Technology
  Architecture (MITA) initiative of the Centers for Medicare and
  Medicaid Services and conform to other standards required under
  federal law. (Gov. Code, Secs. 531.903(a), (b), (d).)
         Sec. 525.0203.  HEALTH INFORMATION EXCHANGE SYSTEM
  IMPLEMENTATION IN STAGES.  The commission shall implement the
  health information exchange system in stages as described by this
  subchapter, except that the commission may deviate from those
  stages if technological advances make a deviation advisable or more
  efficient.  (Gov. Code, Sec. 531.903(c).)
         Sec. 525.0204.  HEALTH INFORMATION EXCHANGE SYSTEM STAGE
  ONE: ENCOUNTER DATA. In stage one of implementing the health
  information exchange system and for purposes of the implementation,
  the commission shall require each managed care organization with
  which the commission contracts under Chapter 540 or 540A for the
  provision of Medicaid managed care services or under Chapter 62,
  Health and Safety Code, for the provision of child health plan
  program services to submit to the commission complete and accurate
  encounter data not later than the 30th day after the last day of the
  month in which the managed care organization adjudicated the claim.
  (Gov. Code, Sec. 531.9051.)
         Sec. 525.0205.  HEALTH INFORMATION EXCHANGE SYSTEM STAGE
  ONE: ELECTRONIC PRESCRIBING. (a) In stage one of implementing the
  health information exchange system, the commission shall support
  and coordinate electronic prescribing tools health care providers
  and health care facilities use under Medicaid and the child health
  plan program.
         (b)  The commission shall collaborate with, and accept
  recommendations from, physicians and other stakeholders to ensure
  that the electronic prescribing tools described by Subsection (a):
               (1)  are integrated with existing electronic
  prescribing systems otherwise in use in the public and private
  sectors; and
               (2)  to the extent feasible:
                     (A)  provide current payer formulary information
  at the time a health care provider writes a prescription; and
                     (B)  support the electronic transmission of a
  prescription.
         (c)  The commission may take any reasonable action to comply
  with this section, including establishing information exchanges
  with national electronic prescribing networks or providing health
  care providers with access to an Internet-based prescribing tool
  the commission develops.
         (d)  The commission shall apply for and actively pursue any
  waiver to the state Medicaid plan or the child health plan program
  from the Centers for Medicare and Medicaid Services or any other
  federal agency as necessary to remove an identified impediment to
  supporting and implementing electronic prescribing tools under
  this section, including the requirement for handwritten
  certification of certain drugs under 42 C.F.R. Section 447.512. If
  the commission, with assistance from the Legislative Budget Board,
  determines that the implementation of an operational modification
  in accordance with a waiver the commission obtains as required by
  this subsection has resulted in a cost increase in Medicaid or the
  child health plan program, the commission shall take the necessary
  actions to reverse the operational modification. (Gov. Code, Sec.
  531.906.)
         Sec. 525.0206.  HEALTH INFORMATION EXCHANGE SYSTEM STAGE
  TWO: EXPANSION.  (a)  In stage two of implementing the health
  information exchange system and based on feedback provided by
  interested parties, the commission may expand the system by:
               (1)  providing an electronic health record for each
  child health plan program enrollee;
               (2)  including state laboratory results information in
  an electronic health record, including the results of newborn
  screenings and tests conducted under the Texas Health Steps
  program, based on the system developed for the health passport
  under Section 266.006, Family Code;
               (3)  improving electronic health record data-gathering
  capabilities to allow the record to include basic health and
  clinical information as the executive commissioner determines in
  addition to available claims information;
               (4)  using evidence-based technology tools to create a
  unique health profile to alert health care providers regarding the
  need for additional care, education, counseling, or health
  management activities for specific patients; and
               (5)  continuing to enhance the electronic health record
  created for each Medicaid recipient as technology becomes available
  and interoperability capabilities improve.
         (b)  In expanding the health information exchange system,
  the commission shall collaborate with, and accept recommendations
  from, physicians and other stakeholders to ensure that electronic
  health records provided under this section support health
  information exchange with electronic medical records systems
  physicians use in the public and private sectors. (Gov. Code, Sec.
  531.907.)
         Sec. 525.0207.  HEALTH INFORMATION EXCHANGE SYSTEM STAGE
  THREE: EXPANSION.  In stage three of implementing the health
  information exchange system, the commission may expand the system
  by:
               (1)  developing evidence-based benchmarking tools for
  a health care provider to use in evaluating the provider's own
  performance on health care outcomes and overall quality of care as
  compared to aggregated peer performance data; and
               (2)  expanding the system to include state agencies,
  additional health care providers, laboratories, diagnostic
  facilities, hospitals, and medical offices. (Gov. Code, Sec.
  531.908.)
         Sec. 525.0208.  STRATEGIES TO ENCOURAGE HEALTH INFORMATION
  EXCHANGE SYSTEM USE. The commission shall develop strategies to
  encourage health care providers to use the health information
  exchange system, including incentives, education, and outreach
  tools to increase usage. (Gov. Code, Sec. 531.909.)
         Sec. 525.0209.  RULES.  The executive commissioner may adopt
  rules to implement this subchapter. (Gov. Code, Sec. 531.911.)
  SUBCHAPTER F. INFORMATION RESOURCES AND TECHNOLOGY
         Sec. 525.0251.  INFORMATION RESOURCES STRATEGIC PLANNING
  AND MANAGEMENT. (a) The commission is responsible for strategic
  planning for information resources at each health and human
  services agency and shall direct the management of information
  resources at each health and human services agency.
         (b)  The commission shall:
               (1)  develop a coordinated strategic plan for
  information resources management that:
                     (A)  covers a five-year period;
                     (B)  defines objectives for information resources
  management at each health and human services agency;
                     (C)  prioritizes information resources projects
  and implementation of new technology for all health and human
  services agencies;
                     (D)  integrates planning and development of each
  information resources system a health and human services agency
  uses into a coordinated information resources management planning
  and development system the commission establishes;
                     (E)  establishes standards for information
  resources system security and that promotes the capability of
  information resources systems operating with each other;
                     (F)  achieves economies of scale and related
  benefits in purchasing for health and human services information
  resources systems; and
                     (G)  is consistent with the state strategic plan
  for information resources developed under Chapter 2054;
               (2)  establish and ensure compliance with information
  resources management policies, procedures, and technical
  standards; and
               (3)  review and approve the information resources
  deployment review and biennial operating plan of each health and
  human services agency.
         (c)  A health and human services agency may not submit the
  agency's plans to the Department of Information Resources or the
  Legislative Budget Board under Subchapter E, Chapter 2054, until
  the commission approves the plans. (Gov. Code, Sec. 531.0273.)
         Sec. 525.0252.  TECHNOLOGICAL SOLUTIONS POLICIES. (a) The
  commission shall develop and implement a policy requiring the
  agency commissioner and employees of each health and human services
  agency to research and propose appropriate technological solutions
  to improve the agency's ability to perform the agency's functions.
  The technological solutions must:
               (1)  ensure that the public is able to easily find
  information about a health and human services agency on the
  Internet;
               (2)  ensure that an individual who wants to use a health
  and human services agency's services is able to:
                     (A)  interact with the agency through the
  Internet; and
                     (B)  access any service that can be effectively
  provided through the Internet;
               (3)  be cost-effective and developed through the
  commission's planning process; and
               (4)  meet federal accessibility standards for
  individuals with disabilities.
         (b)  The commission shall develop and implement the policy
  described by Subsection (a) in relation to the commission's
  functions. (Gov. Code, Secs. 531.0162(a), (b).)
         Sec. 525.0253.  TECHNOLOGY USE FOR ADULT PROTECTIVE SERVICES
  PROGRAM. (a)  Subject to available appropriations, the commission
  shall use technology whenever possible in connection with the
  Department of Family and Protective Services' adult protective
  services program to:
               (1)  provide for automated collection of information
  necessary to evaluate program effectiveness using systems that
  integrate collection of necessary information with other routine
  duties of caseworkers and other service providers; and
               (2)  consequently reduce the time required for
  caseworkers and other service providers to gather and report
  information necessary for program evaluation.
         (b)  The commission shall include private sector
  representatives in the technology planning process used to
  determine appropriate technology for the Department of Family and
  Protective Services' adult protective services program.  (Gov.
  Code, Secs. 531.0162(c), (d).)
         Sec. 525.0254.  ELECTRONIC SIGNATURES. (a)  In this
  section, "transaction" has the meaning assigned by Section 322.002,
  Business & Commerce Code.
         (b)  The executive commissioner shall establish standards
  for the use of electronic signatures in accordance with Chapter
  322, Business & Commerce Code, with respect to any transaction in
  connection with the administration of health and human services
  programs.
         (c)  The executive commissioner shall adopt rules to
  implement the executive commissioner's authority under this
  section.  (Gov. Code, Secs. 531.0055(j), (m).)
         Sec. 525.0255.  HEALTH AND HUMAN SERVICES SYSTEM INTERNET
  WEBSITES. The commission shall establish a process to ensure that
  Internet websites across the health and human services system are
  developed and maintained according to standard criteria for
  uniformity, efficiency, and technical capabilities.  Under the
  process, the commission shall:
               (1)  develop and maintain an inventory of all health
  and human services system Internet websites; and
               (2)  on an ongoing basis, evaluate the inventory the
  commission maintains under Subdivision (1) to:
                     (A)  determine whether any Internet websites
  should be consolidated to improve public access to those websites'
  content and, if appropriate, consolidate those websites; and
                     (B)  ensure that the Internet websites comply with
  the standard criteria.  (Gov. Code, Sec. 531.0164.)
         Sec. 525.0256.  AUTOMATION STANDARDS FOR DATA SHARING. The
  executive commissioner, with the Department of Information
  Resources, shall develop automation standards for computer systems
  to enable health and human services agencies, including agencies
  operating at a local level, to share pertinent data.  (Gov. Code,
  Sec. 531.024(a) (part).)
         Sec. 525.0257.  ELECTRONIC EXCHANGE OF HEALTH INFORMATION;
  BIENNIAL REPORT. (a)  In this section, "health care provider"
  includes a physician.
         (b)  The executive commissioner shall ensure that:
               (1)  all information systems available for the
  commission or a health and human services agency to use in sending
  protected health information to a health care provider or receiving
  protected health information from a health care provider, and for
  which planning or procurement begins on or after September 1, 2015,
  are capable of sending or receiving the information in accordance
  with the applicable data exchange standards developed by the
  appropriate standards development organization accredited by the
  American National Standards Institute;
               (2)  if national data exchange standards do not exist
  for a system described by Subdivision (1), the commission makes
  every effort to ensure that the system is interoperable with the
  national standards for electronic health record systems; and
               (3)  the commission and each health and human services
  agency establish an interoperability standards plan for all
  information systems that exchange protected health information
  with health care providers.
         (c)  Not later than December 1 of each even-numbered year,
  the executive commissioner shall report to the governor and the
  Legislative Budget Board on the commission's and the health and
  human services agencies' measurable progress in ensuring that the
  information systems described by Subsection (b) are interoperable
  with one another and meet the appropriate standards specified by
  that subsection.  The report must include an assessment of the
  progress made in achieving commission goals related to the exchange
  of health information, including facilitating care coordination
  among the agencies, ensuring quality improvement, and realizing
  cost savings. (Gov. Code, Secs. 531.0162(e), (f), (h) (part).)
  SUBCHAPTER G.  STUDIES, REPORTS, AND PUBLICATIONS
         Sec. 525.0301.  BIENNIAL REFERENCE GUIDE. (a) The
  commission shall:
               (1)  publish a biennial reference guide describing
  available public health and human services in this state; and
               (2)  make the guide available to all interested parties
  and agencies.
         (b)  The reference guide must include a dictionary of uniform
  terms and services. (Gov. Code, Sec. 531.040.)
         Sec. 525.0302.  CONSOLIDATION OF REPORTS. The commission
  may consolidate any annual or biennial reports required to be made
  under this chapter or another law if:
               (1)  the consolidated report is submitted not later
  than the earliest deadline for the submission of any component of
  the report; and
               (2)  each person required to receive a component of the
  consolidated report receives the report, and the report identifies
  the component the person was required to receive. (Gov. Code, Sec.
  531.014.)
         Sec. 525.0303.  ANNUAL REPORT ON SAFEGUARDING PROTECTED
  HEALTH INFORMATION. (a) The commission, in consultation with the
  Department of State Health Services, the Texas Medical Board, and
  the Texas Department of Insurance, shall explore and evaluate new
  developments in safeguarding protected health information.
         (b)  Not later than December 1 of each year, the commission
  shall report to the legislature on:
               (1)  new developments in safeguarding protected health
  information; and
               (2)  recommendations for implementing safeguards
  within the commission. (Gov. Code, Sec. 531.0994.)
  CHAPTER 526. ADDITIONAL POWERS AND DUTIES OF COMMISSION AND
  EXECUTIVE COMMISSIONER
  SUBCHAPTER A. INTERNET WEBSITES, ELECTRONIC RESOURCES, AND OTHER
  TECHNOLOGY
  Sec. 526.0001.  DEFINITIONS
  Sec. 526.0002.  INTERNET WEBSITE FOR HEALTH AND HUMAN
                   SERVICES INFORMATION
  Sec. 526.0003.  INFORMATION ON LONG-TERM CARE SERVICES
  Sec. 526.0004.  TEXAS INFORMATION AND REFERRAL NETWORK
  Sec. 526.0005.  INTERNET WEBSITE FOR HEALTH AND HUMAN
                   SERVICES REFERRAL INFORMATION
  Sec. 526.0006.  INTERNET WEBSITE FOR CHILD-CARE AND
                   EDUCATION SERVICES REFERRAL
                   INFORMATION
  Sec. 526.0007.  INTERNET WEBSITE FOR REFERRAL
                   INFORMATION ON HOUSING OPTIONS FOR
                   INDIVIDUALS WITH MENTAL ILLNESS
  Sec. 526.0008.  COMPLIANCE WITH NATIONAL ELECTRONIC
                   DATA INTERCHANGE STANDARDS FOR HEALTH
                   CARE INFORMATION
  Sec. 526.0009.  TECHNICAL ASSISTANCE FOR HUMAN SERVICES
                   PROVIDERS
  Sec. 526.0010.  INFORMATION RESOURCES MANAGER REPORTS
  SUBCHAPTER B.  PROGRAMS AND SERVICES PROVIDED OR ADMINISTERED BY
  COMMISSION
  Sec. 526.0051.  RESTRICTIONS ON AWARDS TO FAMILY
                   PLANNING SERVICE PROVIDERS
  Sec. 526.0052.  INFORMATION FOR CERTAIN ENROLLEES IN
                   HEALTHY TEXAS WOMEN PROGRAM
  Sec. 526.0053.  VACCINES FOR CHILDREN PROGRAM PROVIDER
                   ENROLLMENT; IMMUNIZATION REGISTRY
  Sec. 526.0054.  PRIOR AUTHORIZATION FOR HIGH-COST
                   MEDICAL SERVICES AND PROCEDURES
  Sec. 526.0055.  TAILORED BENEFIT PACKAGES FOR
                   NON-MEDICAID POPULATIONS
  Sec. 526.0056.  PILOT PROGRAM TO PREVENT SPREAD OF
                   INFECTIOUS OR COMMUNICABLE DISEASES
  Sec. 526.0057.  APPLICATION REQUIREMENT FOR COLONIAS
                   PROJECTS
  Sec. 526.0058.  RULES REGARDING REFUGEE RESETTLEMENT
  Sec. 526.0059.  PROHIBITED AWARD OF CONTRACTS TO
                   MANAGED CARE ORGANIZATIONS FOR
                   CERTAIN CRIMINAL CONVICTIONS
  SUBCHAPTER C. COORDINATION OF QUALITY INITIATIVES
  Sec. 526.0101.  DEFINITION
  Sec. 526.0102.  OPERATIONAL PLAN TO COORDINATE MAJOR
                   QUALITY INITIATIVES
  Sec. 526.0103.  REVISION AND EVALUATION OF MAJOR
                   QUALITY INITIATIVES
  Sec. 526.0104.  INCENTIVES FOR MAJOR QUALITY INITIATIVE
                   COORDINATION
  SUBCHAPTER D.  TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
  Sec. 526.0151.  DEFINITION
  Sec. 526.0152.  AUTHORITY TO OBTAIN FEDERAL WAIVER
  Sec. 526.0153.  TEXAS HEALTH OPPORTUNITY POOL TRUST
                   FUND ESTABLISHED
  Sec. 526.0154.  DEPOSITS TO FUND
  Sec. 526.0155.  USE OF FUND IN GENERAL; RULES FOR
                   ALLOCATION
  Sec. 526.0156.  REIMBURSEMENTS FOR UNCOMPENSATED HEALTH
                   CARE COSTS
  Sec. 526.0157.  INCREASING ACCESS TO HEALTH BENEFITS
                   COVERAGE
  Sec. 526.0158.  INFRASTRUCTURE IMPROVEMENTS
  SUBCHAPTER E. LONG-TERM CARE FACILITIES
  Sec. 526.0201.  DEFINITION
  Sec. 526.0202.  INFORMAL DISPUTE RESOLUTION FOR CERTAIN
                   LONG-TERM CARE FACILITIES
  Sec. 526.0203.  LONG-TERM CARE FACILITIES COUNCIL
  Sec. 526.0204.  COUNCIL DUTIES; REPORT
  SUBCHAPTER F. UNCOMPENSATED HOSPITAL CARE REPORTING AND ANALYSIS;
  ADMINISTRATIVE PENALTY
  Sec. 526.0251.  RULES
  Sec. 526.0252.  NOTICE OF FAILURE TO REPORT;
                   ADMINISTRATIVE PENALTY
  Sec. 526.0253.  NOTICE OF INCOMPLETE OR INACCURATE
                   REPORT; ADMINISTRATIVE PENALTY
  Sec. 526.0254.  REQUIREMENTS FOR ATTORNEY GENERAL
                   NOTIFICATION
  Sec. 526.0255.  ATTORNEY GENERAL NOTICE TO HOSPITAL
  Sec. 526.0256.  PENALTY PAID OR HEARING REQUESTED
  Sec. 526.0257.  HEARING
  Sec. 526.0258.  OPTIONS FOLLOWING DECISION: PAY OR
                   APPEAL
  Sec. 526.0259.  DECISION BY COURT
  Sec. 526.0260.  RECOVERY OF PENALTY
  SUBCHAPTER G. RURAL HOSPITAL INITIATIVES
  Sec. 526.0301.  STRATEGIC PLAN FOR RURAL HOSPITAL
                   SERVICES; REPORT
  Sec. 526.0302.  RURAL HOSPITAL ADVISORY COMMITTEE
  Sec. 526.0303.  COLLABORATION WITH OFFICE OF RURAL
                   AFFAIRS
  SUBCHAPTER H.  MEDICAL TRANSPORTATION
  Sec. 526.0351.  DEFINITIONS
  Sec. 526.0352.  DUTY TO PROVIDE MEDICAL TRANSPORTATION
                   SERVICES
  Sec. 526.0353.  APPLICABILITY
  Sec. 526.0354.  COMMISSION SUPERVISION OF MEDICAL
                   TRANSPORTATION PROGRAM
  Sec. 526.0355.  CONTRACT FOR PUBLIC TRANSPORTATION
                   SERVICES
  Sec. 526.0356.  RULES FOR NONEMERGENCY TRANSPORTATION
                   SERVICES; COMPLIANCE
  Sec. 526.0357.  MEMORANDUM OF UNDERSTANDING; DRIVER AND
                   VEHICLE INFORMATION
  Sec. 526.0358.  MEDICAL TRANSPORTATION SERVICES
                   SUBCONTRACTS
  Sec. 526.0359.  CERTAIN PROVIDERS PROHIBITED FROM
                   PROVIDING NONEMERGENCY TRANSPORTATION
                   SERVICES
  Sec. 526.0360.  CERTAIN WHEELCHAIR-ACCESSIBLE VEHICLES
                   AUTHORIZED
  SUBCHAPTER I. CASEWORKERS AND PROGRAM PERSONNEL
  Sec. 526.0401.  CASELOAD STANDARDS FOR DEPARTMENT OF
                   FAMILY AND PROTECTIVE SERVICES
  Sec. 526.0402.  JOINT TRAINING FOR CERTAIN CASEWORKERS
  Sec. 526.0403.  COORDINATION AND APPROVAL OF CASELOAD
                   ESTIMATES
  Sec. 526.0404.  DEAF-BLIND WITH MULTIPLE DISABILITIES
                   (DBMD) WAIVER PROGRAM: CAREER LADDER
                   FOR INTERVENERS
  SUBCHAPTER J. LICENSING, LISTING, OR REGISTRATION OF CERTAIN
  ENTITIES
  Sec. 526.0451.  APPLICABILITY
  Sec. 526.0452.  REQUIRED APPLICATION INFORMATION
  Sec. 526.0453.  APPLICATION DENIAL BASED ON ADVERSE
                   AGENCY DECISION
  Sec. 526.0454.  RECORD OF FINAL DECISION
  SUBCHAPTER K. CHILDREN AND FAMILIES
  Sec. 526.0501.  SUBSTITUTE CARE PROVIDER OUTCOME
                   STANDARDS
  Sec. 526.0502.  REPORT ON DELIVERY OF HEALTH AND HUMAN
                   SERVICES TO YOUNG TEXANS
  Sec. 526.0503.  POOLED FUNDING FOR FOSTER CARE
                   PREVENTIVE SERVICES
  Sec. 526.0504.  PARTICIPATION BY FATHERS
  Sec. 526.0505.  PROHIBITED PUNITIVE ACTION FOR FAILURE
                   TO IMMUNIZE
  Sec. 526.0506.  INVESTIGATION UNIT FOR CHILD-CARE
                   FACILITIES OPERATING ILLEGALLY
  SUBCHAPTER L. TEXAS HOME VISITING PROGRAM
  Sec. 526.0551.  DEFINITIONS
  Sec. 526.0552.  RULES
  Sec. 526.0553.  STRATEGIC PLAN; ELIGIBILITY
  Sec. 526.0554.  TYPES OF HOME VISITING PROGRAMS
  Sec. 526.0555.  OUTCOMES
  Sec. 526.0556.  EVALUATION OF HOME VISITING PROGRAM
  Sec. 526.0557.  FUNDING
  Sec. 526.0558.  REPORTS TO LEGISLATURE
  SUBCHAPTER M. SERVICE MEMBERS, DEPENDENTS, AND VETERANS
  Sec. 526.0601.  SERVICES FOR SERVICE MEMBERS
  Sec. 526.0602.  INTEREST OR OTHER WAITING LIST FOR
                   CERTAIN SERVICE MEMBERS AND
                   DEPENDENTS
  Sec. 526.0603.  MEMORANDUM OF UNDERSTANDING REGARDING
                   PUBLIC ASSISTANCE REPORTING
                   INFORMATION SYSTEM; MAXIMIZATION OF
                   BENEFITS
  SUBCHAPTER N. PLAN TO SUPPORT GUARDIANSHIPS
  Sec. 526.0651.  DEFINITIONS
  Sec. 526.0652.  PLAN ESTABLISHMENT
  Sec. 526.0653.  GUARDIANSHIP PROGRAM GRANT REQUIREMENTS
  SUBCHAPTER O. ASSISTANCE PROGRAM FOR DOMESTIC VICTIMS OF
  TRAFFICKING
  Sec. 526.0701.  DEFINITIONS
  Sec. 526.0702.  VICTIM ASSISTANCE PROGRAM
  Sec. 526.0703.  GRANT PROGRAM
  Sec. 526.0704.  TRAINING PROGRAMS
  Sec. 526.0705.  FUNDING
  SUBCHAPTER P. AGING ADULTS WITH VISUAL IMPAIRMENTS
  Sec. 526.0751.  OUTREACH CAMPAIGNS FOR AGING ADULTS
                   WITH VISUAL IMPAIRMENTS
  Sec. 526.0752.  RULES
  Sec. 526.0753.  COMMISSION SUPPORT
  CHAPTER 526. ADDITIONAL POWERS AND DUTIES OF COMMISSION AND
  EXECUTIVE COMMISSIONER
  SUBCHAPTER A. INTERNET WEBSITES, ELECTRONIC RESOURCES, AND OTHER
  TECHNOLOGY
         Sec. 526.0001.  DEFINITIONS. In this subchapter:
               (1)  "Council" means the Records Management
  Interagency Coordinating Council.
               (2)  "Network" means the Texas Information and Referral
  Network.  (New.)
         Sec. 526.0002.  INTERNET WEBSITE FOR HEALTH AND HUMAN
  SERVICES INFORMATION. (a) The commission, in cooperation with the
  Department of Information Resources, shall maintain through the
  state electronic Internet portal project established by the
  department a generally accessible and interactive Internet website
  that contains information for the public regarding the services and
  programs each health and human services agency provides or
  administers in this state.  The commission shall establish the
  website in such a manner that allows it to be located easily through
  electronic means.
         (b)  The Internet website must:
               (1)  include information that is:
                     (A)  presented in a concise and easily
  understandable and accessible format; and
                     (B)  organized by the type of service provided
  rather than by the agency or provider delivering the service;
               (2)  provide eligibility criteria for each health and
  human services agency program;
               (3)  provide application forms for each of the public
  assistance programs administered by a health and human services
  agency, including forms for:
                     (A)  the financial assistance program under
  Chapter 31, Human Resources Code;
                     (B)  Medicaid; and
                     (C)  the nutritional assistance program under
  Chapter 33, Human Resources Code;
               (4)  to avoid duplication of functions and efforts,
  provide a link to an Internet website maintained by the network
  under Section 526.0005;
               (5)  provide the telephone number and, to the extent
  available, the e-mail address for each health and human services
  agency and local health and human services provider;
               (6)  be designed in a manner that allows a member of the
  public to electronically:
                     (A)  send questions about each agency's programs
  or services; and
                     (B)  receive the agency's responses to those
  questions; and
               (7)  be updated at least quarterly.
         (c)  In designing the Internet website, the commission shall
  comply with any state standards for Internet websites that are
  prescribed by the Department of Information Resources or any other
  state agency.
         (d)  The commission shall ensure that:
               (1)  the Internet website's design and applications:
                     (A)  comply with generally acceptable standards
  for Internet accessibility for individuals with disabilities; and
                     (B)  contain appropriate controls for information
  security; and
               (2)  the Internet website does not contain any
  confidential information, including any confidential information
  regarding a client of a human services provider.
         (e)  A health and human services agency, the network, and the
  Department of Information Resources shall cooperate with the
  commission to the extent necessary to enable the commission to
  perform its duties under this section. (Gov. Code, Secs.
  531.0317(b), (c), (d), (e), (f).)
         Sec. 526.0003.  INFORMATION ON LONG-TERM CARE SERVICES.  (a)  
  The Internet website maintained under Section 526.0002 must include
  information for consumers concerning long-term care services.  The
  information must:
               (1)  be presented in a manner that is easily accessible
  to and understandable by a consumer; and
               (2)  allow a consumer to make informed choices
  concerning long-term care services and include:
                     (A)  an explanation of the manner in which
  long-term care service delivery is administered in different
  counties through different programs the commission operates so that
  an individual can easily understand the service options available
  in the area in which that individual lives; and
                     (B)  for the STAR+PLUS Medicaid managed care
  program, information in an accessible format, such as a table, that
  allows a consumer to evaluate the performance of each participating
  plan issuer, including for each issuer:
                           (i)  the enrollment in each county;
                           (ii)  additional "value-added" services
  provided;
                           (iii)  a summary of the financial
  statistical report required under Section 540.0211;
                           (iv)  complaint information;
                           (v)  any sanction or penalty imposed by any
  state agency, including a sanction or penalty imposed by the
  commission or the Texas Department of Insurance;
                           (vi)  consumer satisfaction information;
  and
                           (vii)  other data, including relevant data
  from reports of external quality review organizations, that may be
  used by the consumer to evaluate the quality of the services
  provided.
         (b)  In addition to providing the information required by
  this section through the Internet website, the commission shall, on
  request by a consumer without Internet access, provide the consumer
  with a printed copy of the information from the Internet website.  
  The commission may charge a reasonable fee for printing the
  information. The executive commissioner by rule shall establish the
  fee amount.  (Gov. Code, Sec. 531.0318.)
         Sec. 526.0004.  TEXAS INFORMATION AND REFERRAL NETWORK. (a)  
  The Texas Information and Referral Network is responsible for
  developing, coordinating, and implementing a statewide information
  and referral network that integrates existing community-based
  structures with state and local agencies. The network must:
               (1)  include information relating to transportation
  services provided to clients of state and local agencies;
               (2)  be capable of assisting with statewide disaster
  response and emergency management, including through the use of
  interstate agreements with out-of-state call centers to ensure
  preparedness and responsiveness;
               (3)  include technology capable of communicating with
  clients of state and local agencies using electronic text
  messaging; and
               (4)  include a publicly accessible Internet-based
  system to provide real-time, searchable data about the location and
  number of clients of state and local agencies using the system and
  the types of requests the clients made.
         (b)  The commission shall cooperate with the council and the
  comptroller to establish a single method of categorizing
  information about health and human services to be used by the
  council and the network.  The network, in cooperation with the
  council and the comptroller, shall ensure that:
               (1)  information relating to health and human services
  is included in each residential telephone directory published by a
  for-profit publisher and distributed to the public at minimal or no
  cost; and
               (2)  the single method of categorizing information
  about health and human services is used in the directory.
         (c)  A health and human services agency or a public or
  private entity receiving state-appropriated funds to provide
  health and human services shall provide the council and the network
  with information about the health and human services the agency or
  entity provides for inclusion in the statewide information and
  referral network, residential telephone directories described by
  Subsection (b), and any other materials produced under the
  council's or the network's direction.  The agency or entity shall
  provide the information in the format the council or the network
  requires and shall update the information at least quarterly or as
  required by the council or the network.
         (d)  The Texas Department of Housing and Community Affairs
  shall provide the network with information regarding the
  department's housing and community affairs programs for inclusion
  in the statewide information and referral network.  The department
  shall provide the information in a form the commission determines
  and shall update the information at least quarterly.
         (e)  Each local workforce development board, the Texas Head
  Start State Collaboration Office, and each school district shall
  provide the network with information regarding eligibility for and
  availability of child-care and education services as defined by
  Section 526.0006 for inclusion in the statewide information and
  referral network.  The local workforce development boards, Texas
  Head Start State Collaboration Office, and school districts shall
  provide the information in a form the executive commissioner
  determines.  (Gov. Code, Sec. 531.0312.)
         Sec. 526.0005.  INTERNET WEBSITE FOR HEALTH AND HUMAN
  SERVICES REFERRAL INFORMATION. (a)  The network may develop an
  Internet website to provide information to the public regarding the
  health and human services provided by public or private entities
  throughout this state.
         (b)  The material on the network Internet website must be:
               (1)  geographically indexed, including by type of
  service provided within each geographic area; and
               (2)  designed to inform an individual about the health
  and human services provided in the area in which the individual
  lives.
         (c)  The Internet website may contain:
               (1)  links to the Internet websites of any local health
  and human services provider;
               (2)  the name, address, and telephone number of
  organizations providing health and human services in a county and a
  description of the type of services those organizations provide;
  and
               (3)  any other information that educates the public
  about the health and human services provided in a county.
         (d)  The network shall coordinate with the Department of
  Information Resources to maintain the Internet website through the
  state electronic Internet portal project established by the
  department.  (Gov. Code, Secs. 531.0313(a), (b), (c), (d).)
         Sec. 526.0006.  INTERNET WEBSITE FOR CHILD-CARE AND
  EDUCATION SERVICES REFERRAL INFORMATION.  (a)  In this section,
  "child-care and education services" means:
               (1)  subsidized child-care services administered by
  the Texas Workforce Commission and local workforce development
  boards and funded wholly or partly by federal child-care
  development funds;
               (2)  child-care and education services provided by a
  Head Start or Early Head Start program provider;
               (3)  child-care and education services provided by a
  school district through a prekindergarten or after-school program;
  and
               (4)  any other government-funded child-care and
  education services, other than education and services a school
  district provides as part of the general program of public
  education, designed to educate or provide care for children younger
  than 13 years of age in middle-income or low-income families.
         (b)  In addition to providing health and human services
  information, the network Internet website established under
  Section 526.0005 must provide information to the public regarding
  child-care and education services public or private entities
  provide throughout this state.  The Internet website will serve as a
  single point of access through which an individual may be directed
  toward information regarding the manner of or location for applying
  for all child-care and education services available in the
  individual's community.
         (c)  To the extent resources are available, the Internet
  website must:
               (1)  be geographically indexed and designed to inform
  an individual about the child-care and education services provided
  in the area in which the individual lives;
               (2)  contain prescreening questions to determine an
  individual's or family's probable eligibility for child-care and
  education services; and
               (3)  be designed in a manner that allows network staff
  to:
                     (A)  provide an applicant with the telephone
  number, physical address, and e-mail address of the:
                           (i)  nearest Head Start or Early Head Start
  office or center and local workforce development center; and
                           (ii)  appropriate school district; and
                     (B)  send an e-mail message to each appropriate
  entity described by Paragraph (A) containing each applicant's name
  and contact information and a description of the services for which
  the applicant is applying.
         (d)  On receipt of an e-mail message from the network under
  Subsection (c)(3)(B), each applicable entity shall:
               (1)  contact the applicant to verify information
  regarding the applicant's eligibility for available child-care and
  education services; and
               (2)  on certifying the applicant's eligibility, match
  the applicant with entities providing those services in the
  applicant's community, including local workforce development
  boards, local child-care providers, or a Head Start or Early Head
  Start program provider.
         (e)  The child-care resource and referral network described
  by Chapter 310, Labor Code, and each entity providing child-care
  and education services in this state, including local workforce
  development boards, the Texas Education Agency, school districts,
  Head Start and Early Head Start program providers, municipalities,
  counties, and other political subdivisions of this state, shall
  cooperate with the network as necessary to administer this section.  
  (Gov. Code, Sec. 531.03131.)
         Sec. 526.0007.  INTERNET WEBSITE FOR REFERRAL INFORMATION ON
  HOUSING OPTIONS FOR INDIVIDUALS WITH MENTAL ILLNESS. (a)  The
  commission shall make available through the network Internet
  website established under Section 526.0005 information regarding
  housing options for individuals with mental illness provided by
  public or private entities throughout this state.  The Internet
  website serves as a single point of access through which an
  individual may be directed toward information regarding the manner
  of or where to apply for housing for individuals with mental illness
  in the individual's community.  In this subsection, "private
  entity" includes any provider of housing specifically for
  individuals with mental illness other than a state agency, county,
  municipality, or other political subdivision of this state,
  regardless of whether the provider accepts payment for providing
  housing for those individuals.
         (b)  To the extent resources are available, the Internet
  website must be geographically indexed and designed to inform an
  individual about the housing options for individuals with mental
  illness provided in the area in which the individual lives.
         (c)  The Internet website must contain a searchable listing
  of available housing options for individuals with mental illness by
  type with a definition for each type of housing and an explanation
  of the populations of individuals with mental illness generally
  served by that type of housing.  The list must include the following
  types of housing for individuals with mental illness:
               (1)  state hospitals;
               (2)  step-down units in state hospitals;
               (3)  community hospitals;
               (4)  private psychiatric hospitals;
               (5)  an inpatient treatment service provider in the
  network of service providers assembled by a local mental health
  authority under Section 533.035(c), Health and Safety Code;
               (6)  assisted living facilities;
               (7)  continuing care facilities;
               (8)  boarding homes;
               (9)  emergency shelters for individuals who are
  homeless;
               (10)  transitional housing intended to move
  individuals who are homeless to permanent housing;
               (11)  supportive housing or long-term, community-based
  affordable housing that provides supportive services;
               (12)  general residential operations, as defined by
  Section 42.002, Human Resources Code; and
               (13)  residential treatment centers or a type of
  general residential operation that provides services to children
  with emotional disorders in a structured and supportive
  environment.
         (d)  For each housing facility named in the listing of
  available housing options for individuals with mental illness, the
  Internet website must indicate whether the provider operating the
  housing facility is licensed by this state.
         (e)  The Internet website must display a disclaimer that the
  information provided is for informational purposes only and is not
  an endorsement or recommendation of any type of housing or any
  housing facility.
         (f)  Each entity providing housing specifically for
  individuals with mental illness in this state, including the
  commission, counties, municipalities, other political subdivisions
  of this state, and private entities, shall cooperate with the
  network as necessary to administer this section.  (Gov. Code, Sec.
  531.03132.)
         Sec. 526.0008.  COMPLIANCE WITH NATIONAL ELECTRONIC DATA
  INTERCHANGE STANDARDS FOR HEALTH CARE INFORMATION. Each health and
  human services agency and other state agency that acts as a health
  care provider or a claims payer for the provision of health care
  shall:
               (1)  process information related to health care in
  compliance with national data interchange standards adopted under
  Subtitle F, Title II, Health Insurance Portability and
  Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.),
  within the applicable deadline established under federal law or
  federal regulations; or
               (2)  demonstrate to the commission the reasons the
  agency should not be required to comply with Subdivision (1), and to
  the extent allowed under federal law, obtain the commission's
  approval to:
                     (A)  comply with the standards at a later date; or
                     (B)  not comply with one or more of the standards.  
  (Gov. Code, Sec. 531.0315.)
         Sec. 526.0009.  TECHNICAL ASSISTANCE FOR HUMAN SERVICES
  PROVIDERS. (a) A health and human services agency shall, in
  conjunction with the Department of Information Resources,
  coordinate and enhance the agency's existing Internet website to
  provide technical assistance for human services providers. The
  commission shall take the lead and ensure involvement of the
  agencies with the greatest potential to produce cost savings.
         (b)  Assistance provided under this section:
               (1)  must include information on the impact of federal
  and state welfare reform changes on human services providers;
               (2)  may include information in the following subjects:
                     (A)  case management;
                     (B)  contract management;
                     (C)  financial management;
                     (D)  performance measurement and evaluation;
                     (E)  research; and
                     (F)  other matters the commission considers
  appropriate; and
               (3)  may not include any confidential information
  regarding a client of a human services provider. (Gov. Code, Sec.
  531.013.)
         Sec. 526.0010.  INFORMATION RESOURCES MANAGER REPORTS.
  Notwithstanding Section 2054.075(b), the information resources
  manager of a health and human services agency shall report directly
  to the executive commissioner or a deputy executive commissioner
  the executive commissioner designates.  (Gov. Code,
  Sec. 531.02731.)
  SUBCHAPTER B.  PROGRAMS AND SERVICES PROVIDED OR ADMINISTERED BY
  COMMISSION
         Sec. 526.0051.  RESTRICTIONS ON AWARDS TO FAMILY PLANNING
  SERVICE PROVIDERS. (a) Notwithstanding any other law, money
  appropriated to the commission for the purpose of providing family
  planning services must be awarded:
               (1)  to eligible entities in the following order of
  descending priority:
                     (A)  public entities that provide family planning
  services, including state, county, and local community health
  clinics and federally qualified health centers;
                     (B)  nonpublic entities that provide
  comprehensive primary and preventive care services in addition to
  family planning services; and
                     (C)  nonpublic entities that provide family
  planning services but do not provide comprehensive primary and
  preventive care services; or
               (2)  as otherwise directed by the legislature in the
  General Appropriations Act.
         (b)  Notwithstanding Subsection (a), the commission shall,
  in compliance with federal law, ensure distribution of funds for
  family planning services in a manner that does not severely limit or
  eliminate access to those services in any region of this state.  
  (Gov. Code, Sec. 531.0025.)
         Sec. 526.0052.  INFORMATION FOR CERTAIN ENROLLEES IN HEALTHY
  TEXAS WOMEN PROGRAM. (a)  In this section, "Healthy Texas Women
  program" means a program the commission operates that is
  substantially similar to the demonstration project operated under
  former Section 32.0248, Human Resources Code, and that is intended
  to expand access to preventive health and family planning services
  for women in this state.
         (b)  This section applies to a woman who is automatically
  enrolled in the Healthy Texas Women program following a pregnancy
  for which the woman received Medicaid, but who is no longer eligible
  to participate in Medicaid.
         (c)  After a woman to whom this section applies is enrolled
  in the Healthy Texas Women program, the commission shall provide to
  the woman:
               (1)  information about the Healthy Texas Women program,
  including the services provided under the program; and
               (2)  a list of health care providers who participate in
  the Healthy Texas Women program and are located in the same
  geographical area in which the woman resides.
         (d)  The commission shall consult with the Texas Maternal
  Mortality and Morbidity Review Committee established under Chapter
  34, Health and Safety Code, to improve the process for providing the
  information required by Subsection (c), including by determining:
               (1)  the best time for providing the information; and
               (2)  the manner of providing the information, including
  the information about health care providers described by Subsection
  (c)(2).  (Gov. Code, Sec. 531.0995.)
         Sec. 526.0053.  VACCINES FOR CHILDREN PROGRAM PROVIDER
  ENROLLMENT; IMMUNIZATION REGISTRY. (a)  In this section, "vaccines
  for children program" means the program the Department of State
  Health Services operates under 42 U.S.C. Section 1396s.
         (b)  The commission shall ensure that a provider may enroll
  in the vaccines for children program on the same form the provider
  completes to apply as a Medicaid health care provider.
         (c)  The commission shall allow providers to:
               (1)  report vaccines administered under the vaccines
  for children program to the immunization registry established under
  Section 161.007, Health and Safety Code; and
               (2)  use the immunization registry, including
  individually identifiable information in accordance with state and
  federal law, to determine whether a child received an immunization.  
  (Gov. Code, Sec. 531.064.)
         Sec. 526.0054.  PRIOR AUTHORIZATION FOR HIGH-COST MEDICAL
  SERVICES AND PROCEDURES.  (a)  The commission may:
               (1)  evaluate and implement, as appropriate,
  procedures, policies, and methodologies to require prior
  authorization for high-cost medical services and procedures; and
               (2)  contract with qualified service providers or
  organizations to perform those functions.
         (b)  A procedure, policy, or methodology implemented under
  this section must comply with any prohibitions in state or federal
  law on limits in the amount, duration, or scope of medically
  necessary services for Medicaid recipients who are children.  (Gov.
  Code, Sec. 531.075.)
         Sec. 526.0055.  TAILORED BENEFIT PACKAGES FOR NON-MEDICAID
  POPULATIONS.  (a)  The commission shall identify state or federal
  non-Medicaid programs that provide health care services to
  individuals whose health care needs could be met by providing
  customized benefits through a system of care that is used under a
  Medicaid tailored benefit package implemented under Section
  532.0351.
         (b)  If the commission determines it is feasible and to the
  extent permitted by federal and state law, the commission shall:
               (1)  provide the health care services for individuals
  described by Subsection (a) through the applicable Medicaid
  tailored benefit package; and
               (2)  if appropriate or necessary to provide the
  services as required by Subdivision (1), develop and implement a
  system of blended funding methodologies to provide the services in
  that manner.  (Gov. Code, Sec. 531.0971.)
         Sec. 526.0056.  PILOT PROGRAM TO PREVENT SPREAD OF
  INFECTIOUS OR COMMUNICABLE DISEASES. The commission may provide
  guidance to the local health authority of Bexar County in
  establishing a pilot program funded by the county to prevent the
  spread of HIV, hepatitis B, hepatitis C, and other infectious and
  communicable diseases. The program may include a disease control
  program that provides for the anonymous exchange of used hypodermic
  needles and syringes.  (Gov. Code, Sec. 531.0972.)
         Sec. 526.0057.  APPLICATION REQUIREMENT FOR COLONIAS
  PROJECTS. (a)  In this section, "colonia" means a geographic area
  that:
               (1)  is an economically distressed area as defined by
  Section 17.921, Water Code;
               (2)  is located in a county any part of which is within
  62 miles of an international border; and
               (3)  consists of 11 or more dwellings located in
  proximity to each other in an area that may be described as a
  community or neighborhood.
         (b)  The commission shall require an applicant for funds
  under any project the commission funds that provides assistance to
  colonias to submit to the commission any existing colonia
  classification number for each colonia that may be served by the
  project proposed in the application.
         (c)  The commission may contact the secretary of state or the
  secretary of state's representative to obtain a classification
  number for a colonia that does not have a classification number. On
  request of the commission, the secretary of state or the secretary
  of state's representative shall assign a classification number to
  the colonia.  (Gov. Code, Sec. 531.0141.)
         Sec. 526.0058.  RULES REGARDING REFUGEE RESETTLEMENT. (a)
  In this section, "local resettlement agency" and "national
  voluntary agency" have the meanings assigned by 45 C.F.R. Section
  400.2.
         (b)  The executive commissioner shall adopt rules to ensure
  that:
               (1)  any refugee placement report required under a
  federal refugee resettlement program includes local governmental
  and community input; and
               (2)  governmental entities and officials are provided
  with related information.
         (c)  In adopting the rules, the executive commissioner
  shall, to the extent permitted by federal law, ensure that meetings
  are convened at least quarterly in the communities proposed for
  refugee placement at which representatives of local resettlement
  agencies have an opportunity to consult with and obtain feedback
  regarding proposed refugee placement from:
               (1)  local governmental entities and officials,
  including:
                     (A)  municipal and county officials;
                     (B)  local school district officials; and
                     (C)  representatives of local law enforcement
  agencies; and
               (2)  other community stakeholders, including:
                     (A)  major providers under the local health care
  system; and
                     (B)  major employers of refugees.
         (d)  In adopting the rules, the executive commissioner
  shall, to the extent permitted by federal law, ensure that:
               (1)  a local resettlement agency:
                     (A)  considers all feedback obtained in meetings
  conducted under Subsection (c) before preparing a proposed annual
  report on the placement of refugees for purposes of 8 U.S.C. Section
  1522(b)(7)(E);
                     (B)  informs the state and local governmental
  entities and officials and community stakeholders described by
  Subsection (c) of the proposed annual report; and
                     (C)  develops a final annual report for the
  national voluntary agencies and the commission that includes a
  summary regarding the manner in which stakeholder input contributed
  to the report; and
               (2)  the commission:
                     (A)  obtains from local resettlement agencies the
  preliminary number of refugees the local resettlement agencies
  recommended to the national voluntary agencies for placement in
  communities throughout this state and provides that information to
  local governmental entities and officials in those communities; and
                     (B)  obtains from the United States Department of
  State or other appropriate federal agency the number of refugees
  apportioned to this state and provides that information and
  information regarding the number of refugees intended to be placed
  in each community in this state to local governmental entities and
  officials in those communities. (Gov. Code, Sec. 531.0411.)
         Sec. 526.0059.  PROHIBITED AWARD OF CONTRACTS TO MANAGED
  CARE ORGANIZATIONS FOR CERTAIN CRIMINAL CONVICTIONS. The
  commission may not contract with a managed care organization,
  including a health maintenance organization, or a pharmacy benefit
  manager if, in the preceding three years, the organization or
  manager, in connection with a bid, proposal, or contract with the
  commission, was subject to a final judgment by a court of competent
  jurisdiction resulting in:
               (1)  a conviction for:
                     (A)  a criminal offense under state or federal law
  related to the delivery of an item or service;
                     (B)  a criminal offense under state or federal law
  related to neglect or abuse of patients in connection with the
  delivery of an item or service; or
                     (C)  a felony offense under state or federal law
  related to fraud, theft, embezzlement, breach of fiduciary
  responsibility, or other financial misconduct; or
               (2)  the imposition of a penalty or fine in the amount
  of $500,000 or more in a state or federal administrative proceeding
  based on a conviction for a criminal offense under state or federal
  law.  (Gov. Code, Sec. 531.0696.)
  SUBCHAPTER C. COORDINATION OF QUALITY INITIATIVES
         Sec. 526.0101.  DEFINITION. In this subchapter, "waiver"
  means the Texas Healthcare Transformation and Quality Improvement
  Program waiver issued under Section 1115 of the Social Security Act
  (42 U.S.C. Section 1315). (New.)
         Sec. 526.0102.  OPERATIONAL PLAN TO COORDINATE MAJOR QUALITY
  INITIATIVES. (a) The commission shall develop and implement a
  comprehensive, coordinated operational plan to ensure a consistent
  approach across the major quality initiatives of the health and
  human services system for improving the quality of health care.  The
  plan must include broad goals for improving the quality of health
  care in this state, including health care services provided through
  Medicaid.
         (b)  The plan may evaluate:
               (1)  the Delivery System Reform Incentive Payment
  (DSRIP) program under the waiver;
               (2)  enhancing funding to disproportionate share
  hospitals in this state;
               (3)  Section 1332 of the Patient Protection and
  Affordable Care Act (42 U.S.C. Section 18052);
               (4)  enhancing uncompensated care pool payments to
  hospitals in this state under the waiver;
               (5)  home and community-based services state plan
  options under Section 1915(i) of the Social Security Act (42 U.S.C.
  Section 1396n(i)); and
               (6)  a contingency plan in the event the commission
  does not obtain an extension or renewal of the uncompensated care
  pool provisions or any other provisions of the granted waiver.
  (Gov. Code, Sec. 531.451.)
         Sec. 526.0103.  REVISION AND EVALUATION OF MAJOR QUALITY
  INITIATIVES. Notwithstanding other law, the commission shall
  revise major quality initiatives of the health and human services
  system in accordance with the operational plan and health care
  quality improvement goals developed under Section 526.0102.  To the
  extent possible, the commission shall ensure that outcome measure
  data is collected and reported consistently across all major
  quality initiatives to improve the evaluation of the initiatives'
  statewide impact.  (Gov. Code, Sec. 531.452.)
         Sec. 526.0104.  INCENTIVES FOR MAJOR QUALITY INITIATIVE
  COORDINATION. The commission shall consider and, if appropriate,
  develop in accordance with this subchapter, incentives that promote
  coordination among the various major quality initiatives,
  including projects and initiatives approved under the granted
  waiver.  (Gov. Code, Sec. 531.453.)
  SUBCHAPTER D.  TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
         Sec. 526.0151.  DEFINITION. In this subchapter, "fund"
  means the Texas health opportunity pool trust fund established
  under Section 526.0153.  (Gov. Code, Sec. 531.501.)
         Sec. 526.0152.  AUTHORITY TO OBTAIN FEDERAL WAIVER. (a)  The
  executive commissioner may seek a waiver under Section 1115 of the
  Social Security Act (42 U.S.C. Section 1315) to the state Medicaid
  plan to allow the commission to more efficiently and effectively
  use federal money paid to this state under various programs to
  defray costs associated with providing uncompensated health care in
  this state by using that federal money, appropriated state money to
  the extent necessary, and any other money described by this section
  for purposes consistent with this subchapter.
         (b)  The executive commissioner may include the following
  federal money in the waiver:
               (1)  money provided under:
                     (A)  the disproportionate share hospitals
  program;
                     (B)  the upper payment limit supplemental payment
  program; or
                     (C)  both;
               (2)  money provided by the federal government in lieu
  of some or all of the payments provided under one or both of the
  programs described by Subdivision (1);
               (3)  any combination of funds authorized to be pooled
  by Subdivisions (1) and (2); and
               (4)  any other money available for that purpose,
  including:
                     (A)  federal money and money identified under
  Subsection (c);
                     (B)  gifts, grants, or donations for that purpose;
                     (C)  local funds received by this state through
  intergovernmental transfers; and
                     (D)  if approved in the waiver, federal money
  obtained through the use of certified public expenditures.
         (c)  The commission shall seek to optimize federal funding
  by:
               (1)  identifying health care-related state and local
  funds and program expenditures that, before September 1, 2011, are
  not being matched with federal money; and
               (2)  exploring the feasibility of:
                     (A)  certifying or otherwise using those funds and
  expenditures as state expenditures for which this state may receive
  federal matching money; and
                     (B)  depositing federal matching money received
  as provided by Paragraph (A) with other federal money deposited as
  provided by Section 526.0154, or substituting that federal matching
  money for federal money that otherwise would be received under the
  disproportionate share hospitals and upper payment limit
  supplemental payment programs as a match for local funds received
  by this state through intergovernmental transfers.
         (d)  The terms of a waiver approved under this section must:
               (1)  include safeguards to ensure that the total amount
  of federal money provided under the disproportionate share
  hospitals or upper payment limit supplemental payment program that
  is deposited as provided by Section 526.0154 is, for a particular
  state fiscal year, at least equal to the greater of the annualized
  amount provided to this state under those supplemental payment
  programs during:
                     (A)  state fiscal year 2011, excluding
  retroactive payment amounts provided during that state fiscal year;
  or
                     (B)  the state fiscal years during which the
  waiver is in effect; and
               (2)  allow this state to develop a methodology for
  allocating money in the fund to:
                     (A)  supplement Medicaid hospital reimbursements
  under a waiver that includes terms consistent with, or that produce
  revenues consistent with, disproportionate share hospital and
  upper payment limit principles;
                     (B)  reduce the number of individuals in this
  state who do not have health benefits coverage; and
                     (C)  maintain and enhance the community public
  health infrastructure provided by hospitals.
         (e)  In seeking a waiver under this section, the executive
  commissioner shall attempt to:
               (1)  obtain maximum flexibility in the use of the money
  in the fund for purposes consistent with this subchapter;
               (2)  include an annual adjustment to the aggregate caps
  under the upper payment limit supplemental payment program to
  account for inflation, population growth, and other appropriate
  demographic factors that affect the ability of residents of this
  state to obtain health benefits coverage;
               (3)  ensure, for the term of the waiver, that the
  aggregate caps under the upper payment limit supplemental payment
  program for each of the three classes of hospitals are not less than
  the aggregate caps applied during state fiscal year 2007; and
               (4)  to the extent allowed by federal law, including
  federal regulations, and federal waiver authority, preserve the
  federal supplemental payment program payments made to hospitals,
  the state match with respect to which is funded by
  intergovernmental transfers or certified public expenditures that
  are used to optimize Medicaid payments to safety net providers for
  uncompensated care, and preserve allocation methods for those
  payments, unless the need for the payments is revised through
  measures that reduce the Medicaid shortfall or uncompensated care
  costs.
         (f)  The executive commissioner shall seek broad-based
  stakeholder input in the development of the waiver under this
  section and shall provide information to stakeholders regarding the
  terms of the waiver for which the executive commissioner seeks
  federal approval. (Gov. Code, Sec. 531.502.)
         Sec. 526.0153.  TEXAS HEALTH OPPORTUNITY POOL TRUST FUND
  ESTABLISHED. (a) Subject to approval of the waiver authorized by
  Section 526.0152, the Texas health opportunity pool trust fund is
  created as a trust fund outside the state treasury to be held by the
  comptroller and administered by the commission as trustee on behalf
  of residents of this state who do not have private health benefits
  coverage and health care providers providing uncompensated care to
  those individuals.
         (b)  The commission may spend money in the fund only for
  purposes consistent with this subchapter and the terms of the
  waiver authorized by Section 526.0152.  (Gov. Code, Sec. 531.503.)
         Sec. 526.0154.  DEPOSITS TO FUND. (a)  The comptroller shall
  deposit in the fund:
               (1)  federal money provided to this state under the
  disproportionate share hospitals supplemental payment program, the
  hospital upper payment limit supplemental payment program, or both,
  other than money provided under those programs to state-owned and
  -operated hospitals, and all other nonsupplemental payment program
  federal money provided to this state that is included in the waiver
  authorized by Section 526.0152; and
               (2)  state money appropriated to the fund.
         (b)  The commission and comptroller may accept gifts,
  grants, and donations from any source, and receive
  intergovernmental transfers, for purposes consistent with this
  subchapter and the terms of the waiver authorized by Section
  526.0152. The comptroller shall deposit a gift, grant, or donation
  made for those purposes in the fund.
         (c)  Any intergovernmental transfer received, including
  associated federal matching funds, shall be used, if feasible, for
  the purposes intended by the transferring entity and in accordance
  with the terms of the waiver authorized by Section 526.0152. (Gov.
  Code, Sec. 531.504.)
         Sec. 526.0155.  USE OF FUND IN GENERAL; RULES FOR
  ALLOCATION.  (a)  Except as otherwise provided by the terms of a
  waiver authorized by Section 526.0152, money in the fund may be
  used:
               (1)  subject to Section 526.0156, to provide to health
  care providers reimbursements that:
                     (A)  are based on the providers' costs related to
  providing uncompensated care; and
                     (B)  compensate the providers for at least a
  portion of those costs;
               (2)  to reduce the number of individuals in this state
  who do not have health benefits coverage;
               (3)  to reduce the need for uncompensated health care
  provided by hospitals in this state; and
               (4)  for any other purpose specified by this subchapter
  or the waiver.
         (b)  On approval of the waiver authorized by Section
  526.0152, the executive commissioner shall:
               (1)  seek input from a broad base of stakeholder
  representatives on the development of rules with respect to and for
  the administration of the fund; and
               (2)  by rule develop a methodology for allocating money
  in the fund that is consistent with the terms of the waiver. (Gov.
  Code, Sec. 531.505.)
         Sec. 526.0156.  REIMBURSEMENTS FOR UNCOMPENSATED HEALTH
  CARE COSTS. (a)  Except as otherwise provided by the terms of a
  waiver authorized by Section 526.0152 and subject to Subsections
  (b) and (c), money in the fund may be allocated to hospitals in this
  state and political subdivisions of this state to defray the costs
  of providing uncompensated health care.
         (b)  To be eligible for money allocated from the fund under
  this section, a hospital or political subdivision must use a
  portion of the money to implement strategies that will reduce the
  need for uncompensated inpatient and outpatient care, including
  care provided in a hospital emergency room. The strategies may
  include:
               (1)  fostering improved access for patients to primary
  care systems or other programs that offer those patients medical
  homes, including the following programs:
                     (A)  regional or local health care programs;
                     (B)  programs to provide premium subsidies for
  health benefits coverage; and
                     (C)  other programs to increase access to health
  benefits coverage; and
               (2)  creating health care systems efficiencies, such as
  using electronic medical records systems.
         (c)  The allocation methodology the executive commissioner
  develops under Section 526.0155(b) must specify the percentage of
  the money from the fund allocated to a hospital or political
  subdivision that the hospital or political subdivision must use for
  strategies described by Subsection (b) of this section. (Gov.
  Code, Sec. 531.506.)
         Sec. 526.0157.  INCREASING ACCESS TO HEALTH BENEFITS
  COVERAGE. (a)  Except as otherwise provided by the terms of a
  waiver authorized by Section 526.0152, money in the fund that is
  available to reduce the number of individuals in this state who do
  not have health benefits coverage or to reduce the need for
  uncompensated health care provided by hospitals in this state may
  be used for purposes relating to increasing access to health
  benefits coverage for individuals with low income, including:
               (1)  providing premium payment assistance to those
  individuals through a premium payment assistance program developed
  under this section;
               (2)  making contributions to health savings accounts
  for those individuals; and
               (3)  providing other financial assistance to those
  individuals through alternate mechanisms established by hospitals
  in this state or political subdivisions of this state that meet
  certain commission-specified criteria.
         (b)  The commission and the Texas Department of Insurance
  shall jointly develop a premium payment assistance program designed
  to assist individuals described by Subsection (a) in obtaining and
  maintaining health benefits coverage. The program may provide
  assistance in the form of payments for all or part of the premiums
  for that coverage. In developing the program, the executive
  commissioner shall adopt rules establishing:
               (1)  eligibility criteria for the program;
               (2)  the amount of premium payment assistance that will
  be provided under the program;
               (3)  the process by which that assistance will be paid;
  and
               (4)  the mechanism for measuring and reporting the
  number of individuals who obtained health insurance or other health
  benefits coverage as a result of the program.
         (c)  The commission shall implement the premium payment
  assistance program developed under Subsection (b), subject to
  availability of money in the fund for that purpose. (Gov. Code, Sec.
  531.507.)
         Sec. 526.0158.  INFRASTRUCTURE IMPROVEMENTS. (a)  Except as
  otherwise provided by the terms of a waiver authorized by Section
  526.0152 and subject to Subsection (c), money in the fund may be
  used for purposes related to developing and implementing
  initiatives to improve the infrastructure of local provider
  networks that provide services to Medicaid recipients and
  individuals with low income and without health benefits coverage in
  this state.
         (b)  The infrastructure improvements may include developing
  and implementing a system for maintaining medical records in an
  electronic format.
         (c)  Not more than 10 percent of the total amount of the money
  in the fund used in a state fiscal year for purposes other than
  providing reimbursements to hospitals for uncompensated health
  care may be used for infrastructure improvements described by
  Subsection (b).
         (d)  Money from the fund may not be used to finance the
  construction, improvement, or renovation of a building or land
  unless the commission approves the construction, improvement, or
  renovation in accordance with rules the executive commissioner
  adopts for that purpose. (Gov. Code, Sec. 531.508.)
  SUBCHAPTER E. LONG-TERM CARE FACILITIES
         Sec. 526.0201.  DEFINITION. In this subchapter, "council"
  means the Long-Term Care Facilities Council. (Gov. Code, Sec.
  531.0581(a)(1).)
         Sec. 526.0202.  INFORMAL DISPUTE RESOLUTION FOR CERTAIN
  LONG-TERM CARE FACILITIES.  (a)  The executive commissioner by rule
  shall establish an informal dispute resolution process in
  accordance with this section.  The process must:
               (1)  provide for adjudication by an appropriate
  disinterested person of disputes relating to a proposed commission
  enforcement action or related proceeding under:
                     (A)  Section 32.021(d), Human Resources Code; or
                     (B)  Chapter 242, 247, or 252, Health and Safety
  Code; and
               (2)  require:
                     (A)  a facility to request informal dispute
  resolution not later than the 10th calendar day after the
  commission notifies the facility of the violation of a standard or
  standards; and
                     (B)  the completion of the process not later than:
                           (i)  the 30th calendar day after receipt of a
  request for informal dispute resolution from a facility, other than
  an assisted living facility; or
                           (ii)  the 90th calendar day after receipt of
  a request from an assisted living facility for informal dispute
  resolution.
         (b)  As part of the informal dispute resolution process, the
  commission shall contract with an appropriate disinterested person
  to adjudicate disputes between a facility licensed under Chapter
  242 or 247, Health and Safety Code, and the commission concerning a
  statement of violations the commission prepares in connection with
  a survey the commission conducts of the facility. The contracting
  person shall adjudicate all disputes described by this subsection.
  The informal dispute resolution process for the statement of
  violations must require:
               (1)  the surveyor who conducted the survey for which
  the statement was prepared to be available to clarify or answer
  questions asked by the contracting person or by the facility
  related to the facility or statement; and
               (2)  the commission's review of the facility's informal
  dispute resolution request for a standard of care violation to be
  conducted by a registered nurse with long-term care experience.
         (c)  Section 2009.053 does not apply to the commission's
  selection of an appropriate disinterested person under Subsection
  (b).
         (d)  The executive commissioner shall adopt rules to
  adjudicate claims in contested cases.
         (e)  The commission may not delegate to another state agency
  the commission's responsibility to administer the informal dispute
  resolution process.
         (f)  The rules adopted under Subsection (a) that relate to a
  dispute described by Section 247.051(a), Health and Safety Code,
  must incorporate the requirements of Section 247.051, Health and
  Safety Code. (Gov. Code, Sec. 531.058.)
         Sec. 526.0203.  LONG-TERM CARE FACILITIES COUNCIL.  (a)  In
  this section, "long-term care facility" means a facility subject to
  regulation under Section 32.021(d), Human Resources Code, or
  Chapter 242, 247, or 252, Health and Safety Code.
         (b)  The executive commissioner shall establish a long-term
  care facilities council as a permanent advisory committee to the
  commission. The council is composed of the following members the
  executive commissioner appoints:
               (1)  at least one member who is a for-profit nursing
  facility provider;
               (2)  at least one member who is a nonprofit nursing
  facility provider;
               (3)  at least one member who is an assisted living
  services provider;
               (4)  at least one member responsible for survey
  enforcement within the state survey and certification agency;
               (5)  at least one member responsible for survey
  inspection within the state survey and certification agency;
               (6)  at least one member of the state agency
  responsible for informal dispute resolution;
               (7)  at least one member with expertise in Medicaid
  quality-based payment systems for long-term care facilities;
               (8)  at least one member who is a practicing medical
  director of a long-term care facility;
               (9)  at least one member who is a physician with
  expertise in infectious disease or public health; and
               (10)  at least one member who is a community-based
  provider at an intermediate care facility for individuals with
  intellectual or developmental disabilities licensed under Chapter
  252, Health and Safety Code.
         (c)  The executive commissioner shall designate a council
  member to serve as presiding officer. The council members shall
  elect any other necessary officers.
         (d)  A council member serves at the will of the executive
  commissioner.
         (e)  The council shall meet at the call of the executive
  commissioner.
         (f)  A council member is not entitled to reimbursement of
  expenses or to compensation for service on the council.
         (g)  Chapter 2110 does not apply to the council. (Gov. Code,
  Secs. 531.0581(a)(2), (b), (c), (d), (e), (f), (i).)
         Sec. 526.0204.  COUNCIL DUTIES; REPORT. (a)  In this
  section, "long-term care facility" has the meaning assigned by
  Section 526.0203.
         (b)  The council shall:
               (1)  study and make recommendations regarding a
  consistent survey and informal dispute resolution process for
  long-term care facilities, Medicaid quality-based payment systems
  for those facilities, and the allocation of Medicaid beds in those
  facilities;
               (2)  study and make recommendations regarding best
  practices and protocols to make survey, inspection, and informal
  dispute resolution processes more efficient and less burdensome on
  long-term care facilities;
               (3)  recommend uniform standards for those processes;
               (4)  study and make recommendations regarding Medicaid
  quality-based payment systems and a rate-setting methodology for
  long-term care facilities; and
               (5)  study and make recommendations relating to the
  allocation of and need for Medicaid beds in long-term care
  facilities, including studying and making recommendations relating
  to:
                     (A)  the effectiveness of rules adopted by the
  executive commissioner relating to the procedures for certifying
  and decertifying Medicaid beds in long-term care facilities; and
                     (B)  the need for modifications to those rules to
  better control the procedures for certifying and decertifying
  Medicaid beds in long-term care facilities.
         (c)  Not later than January 1 of each odd-numbered year, the
  council shall submit a report on the council's findings and
  recommendations to the executive commissioner, the governor, the
  lieutenant governor, the speaker of the house of representatives,
  and the chairs of the appropriate legislative committees.  (Gov.
  Code, Secs. 531.0581(a)(2), (g), (h).)
  SUBCHAPTER F. UNCOMPENSATED HOSPITAL CARE REPORTING AND ANALYSIS;
  ADMINISTRATIVE PENALTY
         Sec. 526.0251.  RULES. The executive commissioner shall
  adopt rules providing for:
               (1)  a standard definition of "uncompensated hospital
  care";
               (2)  a methodology for hospitals in this state to use in
  computing the cost of uncompensated hospital care that incorporates
  a standard set of adjustments to a hospital's initial computation
  of the cost that accounts for all funding streams that:
                     (A)  are not patient-specific; and
                     (B)  are used to offset the hospital's initially
  computed amount of uncompensated hospital care; and
               (3)  procedures for hospitals to use in reporting the
  cost of uncompensated hospital care to the commission and in
  analyzing that cost, which may include procedures by which the
  commission may periodically verify the completeness and accuracy of
  the reported information.  (Gov. Code, Secs. 531.551(a), (b).)
         Sec. 526.0252.  NOTICE OF FAILURE TO REPORT; ADMINISTRATIVE
  PENALTY.  (a)  The commission shall notify the attorney general of a
  hospital's failure to report the cost of uncompensated hospital
  care on or before the report due date in accordance with rules
  adopted under Section 526.0251(3).
         (b)  On receipt of the notice, the attorney general shall
  impose an administrative penalty on the hospital in the amount of
  $1,000 for each day after the report due date that the hospital has
  not submitted the report, not to exceed $10,000.  (Gov. Code, Sec.
  531.551(c).)
         Sec. 526.0253.  NOTICE OF INCOMPLETE OR INACCURATE REPORT;
  ADMINISTRATIVE PENALTY.  (a)  If the commission determines that a
  hospital submitted a report with incomplete or inaccurate
  information using a procedure adopted under Section 526.0251(3),
  the commission shall:
               (1)  notify the hospital of the specific information
  the hospital must submit; and
               (2)  prescribe a date by which the hospital must
  provide that information.
         (b)  If the hospital fails to submit the specified
  information on or before the date the commission prescribes, the
  commission shall notify the attorney general of that failure.
         (c)  On receipt of the commission's notice, the attorney
  general shall impose an administrative penalty on the hospital in
  an amount not to exceed $10,000. In determining the amount of the
  penalty to be imposed, the attorney general shall consider:
               (1)  the seriousness of the violation;
               (2)  whether the hospital had previously committed a
  violation; and
               (3)  the amount necessary to deter the hospital from
  committing future violations.  (Gov. Code, Sec. 531.551(d).)
         Sec. 526.0254.  REQUIREMENTS FOR ATTORNEY GENERAL
  NOTIFICATION.  The commission's notification to the attorney
  general under Section 526.0252 or 526.0253 must include the facts
  on which the commission based the determination that the hospital
  failed to submit a report or failed to completely and accurately
  report information, as applicable.  (Gov. Code, Sec. 531.551(e).)
         Sec. 526.0255.  ATTORNEY GENERAL NOTICE TO HOSPITAL.  The
  attorney general shall give written notice of the commission's
  notification to the attorney general under Section 526.0252 or
  526.0253 to the hospital that is the subject of the notification.
  The notice must include:
               (1)  a brief summary of the alleged violation;
               (2)  a statement of the amount of the administrative
  penalty to be imposed; and
               (3)  a statement of the hospital's right to a hearing on
  the alleged violation, the amount of the penalty, or both.  (Gov.
  Code, Sec. 531.551(f).)
         Sec. 526.0256.  PENALTY PAID OR HEARING REQUESTED.  Not
  later than the 20th day after the date the attorney general sends
  the notice under Section 526.0255, the hospital receiving the
  notice must submit a written request for a hearing or remit the
  amount of the administrative penalty to the attorney general.
  Failure to timely request a hearing or remit the amount of the
  administrative penalty results in a waiver of the right to a hearing
  under this section. (Gov. Code, Sec. 531.551(g) (part).)
         Sec. 526.0257.  HEARING. (a) If a hospital requests a
  hearing in accordance with Section 526.0256, the attorney general
  shall conduct the hearing in accordance with Chapter 2001.
         (b)  If the hearing results in a finding that a violation has
  occurred, the attorney general shall:
               (1)  provide to the hospital written notice of:
                     (A)  the findings established at the hearing; and
                     (B)  the amount of the penalty; and
               (2)  enter an order requiring the hospital to pay the
  amount of the penalty.
         (c)  An order entered by the attorney general under this
  section is subject to judicial review as a contested case under
  Chapter 2001.  (Gov. Code, Secs. 531.551(g) (part), (i).)
         Sec. 526.0258.  OPTIONS FOLLOWING DECISION: PAY OR APPEAL.
  Not later than the 30th day after the date the hospital receives the
  order entered by the attorney general under Section 526.0257, the
  hospital shall:
               (1)  pay the amount of the administrative penalty;
               (2)  remit the amount of the penalty to the attorney
  general for deposit in an escrow account and file a petition for
  judicial review contesting the occurrence of the violation, the
  amount of the penalty, or both; or
               (3)  without paying the amount of the penalty:
                     (A)  file a petition for judicial review
  contesting the occurrence of the violation, the amount of the
  penalty, or both; and
                     (B)  file with the court a sworn affidavit stating
  that the hospital is financially unable to pay the amount of the
  penalty.  (Gov. Code, Sec. 531.551(h).)
         Sec. 526.0259.  DECISION BY COURT. (a) If a hospital paid
  an administrative penalty imposed under this subchapter and on
  review a court does not sustain the occurrence of the violation or
  finds that the amount of the penalty should be reduced, the attorney
  general shall remit the appropriate amount to the hospital not
  later than the 30th day after the date the court's judgment becomes
  final.
         (b)  If the court sustains the occurrence of the violation:
               (1)  the court:
                     (A)  shall order the hospital to pay the amount of
  the administrative penalty; and
                     (B)  may award to the attorney general the
  attorney's fees and court costs the attorney general incurred in
  defending the action; and
               (2)  the attorney general shall remit the amount of the
  penalty to the comptroller for deposit in the general revenue fund.  
  (Gov. Code, Secs. 531.551(j), (k).)
         Sec. 526.0260.  RECOVERY OF PENALTY. If a hospital does not
  pay the amount of an administrative penalty imposed under this
  subchapter after the attorney general's order becomes final for all
  purposes, the attorney general may enforce the penalty as provided
  by law for legal judgments. (Gov. Code, Sec. 531.551(l).)
  SUBCHAPTER G. RURAL HOSPITAL INITIATIVES
         Sec. 526.0301.  STRATEGIC PLAN FOR RURAL HOSPITAL SERVICES;
  REPORT. (a) The commission shall develop and implement a strategic
  plan to ensure that the citizens in this state residing in rural
  areas have access to hospital services.
         (b)  The strategic plan must include:
               (1)  a proposal for using at least one of the following
  methods to ensure access to hospital services in the rural areas of
  this state:
                     (A)  an enhanced cost reimbursement methodology
  for the payment of rural hospitals participating in the Medicaid
  managed care program in conjunction with a supplemental payment
  program for rural hospitals to cover costs incurred in providing
  services to recipients;
                     (B)  a hospital rate enhancement program
  applicable only to rural hospitals;
                     (C)  a reduction of punitive actions under
  Medicaid that require reimbursement for Medicaid payments made to a
  rural hospital provider, a reduction of the frequency of payment
  reductions under Medicaid made to rural hospitals, and an
  enhancement of payments made under merit-based programs or similar
  programs for rural hospitals;
                     (D)  a reduction of state regulatory-related
  costs related to the commission's review of rural hospitals; or
                     (E)  in accordance with rules the Centers for
  Medicare and Medicaid Services adopts, the establishment of a
  minimum fee schedule that applies to payments made to rural
  hospitals by Medicaid managed care organizations; and
               (2)  target dates for achieving goals related to the
  proposal described by Subdivision (1).
         (c)  Not later than November 1 of each even-numbered year,
  the commission shall submit a report regarding the commission's
  development and implementation of the strategic plan to:
               (1)  the legislature;
               (2)  the governor; and
               (3)  the Legislative Budget Board. (Gov. Code, Secs.
  531.201(a), (b), (d).)
         Sec. 526.0302.  RURAL HOSPITAL ADVISORY COMMITTEE. (a) The
  commission shall establish the rural hospital advisory committee,
  either as an advisory committee or as a subcommittee of the hospital
  payment advisory committee, to advise the commission on issues
  relating specifically to rural hospitals.
         (b)  The rural hospital advisory committee is composed of
  interested individuals the executive commissioner appoints.
  Section 2110.002 does not apply to the advisory committee.
         (c)  An advisory committee member serves without
  compensation. (Gov. Code, Sec. 531.202.)
         Sec. 526.0303.  COLLABORATION WITH OFFICE OF RURAL AFFAIRS.
  The commission shall collaborate with the Office of Rural Affairs
  to ensure that this state is pursuing to the fullest extent possible
  federal grants, funding opportunities, and support programs
  available to rural hospitals as administered by the Health
  Resources and Services Administration and the Office of Minority
  Health in the United States Department of Health and Human
  Services. (Gov. Code, Sec. 531.203.)
  SUBCHAPTER H.  MEDICAL TRANSPORTATION
         Sec. 526.0351.  DEFINITIONS. In this subchapter:
               (1)  "Medical transportation program" means the
  program that provides nonemergency transportation services to
  recipients under Medicaid, subject to Section 526.0353, the
  children with special health care needs program, and the
  transportation for indigent cancer patients program, who have no
  other means of transportation.
               (2)  "Nonemergency transportation service" means
  nonemergency medical transportation services authorized under:
                     (A)  for a Medicaid recipient, the state Medicaid
  plan; and
                     (B)  for a recipient under another program
  described by Subdivision (1), that program.
               (3)  "Regional contracted broker" means an entity that
  contracts with the commission to provide or arrange for the
  provision of nonemergency transportation services under the
  medical transportation program.
               (4)  "Transportation network company" has the meaning
  assigned by Section 2402.001, Occupations Code.  (Gov. Code, Sec.
  531.02414(a).)
         Sec. 526.0352.  DUTY TO PROVIDE MEDICAL TRANSPORTATION
  SERVICES. (a) The commission shall provide medical transportation
  services for clients of eligible health and human services
  programs.
         (b)  The commission may contract with any public or private
  transportation provider or with any regional transportation broker
  for the provision of public transportation services. (Gov. Code,
  Sec. 531.0057.)
         Sec. 526.0353.  APPLICABILITY. Sections 526.0354-526.0360
  do not apply to the provision of nonemergency transportation
  services to a Medicaid recipient who is enrolled in a managed care
  plan offered by a Medicaid managed care organization. (Gov. Code,
  Sec. 531.02414(a-1).)
         Sec. 526.0354.  COMMISSION SUPERVISION OF MEDICAL
  TRANSPORTATION PROGRAM.  Notwithstanding any other law, the
  commission:
               (1)  shall directly supervise the administration and
  operation of the medical transportation program under this
  subchapter; and
               (2)  may not delegate the commission's duty to
  supervise the medical transportation program to any other person,
  including through a contract with the Texas Department of
  Transportation for the department to assume any of the commission's
  responsibilities relating to the provision of services through that
  program. (Gov. Code, Secs. 531.02414(b), (c).)
         Sec. 526.0355.  CONTRACT FOR PUBLIC TRANSPORTATION
  SERVICES. Subject to Subchapter B, Chapter 540A, the commission
  may contract for the provision of public transportation services,
  as defined by Section 461.002, Transportation Code, under the
  medical transportation program, with:
               (1)  a public transportation provider, as defined by
  Section 461.002, Transportation Code;
               (2)  a private transportation provider; or
               (3)  a regional transportation broker. (Gov. Code, Sec.
  531.02414(d).)
         Sec. 526.0356.  RULES FOR NONEMERGENCY TRANSPORTATION
  SERVICES; COMPLIANCE.  (a)  The executive commissioner shall adopt
  rules to ensure the safe and efficient provision of nonemergency
  transportation services under this subchapter. The rules must:
               (1)  include minimum standards regarding the physical
  condition and maintenance of motor vehicles used to provide the
  services, including standards regarding the accessibility of motor
  vehicles by individuals with disabilities;
               (2)  require a regional contracted broker to:
                     (A)  verify that each motor vehicle operator
  providing the services or seeking to provide the services has a
  valid driver's license;
                     (B)  check the driving record information
  maintained by the Department of Public Safety under Subchapter C,
  Chapter 521, Transportation Code, of each motor vehicle operator
  providing the services or seeking to provide the services; and
                     (C)  check the public criminal record information
  maintained by the Department of Public Safety and made available to
  the public through the department's Internet website of each motor
  vehicle operator providing the services or seeking to provide the
  services; and
               (3)  include training requirements for motor vehicle
  operators providing the services through a regional contracted
  broker, including training on:
                     (A)  passenger safety;
                     (B)  passenger assistance;
                     (C)  assistive devices, including wheelchair
  lifts, tie-down equipment, and child safety seats;
                     (D)  sensitivity and diversity;
                     (E)  customer service;
                     (F)  defensive driving techniques; and
                     (G)  prohibited behavior by motor vehicle
  operators.
         (b)  Except as provided by Section 526.0358, the commission
  shall require compliance with the rules adopted under Subsection
  (a) in any contract entered into with a regional contracted broker
  to provide nonemergency transportation services under the medical
  transportation program. (Gov. Code, Secs. 531.02414(e), (f).)
         Sec. 526.0357.  MEMORANDUM OF UNDERSTANDING; DRIVER AND
  VEHICLE INFORMATION.  (a)  The commission shall enter into a
  memorandum of understanding with the Texas Department of Motor
  Vehicles and the Department of Public Safety for purposes of
  obtaining the motor vehicle registration and driver's license
  information of a medical transportation services provider,
  including a regional contracted broker and a subcontractor of the
  broker, to confirm the provider complies with applicable
  requirements adopted under Section 526.0356(a).
         (b)  The commission shall establish a process by which
  medical transportation services providers, including providers
  under a managed transportation delivery model, that contract with
  the commission may request and obtain the information described by
  Subsection (a) to ensure that subcontractors providing medical
  transportation services meet applicable requirements adopted under
  Section 526.0356(a). (Gov. Code, Secs. 531.02414(g), (h).)
         Sec. 526.0358.  MEDICAL TRANSPORTATION SERVICES
  SUBCONTRACTS.  (a)  A regional contracted broker may subcontract
  with a transportation network company to provide services under
  this subchapter. A rule or other requirement the executive
  commissioner adopts under Section 526.0356(a) does not apply to the
  subcontracted transportation network company or a motor vehicle
  operator who is part of the company's network. The commission or the
  regional contracted broker may not require a motor vehicle operator
  who is part of the subcontracted transportation network company's
  network to enroll as a Medicaid provider to provide services under
  this subchapter.
         (b)  The commission or a regional contracted broker that
  subcontracts with a transportation network company under
  Subsection (a) may require the transportation network company or a
  motor vehicle operator who provides services under this subchapter
  to be periodically screened against the list of excluded
  individuals and entities maintained by the Office of Inspector
  General of the United States Department of Health and Human
  Services.
         (c)  Notwithstanding any other law, a motor vehicle operator
  who is part of the network of a transportation network company that
  subcontracts with a regional contracted broker under Subsection (a)
  and who satisfies the driver requirements in Section 2402.107,
  Occupations Code, is qualified to provide services under this
  subchapter. The commission and the regional contracted broker may
  not impose any additional requirements on a motor vehicle operator
  who satisfies the driver requirements in Section 2402.107,
  Occupations Code, to provide services under this subchapter. (Gov.
  Code, Secs. 531.02414(j), (k), (l).)
         Sec. 526.0359.  CERTAIN PROVIDERS PROHIBITED FROM PROVIDING
  NONEMERGENCY TRANSPORTATION SERVICES.  Emergency medical services
  personnel and emergency medical services vehicles, as those terms
  are defined by Section 773.003, Health and Safety Code, may not
  provide nonemergency transportation services under the medical
  transportation program. (Gov. Code, Sec. 531.02414(i).)
         Sec. 526.0360.  CERTAIN WHEELCHAIR-ACCESSIBLE VEHICLES
  AUTHORIZED.  For purposes of this section and Sections
  526.0354-526.0359 and notwithstanding Section 2402.111(a)(2)(A),
  Occupations Code, a motor vehicle operator who provides services
  under Sections 526.0354-526.0359 may use a wheelchair-accessible
  vehicle equipped with a lift or ramp that is capable of transporting
  passengers using a fixed-frame wheelchair in the cabin of the
  vehicle if the vehicle otherwise meets the requirements of Section
  2402.111, Occupations Code. (Gov. Code, Sec. 531.02414(m).)
  SUBCHAPTER I. CASEWORKERS AND PROGRAM PERSONNEL
         Sec. 526.0401.  CASELOAD STANDARDS FOR DEPARTMENT OF FAMILY
  AND PROTECTIVE SERVICES. (a) In this section:
               (1)  "Caseload standards" means the minimum and maximum
  number of cases that an employee can reasonably be expected to
  perform in a normal work month based on the number of cases handled
  by or the number of different job functions performed by the
  employee.
               (2)  "Professional caseload standards" means caseload
  standards for employees of health and human services agencies that
  are established or are recommended for establishment by:
                     (A)  management studies conducted for health and
  human services agencies; or
                     (B)  an authority or association, including:
                           (i)  the Child Welfare League of America;
                           (ii)  the National Eligibility Workers
  Association;
                           (iii)  the National Association of Social
  Workers; and
                           (iv)  associations of state health and human
  services agencies.
         (b)  Subject to Chapter 316 (H.B. 5), Acts of the 85th
  Legislature, Regular Session, 2017, the executive commissioner may
  establish caseload standards and other standards relating to
  caseloads for each category of caseworker the Department of Family
  and Protective Services employs.
         (c)  In establishing standards under this section, the
  executive commissioner shall:
               (1)  ensure that the standards are based on the
  caseworker's actual duties;
               (2)  ensure that the caseload standards are reasonable
  and achievable;
               (3)  ensure that the standards are consistent with
  existing professional caseload standards;
               (4)  consider standards developed by other states for
  caseworkers in similar positions of employment; and
               (5)  ensure that the standards are consistent with
  existing caseload standards of other state agencies.
         (d)  Subject to the availability of funds the legislature
  appropriates:
               (1)  the commissioner of the Department of Family and
  Protective Services shall use the standards established under this
  section to determine the number of personnel to assign as
  caseworkers for the department; and
               (2)  the Department of Family and Protective Services
  shall use the standards established to assign caseloads to
  individual caseworkers the department employs.
         (e)  Nothing in this section may be construed to create a
  cause of action. (Gov. Code, Secs. 531.001(1), (5), 531.048; New.)
         Sec. 526.0402.  JOINT TRAINING FOR CERTAIN CASEWORKERS. (a)
  The executive commissioner shall provide for joint training for
  health and human services caseworkers whose clients are children,
  including caseworkers employed by:
               (1)  the commission;
               (2)  the Department of State Health Services;
               (3)  a local mental health authority; and
               (4)  a local intellectual and developmental disability
  authority.
         (b)  The joint training must be designed to increase a
  caseworker's knowledge and awareness of the services available to
  children at each health and human services agency or local mental
  health or intellectual and developmental disability authority,
  including long-term care programs and services available under a
  Section 1915(c) waiver program. (Gov. Code, Sec. 531.02491.)
         Sec. 526.0403.  COORDINATION AND APPROVAL OF CASELOAD
  ESTIMATES. (a) The commission shall coordinate and approve
  caseload estimates for programs health and human services agencies
  administer.
         (b)  To implement this section, the commission shall:
               (1)  adopt uniform guidelines for health and human
  services agencies to use in estimating each agency's caseload, with
  allowances given for those agencies for which exceptions from the
  guidelines may be necessary;
               (2)  assemble a single set of economic and demographic
  data and provide that data to each health and human services agency
  to use in estimating the agency's caseload; and
               (3)  seek advice from health and human services
  agencies, the Legislative Budget Board, the governor's budget
  office, the comptroller, and other relevant agencies as needed to
  coordinate the caseload estimating process. (Gov. Code, Sec.
  531.0274.)
         Sec. 526.0404.  DEAF-BLIND WITH MULTIPLE DISABILITIES
  (DBMD) WAIVER PROGRAM: CAREER LADDER FOR INTERVENERS. (a) In this
  section:
               (1)  "Deaf-blind-related course work" means
  educational courses designed to improve a student's:
                     (A)  knowledge of deaf-blindness and its effect on
  learning;
                     (B)  knowledge of the intervention role and
  ability to facilitate the intervention process;
                     (C)  knowledge of communication areas relevant to
  deaf-blindness, including methods, adaptations, and use of
  assistive technology, and ability to facilitate development and use
  of communication skills for an individual who is deaf-blind;
                     (D)  knowledge of the effect deaf-blindness has on
  an individual's psychological, social, and emotional development
  and ability to facilitate the emotional well-being of an individual
  who is deaf-blind;
                     (E)  knowledge of and issues related to sensory
  systems and ability to facilitate the use of the senses;
                     (F)  knowledge of motor skills, movement,
  orientation, and mobility strategies and ability to facilitate
  orientation and mobility skills;
                     (G)  knowledge of the effect additional
  disabilities have on an individual who is deaf-blind and ability to
  provide appropriate support; or
                     (H)  professionalism and knowledge of ethical
  issues relevant to the intervener role.
               (2)  "Program" means the deaf-blind with multiple
  disabilities (DBMD) waiver program.
         (b)  The executive commissioner by rule shall adopt a career
  ladder for individuals who provide intervener services under the
  program. The rules must provide a system under which each
  individual may be classified based on the individual's level of
  training, education, and experience, as one of the following:
               (1)  Intervener;
               (2)  Intervener I;
               (3)  Intervener II; or
               (4)  Intervener III.
         (c)  The rules must require that:
               (1)  an Intervener:
                     (A)  complete any orientation or training course
  required to be completed by any individual who provides direct care
  services to recipients of services under the program;
                     (B)  hold a high school diploma or a high school
  equivalency certificate;
                     (C)  have at least two years of experience working
  with individuals with developmental disabilities;
                     (D)  have the ability to proficiently communicate
  in the functional language of the individual who is deaf-blind; and
                     (E)  meet all direct-care worker qualifications
  as determined by the program;
               (2)  an Intervener I:
                     (A)  meet the requirements of an Intervener under
  Subdivision (1);
                     (B)  have at least six months of experience
  working with individuals who are deaf-blind; and
                     (C)  have completed at least eight semester credit
  hours, plus a one-hour practicum in deaf-blind-related course work,
  at an accredited college or university;
               (3)  an Intervener II:
                     (A)  meet the requirements of an Intervener I;
                     (B)  have at least nine months of experience
  working with individuals who are deaf-blind; and
                     (C)  have completed an additional 10 semester
  credit hours in deaf-blind-related course work at an accredited
  college or university; and
               (4)  an Intervener III:
                     (A)  meet the requirements of an Intervener II;
                     (B)  have at least one year of experience working
  with individuals who are deaf-blind; and
                     (C)  hold an associate's or bachelor's degree from
  an accredited college or university in a course of study with a
  focus on deaf-blind-related course work.
         (d)  Notwithstanding Subsections (b) and (c), the executive
  commissioner may adopt a career ladder under this section based on
  credentialing standards for interveners developed by the Academy
  for Certification of Vision Rehabilitation and Education
  Professionals or any other private credentialing entity as the
  executive commissioner determines appropriate.
         (e)  The compensation an intervener receives for providing
  services under the program must be based on and commensurate with
  the intervener's career ladder classification. (Gov. Code, Sec.
  531.0973; New.)
  SUBCHAPTER J. LICENSING, LISTING, OR REGISTRATION OF CERTAIN
  ENTITIES
         Sec. 526.0451.  APPLICABILITY. (a) This subchapter applies
  only to the final licensing, listing, or registration decisions of
  a health and human services agency with respect to a person under
  the law authorizing the agency to regulate the following:
               (1)  a youth camp licensed under Chapter 141, Health
  and Safety Code;
               (2)  a home and community support services agency
  licensed under Chapter 142, Health and Safety Code;
               (3)  a hospital licensed under Chapter 241, Health and
  Safety Code;
               (4)  a facility licensed under Chapter 242, Health and
  Safety Code;
               (5)  an assisted living facility licensed under Chapter
  247, Health and Safety Code;
               (6)  a special care facility licensed under Chapter
  248, Health and Safety Code;
               (7)  an intermediate care facility licensed under
  Chapter 252, Health and Safety Code;
               (8)  a chemical dependency treatment facility licensed
  under Chapter 464, Health and Safety Code;
               (9)  a mental hospital or mental health facility
  licensed under Chapter 577, Health and Safety Code;
               (10)  a child-care facility or child-placing agency
  licensed under or a family home listed or registered under Chapter
  42, Human Resources Code; or
               (11)  a day activity and health services facility
  licensed under Chapter 103, Human Resources Code.
         (b)  This subchapter does not apply to an agency decision
  that did not result in a final order or that was reversed on appeal.
  (Gov. Code, Sec. 531.951.)
         Sec. 526.0452.  REQUIRED APPLICATION INFORMATION. An
  applicant submitting an initial or renewal application for a
  license, including a renewal license or a license that does not
  expire, a listing, or a registration described by Section 526.0451
  must include with the application a written statement of:
               (1)  the name of any person who is or will be a
  controlling person, as the applicable agency regulating the person
  determines, of the entity for which the license, listing, or
  registration is sought; and
               (2)  any other relevant information required by rules
  the executive commissioner adopts. (Gov. Code, Sec. 531.954.)
         Sec. 526.0453.  APPLICATION DENIAL BASED ON ADVERSE AGENCY
  DECISION. A health and human services agency that regulates a
  person to whom this subchapter applies may deny an application for a
  license, including a renewal license or a license that does not
  expire, a listing, or a registration described by Section 526.0451,
  if:
               (1)  any of the following persons are listed in a record
  maintained under Section 526.0454:
                     (A)  the applicant;
                     (B)  a person listed on the application; or
                     (C)  a person the applicable regulating agency
  determines to be a controlling person of an entity for which the
  license, including a renewal license or a license that does not
  expire, the listing, or the registration is sought; and
               (2)  the agency's action resulting in the person being
  listed in a record maintained under Section 526.0454 is based on:
                     (A)  an act or omission that resulted in physical
  or mental harm to an individual in the care of the applicant or
  person;
                     (B)  a threat to the health, safety, or well-being
  of an individual in the care of the applicant or person;
                     (C)  the physical, mental, or financial
  exploitation of an individual in the care of the applicant or
  person; or
                     (D)  the agency's determination that the
  applicant or person has committed an act or omission that renders
  the applicant unqualified or unfit to fulfill the obligations of
  the license, listing, or registration. (Gov. Code, Sec. 531.953.)
         Sec. 526.0454.  RECORD OF FINAL DECISION. (a) Each health
  and human services agency that regulates a person to whom this
  subchapter applies shall, in accordance with this section and rules
  the executive commissioner adopts, maintain a record of:
               (1)  each application for a license, including a
  renewal license or a license that does not expire, a listing, or a
  registration that the agency denies under the law authorizing the
  agency to regulate the person; and
               (2)  each license, listing, or registration that the
  agency revokes, suspends, or terminates under the applicable law.
         (b)  The record of an application required by Subsection
  (a)(1) must be maintained until the 10th anniversary of the date the
  application is denied. The record of the license, listing, or
  registration required by Subsection (a)(2) must be maintained until
  the 10th anniversary of the date of the revocation, suspension, or
  termination.
         (c)  The record required under Subsection (a) must include:
               (1)  the name and address of the applicant for a
  license, listing, or registration that is denied as described by
  Subsection (a)(1);
               (2)  the name and address of each person listed in the
  application for a license, listing, or registration that is denied
  as described by Subsection (a)(1);
               (3)  the name of each person the applicable regulatory
  agency determines to be a controlling person of an entity for which
  an application, license, listing, or registration is denied,
  revoked, suspended, or terminated as described by Subsection (a);
               (4)  the specific type of license, listing, or
  registration the agency denied, revoked, suspended, or terminated;
               (5)  a summary of the terms of the denial, revocation,
  suspension, or termination; and
               (6)  the effective period of the denial, revocation,
  suspension, or termination.
         (d)  Each health and human services agency that regulates a
  person to whom this subchapter applies each month shall provide a
  copy of the records maintained under this section to any other
  health and human services agency that regulates the person. (Gov.
  Code, Sec. 531.952.)
  SUBCHAPTER K. CHILDREN AND FAMILIES
         Sec. 526.0501.  SUBSTITUTE CARE PROVIDER OUTCOME STANDARDS.
  (a) The executive commissioner, after consulting with
  representatives from the commission, the Department of Family and
  Protective Services, and the Texas Juvenile Justice Department,
  shall by rule adopt result-oriented standards that a provider of
  substitute care services for children under the care of this state
  must achieve.
         (b)  A health and human services agency that purchases
  substitute care services shall include the result-oriented
  standards as requirements in each substitute care service provider
  contract.
         (c)  A health and human services agency may provide
  information about a substitute care provider, including rates,
  contracts, outcomes, and client information, to another agency that
  purchases substitute care services. (Gov. Code, Sec. 531.047.)
         Sec. 526.0502.  REPORT ON DELIVERY OF HEALTH AND HUMAN
  SERVICES TO YOUNG TEXANS. (a)  The commission shall publish on the
  commission's Internet website a biennial report that addresses the
  efforts of the health and human services agencies to provide health
  and human services to children younger than six years of age.
         (b)  The report may:
               (1)  contain the commission's recommendations to better
  coordinate state agency programs relating to the delivery of health
  and human services to children younger than six years of age; and
               (2)  propose joint agency collaborative programs.
         (c)  On or before the date the report is due, the commission
  shall notify the governor, the lieutenant governor, the speaker of
  the house of representatives, the comptroller, and the appropriate
  legislative committees that the report is available on the
  commission's Internet website.  (Gov. Code, Sec. 531.02492.)
         Sec. 526.0503.  POOLED FUNDING FOR FOSTER CARE PREVENTIVE
  SERVICES. (a)  The commission and the Department of Family and
  Protective Services shall develop and implement a plan to combine,
  to the extent and in the manner allowed by Section 51, Article III,
  Texas Constitution, and other applicable law, funds held by those
  agencies with funds held by other appropriate state agencies and
  local governmental entities to provide services designed to prevent
  children from being placed in foster care. The preventive services
  may include:
               (1)  child and family counseling;
               (2)  instruction in parenting and homemaking skills;
               (3)  parental support services;
               (4)  temporary respite care; and
               (5)  crisis services.
         (b)  The plan must provide for:
               (1)  state funding to be distributed to other state
  agencies, local governmental entities, or private entities only as
  specifically directed by the terms of a grant or contract to provide
  preventive services;
               (2)  procedures to ensure that funds the commission
  receives by gift, grant, or interagency or interlocal contract from
  another state agency, a local governmental entity, the federal
  government, or any other public or private source for purposes of
  this section are disbursed in accordance with the terms under which
  the commission received the funds; and
               (3)  a reporting mechanism to ensure appropriate use of
  funds.
         (c)  For the purposes of this section, the commission may
  request and accept gifts and grants under the terms of a gift,
  grant, or contract from a local governmental entity, a private
  entity, or any other public or private source for use in providing
  services designed to prevent children from being placed in foster
  care. If required by the terms of a gift, grant, or contract or by
  applicable law, the commission shall use the amounts received:
               (1)  from a local governmental entity to provide the
  services in the geographic area of this state in which the entity is
  located; and
               (2)  from the federal government or a private entity to
  provide the services statewide or in a particular geographic area
  of this state. (Gov. Code, Sec. 531.088.)
         Sec. 526.0504.  PARTICIPATION BY FATHERS. (a) The
  commission and each health and human services agency shall
  periodically examine commission or agency policies and procedures
  to determine if the policies and procedures deter or encourage
  participation of fathers in commission or agency programs and
  services relating to children.
         (b)  Based on the examination required under Subsection (a),
  the commission and each health and human services agency shall
  modify policies and procedures as necessary to permit full
  participation of fathers in commission or agency programs and
  services relating to children in all appropriate circumstances.
  (Gov. Code, Sec. 531.061.)
         Sec. 526.0505.  PROHIBITED PUNITIVE ACTION FOR FAILURE TO
  IMMUNIZE. (a)  In this section:
               (1)  "Person responsible for a child's care, custody,
  or welfare" has the meaning assigned by Section 261.001, Family
  Code.
               (2)  "Punitive action" includes initiating an
  investigation of a person responsible for a child's care, custody,
  or welfare for alleged or suspected abuse or neglect of a child.
         (b)  The executive commissioner by rule shall prohibit a
  health and human services agency from taking a punitive action
  against a person responsible for a child's care, custody, or
  welfare for the person's failure to ensure that the child receives
  the immunization series prescribed by Section 161.004, Health and
  Safety Code.
         (c)  This section does not affect a law, including Chapter
  31, Human Resources Code, that specifically provides a punitive
  action for failure to ensure that a child receives the immunization
  series prescribed by Section 161.004, Health and Safety Code. (Gov.
  Code, Sec. 531.0335.)
         Sec. 526.0506.  INVESTIGATION UNIT FOR CHILD-CARE
  FACILITIES OPERATING ILLEGALLY. The executive commissioner shall
  maintain a unit within the commission's child-care licensing
  division consisting of investigators whose primary responsibility
  is to:
               (1)  identify child-care facilities that are operating
  without a license, certification, registration, or listing
  required by Chapter 42, Human Resources Code; and
               (2)  initiate appropriate enforcement actions against
  those facilities. (Gov. Code, Sec. 531.0084.)
  SUBCHAPTER L. TEXAS HOME VISITING PROGRAM
         Sec. 526.0551.  DEFINITIONS. In this subchapter:
               (1)  "Home visiting program" means a
  voluntary-enrollment program in which early childhood and health
  professionals such as nurses, social workers, or trained and
  supervised paraprofessionals repeatedly visit over a period of at
  least six months the homes of pregnant women or families with
  children younger than six years of age who are born with or exposed
  to one or more risk factors.
               (2)  "Risk factors" means factors that make a child
  more likely to experience adverse experiences leading to negative
  consequences, including preterm birth, poverty, low parental
  education, having a teenaged mother or father, poor maternal
  health, and parental underemployment or unemployment. (Gov. Code,
  Sec. 531.981.)
         Sec. 526.0552.  RULES. The executive commissioner may adopt
  rules as necessary to implement this subchapter. (Gov. Code,
  Sec. 531.988.)
         Sec. 526.0553.  STRATEGIC PLAN; ELIGIBILITY. (a)  The
  commission shall maintain a strategic plan to serve at-risk
  pregnant women and families with children younger than six years of
  age through home visiting programs that improve outcomes for
  parents and families.
         (b)  A pregnant woman or family is considered at-risk for
  purposes of this section and may be eligible for voluntary
  enrollment in a home visiting program if the woman or family is
  exposed to one or more risk factors.
         (c)  The commission may determine if a risk factor or
  combination of risk factors an at-risk pregnant woman or family
  experiences qualifies the woman or family for enrollment in a home
  visiting program. (Gov. Code, Sec. 531.982.)
         Sec. 526.0554.  TYPES OF HOME VISITING PROGRAMS. (a) A home
  visiting program is classified as either an evidence-based program
  or a promising practice program.
         (b)  An evidence-based program is a home visiting program
  that:
               (1)  is research-based and grounded in relevant,
  empirically based knowledge and program-determined outcomes;
               (2)  is associated with a national organization,
  institution of higher education, or national or state public health
  institute;
               (3)  has comprehensive standards that ensure
  high-quality service delivery and continuously improving quality;
               (4)  has demonstrated significant positive short-term
  and long-term outcomes;
               (5)  has been evaluated by at least one rigorous
  randomized controlled research trial across heterogeneous
  populations or communities, the results of at least one of which
  have been published in a peer-reviewed journal;
               (6)  follows with fidelity a program manual or design
  that specifies the purpose, outcomes, duration, and frequency of
  the services that constitute the program;
               (7)  employs well-trained and competent staff and
  provides continual relevant professional development
  opportunities;
               (8)  demonstrates strong links to other
  community-based services; and
               (9)  ensures compliance with home visiting standards.
         (c)  A promising practice program is a home visiting program
  that:
               (1)  has an active impact evaluation program or can
  demonstrate a timeline for implementing an active impact evaluation
  program;
               (2)  has been evaluated by at least one outcome-based
  study demonstrating effectiveness or a randomized controlled trial
  in a homogeneous sample;
               (3)  follows with fidelity a program manual or design
  that specifies the purpose, outcomes, duration, and frequency of
  the services that constitute the program;
               (4)  employs well-trained and competent staff and
  provides continual relevant professional development
  opportunities;
               (5)  demonstrates strong links to other
  community-based services; and
               (6)  ensures compliance with home visiting standards.
  (Gov. Code, Sec. 531.983.)
         Sec. 526.0555.  OUTCOMES. The commission shall ensure that
  a home visiting program achieves favorable outcomes in at least two
  of the following areas:
               (1)  improved maternal or child health outcomes;
               (2)  improved cognitive development of children;
               (3)  increased school readiness of children;
               (4)  reduced child abuse, neglect, and injury;
               (5)  improved child safety;
               (6)  improved social-emotional development of
  children;
               (7)  improved parenting skills, including nurturing
  and bonding;
               (8)  improved family economic self-sufficiency;
               (9)  reduced parental involvement with the criminal
  justice system; and
               (10)  increased father involvement and support. (Gov.
  Code, Sec. 531.985.)
         Sec. 526.0556.  EVALUATION OF HOME VISITING PROGRAM. (a)
  The commission shall adopt outcome indicators to measure the
  effectiveness of a home visiting program in achieving desired
  outcomes.
         (b)  The commission may work directly with the model
  developer of a home visiting program to identify appropriate
  outcome indicators for the program and to ensure that the program
  demonstrates fidelity to its research model.
         (c)  The commission shall develop internal processes to work
  with home visiting programs in sharing data and information to aid
  in relevant analysis of a home visiting program's performance.
         (d)  The commission shall use data gathered under this
  section to monitor, conduct ongoing quality improvement on, and
  evaluate the effectiveness of home visiting programs. (Gov. Code,
  Sec. 531.986.)
         Sec. 526.0557.  FUNDING. (a)  The commission shall ensure
  that at least 75 percent of the funds appropriated for home visiting
  programs is used in evidence-based programs described by Section
  526.0554(b), with any remaining funds dedicated to promising
  practice programs described by Section 526.0554(c).
         (b)  The commission shall actively seek and apply for any
  available federal funds to support home visiting programs,
  including federal funds from the Temporary Assistance for Needy
  Families program.
         (c)  The commission may accept gifts, donations, and grants
  to support home visiting programs. (Gov. Code, Sec. 531.984; New.)
         Sec. 526.0558.  REPORTS TO LEGISLATURE. (a) Not later than
  December 1 of each even-numbered year, the commission shall prepare
  and submit a report on state-funded home visiting programs to the
  Senate Committee on Health and Human Services and the House Human
  Services Committee or their successors.
         (b)  A report submitted under this section must include:
               (1)  a description of home visiting programs being
  implemented and the associated models;
               (2)  data on the number of families being served and
  their demographic information;
               (3)  the goals and achieved outcomes of home visiting
  programs;
               (4)  data on cost per family served, including
  third-party return-on-investment analysis, if available; and
               (5)  data explaining the percentage of funding that has
  been used on evidence-based programs and the percentage of funding
  that has been used on promising practice programs. (Gov. Code, Sec.
  531.9871.)
  SUBCHAPTER M. SERVICE MEMBERS, DEPENDENTS, AND VETERANS
         Sec. 526.0601.  SERVICES FOR SERVICE MEMBERS. (a) In this
  section, "service member" means a member or former member of the
  state military forces or a component of the United States armed
  forces, including a reserve component.
         (b)  The executive commissioner shall ensure that each
  health and human services agency adopts policies and procedures
  that require the agency to:
               (1)  identify service members who are seeking services
  from the agency during the agency's intake and eligibility
  determination process; and
               (2)  direct service members seeking services to
  appropriate service providers, including:
                     (A)  the United States Veterans Health
  Administration;
                     (B)  National Guard Bureau facilities; and
                     (C)  other federal, state, and local service
  providers.
         (c)  The executive commissioner shall make the directory of
  resources established under Section 161.552, Health and Safety
  Code, accessible to each health and human services agency. (Gov.
  Code, Sec. 531.093.)
         Sec. 526.0602.  INTEREST OR OTHER WAITING LIST FOR CERTAIN
  SERVICE MEMBERS AND DEPENDENTS. (a) In this section, "service
  member" means a member of the United States military serving in the
  army, navy, air force, marine corps, or coast guard on active duty.
         (b)  This section applies only to:
               (1)  a service member who has declared and maintains
  this state as the member's state of legal residence in the manner
  provided by the applicable military branch;
               (2)  a spouse or dependent child of a member described
  by Subdivision (1); or
               (3)  the spouse or dependent child of a former service
  member who had declared and maintained this state as the member's
  state of legal residence in the manner provided by the applicable
  military branch and who:
                     (A)  was killed in action; or
                     (B)  died while in service.
         (c)  The executive commissioner by rule shall require the
  commission or another health and human services agency to:
               (1)  maintain the position of an individual to whom
  this section applies in the queue of an interest list or other
  waiting list for any assistance program the commission or other
  health and human services agency provides, including a Section
  1915(c) waiver program, if the individual cannot receive benefits
  under the assistance program because the individual temporarily
  resides out of state as the result of military service; and
               (2)  subject to Subsection (e), offer benefits to the
  individual according to the individual's position on the interest
  list or other waiting list that was attained while the individual
  resided out of state if the individual returns to reside in this
  state.
         (d)  If an individual to whom this section applies reaches a
  position on an interest list or other waiting list that would allow
  the individual to receive benefits under an assistance program but
  the individual cannot receive the benefits because the individual
  temporarily resides out of state as the result of military service,
  the commission or agency providing the benefits shall maintain the
  individual's position on the list relative to other individuals on
  the list but continue to offer benefits to other individuals on the
  interest list or other waiting list in accordance with those
  individuals' respective positions on the list.
         (e)  In adopting rules under Subsection (c), the executive
  commissioner must limit the amount of time an individual to whom
  this section applies may maintain the individual's position on an
  interest list or other waiting list under Subsection (c) to not more
  than one year after the date on which, as applicable:
               (1)  the service member's active duty ends;
               (2)  the member was killed if the member was killed in
  action; or
               (3)  the member died if the member died while in
  service.  (Gov. Code, Sec. 531.0931.)
         Sec. 526.0603.  MEMORANDUM OF UNDERSTANDING REGARDING
  PUBLIC ASSISTANCE REPORTING INFORMATION SYSTEM; MAXIMIZATION OF
  BENEFITS.  (a)  In this section, "system" means the Public
  Assistance Reporting Information System (PARIS) operated by the
  Administration for Children and Families of the United States
  Department of Health and Human Services.
         (b)  The commission, the Texas Veterans Commission, and the
  Veterans' Land Board shall enter into a memorandum of understanding
  for the purposes of:
               (1)  coordinating and collecting information about
  state agencies' use and analysis of data received from the system;
  and
               (2)  developing new strategies for state agencies to
  use system data in ways that:
                     (A)  generate fiscal savings for this state; and
                     (B)  maximize the availability of and access to
  benefits for veterans.
         (c)  The commission and the Texas Veterans Commission:
               (1)  shall coordinate to assist veterans in maximizing
  the benefits available to each veteran by using the system; and
               (2)  together may determine the geographic scope of the
  efforts described by Subdivision (1).
         (d)  Not later than October 1 of each year, the commission,
  the Texas Veterans Commission, and the Veterans' Land Board
  collectively shall submit to the legislature, the governor, and the
  Legislative Budget Board a report describing:
               (1)  interagency progress in identifying and obtaining
  United States Department of Veterans Affairs benefits for veterans
  receiving Medicaid and other public benefits;
               (2)  the number of veterans benefits claims awarded,
  the total dollar amount of veterans benefits claims awarded, and
  the costs to this state that were avoided as a result of state
  agencies' use of the system;
               (3)  efforts to expand the use of the system and improve
  the effectiveness of shifting veterans from Medicaid and other
  public benefits to United States Department of Veterans Affairs
  benefits, including any barriers and the manner in which state
  agencies have addressed those barriers; and
               (4)  the extent to which the Texas Veterans Commission
  has targeted specific veteran populations, including populations
  in rural counties and in specific age and service-connected
  disability categories, in order to maximize benefits for veterans
  and savings to this state.
         (e)  The report may be consolidated with any other report
  relating to the same subject matter the commission is required to
  submit under other law.  (Gov. Code, Sec. 531.0998.)
  SUBCHAPTER N. PLAN TO SUPPORT GUARDIANSHIPS
         Sec. 526.0651.  DEFINITIONS. In this subchapter:
               (1)  "Guardian" has the meaning assigned by Section
  1002.012, Estates Code.
               (2)  "Guardianship program" has the meaning assigned by
  Section 155.001.
               (3)  "Incapacitated individual" means an incapacitated
  person as defined by Section 1002.017, Estates Code.  (Gov. Code,
  Sec. 531.121.)
         Sec. 526.0652.  PLAN ESTABLISHMENT. The commission shall
  develop and, subject to appropriations, implement a plan to:
               (1)  ensure that each incapacitated individual in this
  state who needs a guardianship or another less restrictive type of
  assistance to make decisions concerning the incapacitated
  individual's own welfare and financial affairs receives that
  assistance; and
               (2)  foster the establishment and growth of local
  volunteer guardianship programs.  (Gov. Code, Sec. 531.124.)
         Sec. 526.0653.  GUARDIANSHIP PROGRAM GRANT REQUIREMENTS.
  (a)  The commission in accordance with commission rules may award
  grants to:
               (1)  a local guardianship program; and
               (2)  a local legal guardianship program to enable the
  family members and friends with low incomes of a proposed ward who
  is indigent to have legal representation in court if the
  individuals are willing and able to be appointed guardians of the
  proposed ward.
         (b)  To receive a grant under Subsection (a)(1), a local
  guardianship program operating in a county with a population of at
  least 150,000 must offer or submit a plan acceptable to the
  commission to offer, among the program's services, a money
  management service for appropriate clients, as determined by the
  program. The program may provide the money management service
  directly or by referring a client to a money management service that
  satisfies the requirements under Subsection (c).
         (c)  A money management service to which a local guardianship
  program may refer a client must:
               (1)  use employees or volunteers to provide bill
  payment or representative payee services;
               (2)  provide the service's employees and volunteers
  with training, technical support, monitoring, and supervision;
               (3)  match employees or volunteers with clients in a
  manner that ensures that the match is agreeable to both the employee
  or volunteer and the client;
               (4)  insure each employee and volunteer and hold the
  employee or volunteer harmless from liability for damages
  proximately caused by acts or omissions of the employee or
  volunteer while acting in the course and scope of the employee's or
  volunteer's duties or functions within the organization;
               (5)  have an advisory council that meets regularly and
  is composed of individuals who are knowledgeable with respect to
  issues related to guardianship, alternatives to guardianship, and
  related social services programs;
               (6)  be administered by a nonprofit corporation:
                     (A)  formed under the Texas Nonprofit Corporation
  Law, as described by Section 1.008, Business Organizations Code;
  and
                     (B)  exempt from taxation under Section 501(a),
  Internal Revenue Code of 1986, by being listed as an exempt entity
  under Section 501(c)(3) of that code; and
               (7)  refer clients who are in need of other services
  from an area agency on aging to the appropriate area agency on
  aging.
         (d)  A local guardianship program operating in a county with
  a population of less than 150,000 may, at the program's option,
  offer, either directly or by referral, a money management service
  among the program's services. If the program elects to offer a money
  management service by referral, the service must satisfy the
  requirements under Subsection (c), except as provided by Subsection
  (e).
         (e)  On request by a local guardianship program, the
  commission may waive a requirement under Subsection (c) if the
  commission determines the waiver is appropriate to strengthen the
  continuum of local guardianship programs in a geographic area.  
  (Gov. Code, Sec. 531.125.)
  SUBCHAPTER O. ASSISTANCE PROGRAM FOR DOMESTIC VICTIMS OF
  TRAFFICKING
         Sec. 526.0701.  DEFINITIONS. In this subchapter:
               (1)  "Domestic victim" means a victim of trafficking
  who is a permanent legal resident or citizen of the United States.
               (2)  "Victim of trafficking" has the meaning assigned
  by 22 U.S.C. Section 7102. (Gov. Code, Sec. 531.381.)
         Sec. 526.0702.  VICTIM ASSISTANCE PROGRAM. The commission
  shall develop and implement a program designed to assist domestic
  victims, including victims who are children, in accessing necessary
  services. The program must include:
               (1)  a searchable database of assistance programs for
  domestic victims that may be used to match victims with appropriate
  resources, including:
                     (A)  programs that provide mental health
  services;
                     (B)  other health services;
                     (C)  services to meet victims' basic needs;
                     (D)  case management services; and
                     (E)  any other services the commission considers
  appropriate;
               (2)  the grant program described by Section 526.0703;
               (3)  recommended training programs for judges,
  prosecutors, and law enforcement personnel; and
               (4)  an outreach initiative to ensure that victims,
  judges, prosecutors, and law enforcement personnel are aware of the
  availability of services through the program. (Gov. Code, Sec.
  531.382.)
         Sec. 526.0703.  GRANT PROGRAM. (a)  Subject to available
  funds, the commission shall establish a grant program to award
  grants to public and nonprofit organizations that provide
  assistance to domestic victims, including organizations that
  provide public awareness activities, community outreach and
  training, victim identification services, and legal services.
         (b)  To apply for a grant under this section, an applicant
  must submit an application in the form and manner the commission
  prescribes.  An applicant must describe in the application the
  services the applicant intends to provide to domestic victims if
  the grant is awarded.
         (c)  In awarding grants under this section, the commission
  shall give preference to organizations that have experience in
  successfully providing the types of services for which the grants
  are awarded.
         (d)  A grant recipient shall provide the reports the
  commission requires regarding the use of grant funds.
         (e)  Not later than December 1 of each even-numbered year,
  the commission shall submit a report to the legislature:
               (1)  summarizing the activities, funding, and outcomes
  of programs awarded a grant under this section; and
               (2)  providing recommendations regarding the grant
  program.
         (f)  For purposes of Subchapter I, Chapter 659:
               (1)  the commission, for the sole purpose of
  administering the grant program under this section, is considered
  an eligible charitable organization entitled to participate in the
  state employee charitable campaign; and
               (2)  a state employee is entitled to authorize a
  deduction for contributions to the commission for the purposes of
  administering the grant program under this section as a charitable
  contribution under Section 659.132, and the commission may use the
  contributions as provided by Subsection (a).  (Gov. Code, Sec.
  531.383.)
         Sec. 526.0704.  TRAINING PROGRAMS. The commission, with
  assistance from the Office of Court Administration of the Texas
  Judicial System, the Department of Public Safety, and local law
  enforcement agencies, shall create training programs designed to
  increase the awareness of judges, prosecutors, and law enforcement
  personnel on:
               (1)  the needs of domestic victims;
               (2)  the availability of services under this
  subchapter;
               (3)  the database of services described by Section
  526.0702; and
               (4)  potential funding sources for those services.  
  (Gov. Code, Sec. 531.384.)
         Sec. 526.0705.  FUNDING. The commission may use
  appropriated funds and may accept gifts, grants, and donations from
  any sources for purposes of the victim assistance program
  established under this subchapter.  (Gov. Code, Sec. 531.385.)
  SUBCHAPTER P. AGING ADULTS WITH VISUAL IMPAIRMENTS
         Sec. 526.0751.  OUTREACH CAMPAIGNS FOR AGING ADULTS WITH
  VISUAL IMPAIRMENTS. (a) The commission, in collaboration with the
  Texas State Library and Archives Commission and other appropriate
  state agencies, shall conduct public awareness and education
  outreach campaigns designed to provide information relating to the
  programs and resources available to aging adults who are blind or
  visually impaired in this state.
         (b)  The campaigns must be:
               (1)  tailored to targeted populations, including:
                     (A)  aging adults with or at risk of blindness or
  visual impairment and the families and caregivers of those adults;
                     (B)  health care providers, including home and
  community-based services providers, health care facilities, and
  emergency medical services providers;
                     (C)  community and faith-based organizations; and
                     (D)  the public; and
               (2)  disseminated through methods appropriate for each
  targeted population, including by:
                     (A)  attending health fairs; and
                     (B)  working with organizations or groups that
  serve aging adults, including community clinics, libraries,
  support groups for aging adults, veterans organizations,
  for-profit providers of vision services, and the state and local
  chapters of the National Federation of the Blind. (Gov. Code, Sec.
  531.0319(a).)
         Sec. 526.0752.  RULES. The executive commissioner may adopt
  rules necessary to implement this subchapter. (Gov. Code, Sec.
  531.0319(c).)
         Sec. 526.0753.  COMMISSION SUPPORT. To support campaigns
  conducted under this subchapter, the commission shall:
               (1)  establish a toll-free telephone number for
  providing counseling and referrals to appropriate services for
  aging adults who are blind or visually impaired;
               (2)  post on the commission's Internet website
  information and training resources for aging adults, community
  stakeholders, and health care and other service providers that
  generally serve aging adults, including:
                     (A)  links to Internet websites that contain
  resources for individuals who are blind or visually impaired;
                     (B)  existing videos that provide awareness of
  blindness and visual impairments among aging adults and the
  importance of early intervention;
                     (C)  best practices for referring aging adults at
  risk of blindness or visual impairment for appropriate services;
  and
                     (D)  training about resources available for aging
  adults who are blind or visually impaired for the staff of aging and
  disability resource centers established under the Aging and
  Disability Resource Center initiative funded partly by the federal
  Administration on Aging and the Centers for Medicare and Medicaid
  Services;
               (3)  designate a commission contact to assist aging
  adults who are diagnosed with a visual impairment and are losing
  vision and the families of those adults with locating and obtaining
  appropriate services; and
               (4)  encourage awareness of the reading services the
  Texas State Library and Archives Commission offers for individuals who are blind or visually impaired.  (Gov. Code, Sec. 531.0319(b).)
 
  CHAPTER 532. MEDICAID ADMINISTRATION AND OPERATION IN GENERAL
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 532.0001.  DEFINITION
  SUBCHAPTER B. ADMINISTRATION
  Sec. 532.0051.  COMMISSION ADMINISTRATION OF MEDICAID
  Sec. 532.0052.  STREAMLINING ADMINISTRATIVE PROCESSES
  Sec. 532.0053.  GRIEVANCES
  Sec. 532.0054.  OFFICE OF COMMUNITY ACCESS AND SERVICES
  Sec. 532.0055.  SERVICE DELIVERY AUDIT MECHANISMS
  Sec. 532.0056.  FEDERAL AUTHORIZATION FOR REFORM
  Sec. 532.0057.  FEES, CHARGES, AND RATES
  Sec. 532.0058.  ACUTE CARE BILLING COORDINATION SYSTEM;
                   PENALTIES
  Sec. 532.0059.  RECOVERY OF CERTAIN THIRD-PARTY
                   REIMBURSEMENTS
  Sec. 532.0060.  DENTAL DIRECTOR
  Sec. 532.0061.  ALIGNMENT OF MEDICAID AND MEDICARE
                   DIABETIC EQUIPMENT AND SUPPLIES
                   WRITTEN ORDER PROCEDURES
  SUBCHAPTER C. FINANCING
  Sec. 532.0101.  FINANCING OPTIMIZATION
  Sec. 532.0102.  RETENTION OF CERTAIN MONEY TO
                   ADMINISTER CERTAIN PROGRAMS; ANNUAL
                   REPORT REQUIRED
  Sec. 532.0103.  BIENNIAL FINANCIAL REPORT
  SUBCHAPTER D. PROVIDERS
  Sec. 532.0151.  STREAMLINING PROVIDER ENROLLMENT AND
                   CREDENTIALING PROCESSES
  Sec. 532.0152.  USE OF NATIONAL PROVIDER IDENTIFIER
                   NUMBER
  Sec. 532.0153.  ENROLLMENT OF CERTAIN EYE HEALTH CARE
                   PROVIDERS
  Sec. 532.0154.  RURAL HEALTH CLINIC REIMBURSEMENT
  Sec. 532.0155.  RURAL HOSPITAL REIMBURSEMENT
  Sec. 532.0156.  REIMBURSEMENT SYSTEM FOR ELECTRONIC
                   HEALTH INFORMATION REVIEW AND
                   TRANSMISSION
  SUBCHAPTER E. DATA AND TECHNOLOGY
  Sec. 532.0201.  DATA COLLECTION SYSTEM
  Sec. 532.0202.  INFORMATION COLLECTION AND ANALYSIS
  Sec. 532.0203.  PUBLIC ACCESS TO CERTAIN DATA
  Sec. 532.0204.  DATA REGARDING TREATMENT FOR PRENATAL
                   ALCOHOL OR CONTROLLED SUBSTANCE
                   EXPOSURE
  Sec. 532.0205.  MEDICAL TECHNOLOGY
  Sec. 532.0206.  PILOT PROJECTS RELATING TO TECHNOLOGY
                   APPLICATIONS
  SUBCHAPTER F. ELECTRONIC VISIT VERIFICATION SYSTEM
  Sec. 532.0251.  DEFINITION
  Sec. 532.0252.  IMPLEMENTATION OF CERTAIN PROVISIONS
  Sec. 532.0253.  ELECTRONIC VISIT VERIFICATION SYSTEM
                   IMPLEMENTATION
  Sec. 532.0254.  INFORMATION TO BE VERIFIED
  Sec. 532.0255.  COMPLIANCE STANDARDS AND STANDARDIZED
                   PROCESSES
  Sec. 532.0256.  RECIPIENT COMPLIANCE
  Sec. 532.0257.  HEALTH CARE PROVIDER COMPLIANCE
  Sec. 532.0258.  HEALTH CARE PROVIDER: USE OF
                   PROPRIETARY SYSTEM
  Sec. 532.0259.  STAKEHOLDER INPUT
  Sec. 532.0260.  RULES
  SUBCHAPTER G. APPLICANTS AND RECIPIENTS
  Sec. 532.0301.  BILL OF RIGHTS AND BILL OF
                   RESPONSIBILITIES
  Sec. 532.0302.  UNIFORM FAIR HEARING RULES
  Sec. 532.0303.  SUPPORT AND INFORMATION SERVICES FOR
                   RECIPIENTS
  Sec. 532.0304.  NURSING SERVICES ASSESSMENTS
  Sec. 532.0305.  THERAPY SERVICES ASSESSMENTS
  Sec. 532.0306.  WELLNESS SCREENING PROGRAM
  Sec. 532.0307.  FEDERALLY QUALIFIED HEALTH CENTER AND
                   RURAL HEALTH CLINIC SERVICES
  SUBCHAPTER H. PROGRAMS AND SERVICES FOR CERTAIN CATEGORIES OF
  MEDICAID POPULATION
  Sec. 532.0351.  TAILORED BENEFIT PACKAGES FOR CERTAIN
                   CATEGORIES OF MEDICAID POPULATION
  Sec. 532.0352.  WAIVER PROGRAM FOR CERTAIN INDIVIDUALS
                   WITH CHRONIC HEALTH CONDITIONS
  Sec. 532.0353.  BUY-IN PROGRAMS FOR CERTAIN INDIVIDUALS
                   WITH DISABILITIES
  SUBCHAPTER I. UTILIZATION REVIEW, PRIOR AUTHORIZATION, AND
  COVERAGE PROCESSES AND DETERMINATIONS
  Sec. 532.0401.  REVIEW OF PRIOR AUTHORIZATION AND
                   UTILIZATION REVIEW PROCESSES
  Sec. 532.0402.  ACCESSIBILITY OF INFORMATION REGARDING
                   PRIOR AUTHORIZATION REQUIREMENTS
  Sec. 532.0403.  NOTICE REQUIREMENTS REGARDING COVERAGE
                   OR PRIOR AUTHORIZATION DENIAL AND
                   INCOMPLETE REQUESTS
  Sec. 532.0404.  EXTERNAL MEDICAL REVIEW
  SUBCHAPTER J. COST-SAVING INITIATIVES
  Sec. 532.0451.  HOSPITAL EMERGENCY ROOM USE REDUCTION
                   INITIATIVES
  Sec. 532.0452.  PHYSICIAN INCENTIVE PROGRAM TO REDUCE
                   HOSPITAL EMERGENCY ROOM USE FOR
                   NON-EMERGENT CONDITIONS
  Sec. 532.0453.  CONTINUED IMPLEMENTATION OF CERTAIN
                   INTERVENTIONS AND BEST PRACTICES BY
                   PROVIDERS; SEMIANNUAL REPORT
  Sec. 532.0454.  HEALTH SAVINGS ACCOUNT PILOT PROGRAM
  Sec. 532.0455.  DURABLE MEDICAL EQUIPMENT REUSE PROGRAM
  CHAPTER 532. MEDICAID ADMINISTRATION AND OPERATION IN GENERAL
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 532.0001.  DEFINITION. In this chapter, "recipient"
  means a Medicaid recipient. (New.)
  SUBCHAPTER B. ADMINISTRATION
         Sec. 532.0051.  COMMISSION ADMINISTRATION OF MEDICAID. (a)
  The commission is the state agency designated to administer federal
  Medicaid funds.
         (b)  The commission shall:
               (1)  in each agency that operates a portion of
  Medicaid, plan and direct Medicaid, including the management of the
  Medicaid managed care system and the development, procurement,
  management, and monitoring of contracts necessary to implement that
  system; and
               (2)  establish requirements for and define the scope of
  the ongoing evaluation of the Medicaid managed care system
  conducted in conjunction with the Department of State Health
  Services under Section 108.0065, Health and Safety Code. (Gov.
  Code, Secs. 531.021(a), (b).)
         Sec. 532.0052.  STREAMLINING ADMINISTRATIVE PROCESSES. The
  commission shall make every effort:
               (1)  using the commission's existing resources, to
  reduce the paperwork and other administrative burdens placed on
  recipients, Medicaid providers, and other Medicaid participants,
  and shall use technology and efficient business practices to reduce
  those burdens; and
               (2)  to improve the business practices associated with
  Medicaid administration by any method the commission determines is
  cost-effective, including:
                     (A)  expanding electronic claims payment system
  use;
                     (B)  developing an Internet portal system for
  prior authorization requests;
                     (C)  encouraging Medicaid providers to submit
  program participation applications electronically;
                     (D)  ensuring that the Medicaid provider
  application is easy to locate on the Internet so that providers can
  conveniently apply to the program;
                     (E)  working with federal partners to take
  advantage of every opportunity to maximize additional federal
  funding for technology in Medicaid; and
                     (F)  encouraging providers' increased use of
  medical technology, including increasing providers' use of:
                           (i)  electronic communications between
  patients and their physicians or other health care providers;
                           (ii)  electronic prescribing tools that
  provide current payer formulary information at the time the
  physician or other health care provider writes a prescription and
  that support the electronic transmission of a prescription;
                           (iii)  ambulatory computerized order entry
  systems that facilitate at the point of care physician and other
  health care provider orders for medications and laboratory and
  radiological tests;
                           (iv)  inpatient computerized order entry
  systems to reduce errors, improve health care quality, and lower
  costs in a hospital setting;
                           (v)  regional data-sharing to coordinate
  patient care across a community for patients who are treated by
  multiple providers; and
                           (vi)  electronic intensive care unit
  technology to allow physicians to fully monitor hospital patients
  remotely. (Gov. Code, Sec. 531.02411.)
         Sec. 532.0053.  GRIEVANCES. (a) The commission shall:
               (1)  adopt a definition of "grievance" related to
  Medicaid and ensure the definition is consistent among divisions
  within the commission to ensure all grievances are managed
  consistently;
               (2)  standardize Medicaid grievance data reporting and
  tracking among divisions within the commission;
               (3)  implement a no-wrong-door system for Medicaid
  grievances reported to the commission; and
               (4)  verify grievance data a Medicaid managed care
  organization reports.
         (b)  The commission shall establish a procedure for
  expedited resolution of a grievance related to Medicaid that allows
  the commission to:
               (1)  identify a grievance related to a Medicaid
  access-to-care issue that is urgent and requires an expedited
  resolution; and
               (2)  resolve the grievance within a specified period.
         (c)  The commission shall:
               (1)  aggregate recipient and Medicaid provider
  grievance data to provide a comprehensive data set of grievances;
  and
               (2)  make the aggregated data available to the
  legislature and the public in a manner that does not allow for the
  identification of a particular recipient or provider. (Gov. Code,
  Sec. 531.02131.)
         Sec. 532.0054.  OFFICE OF COMMUNITY ACCESS AND SERVICES.
  The executive commissioner shall establish within the commission an
  office of community access and services. The office is responsible
  for:
               (1)  collaborating with community, state, and federal
  stakeholders to improve the elements of the health care system that
  are involved in delivering Medicaid services; and
               (2)  sharing with Medicaid providers, including
  hospitals, any best practices, resources, or other information
  regarding improvements to the health care system. (Gov. Code, Sec.
  531.020.)
         Sec. 532.0055.  SERVICE DELIVERY AUDIT MECHANISMS. The
  commission shall make every effort to ensure the integrity of
  Medicaid. To ensure that integrity, the commission shall:
               (1)  perform risk assessments of every element of the
  program and audit the program elements determined to present the
  greatest risks;
               (2)  ensure that sufficient oversight is in place for
  the Medicaid medical transportation program and that a quality
  review assessment of that program occurs; and
               (3)  evaluate Medicaid with respect to use of the
  metrics developed through the Texas Health Steps performance
  improvement plan to guide changes and improvements to the program.
  (Gov. Code, Sec. 531.02412.)
         Sec. 532.0056.  FEDERAL AUTHORIZATION FOR REFORM. The
  executive commissioner shall seek a waiver under Section 1115 of
  the Social Security Act (42 U.S.C. Section 1315) to the state
  Medicaid plan that is designed to achieve the following objectives
  regarding Medicaid and alternatives to Medicaid:
               (1)  provide flexibility to determine Medicaid
  eligibility categories and income levels;
               (2)  provide flexibility to design Medicaid benefits
  that meet the demographic, public health, clinical, and cultural
  needs of this state or regions within this state;
               (3)  encourage use of the private health benefits
  coverage market rather than public benefits systems;
               (4)  encourage individuals who have access to private
  employer-based health benefits to obtain or maintain those
  benefits;
               (5)  create a culture of shared financial
  responsibility, accountability, and participation in Medicaid by:
                     (A)  establishing and enforcing copayment
  requirements similar to private sector principles for all
  eligibility groups;
                     (B)  promoting the use of health savings accounts
  to influence a culture of individual responsibility; and
                     (C)  promoting the use of vouchers for
  consumer-directed services in which consumers manage and pay for
  health-related services provided to them using program vouchers;
               (6)  consolidate federal funding streams, including
  funds from the disproportionate share hospitals and upper payment
  limit supplemental payment programs and other federal Medicaid
  funds, to ensure the most effective and efficient use of those
  funding streams;
               (7)  allow flexibility in the use of state funds used to
  obtain federal matching funds, including allowing the use of
  intergovernmental transfers, certified public expenditures, costs
  not otherwise matchable, or other funds and funding mechanisms to
  obtain federal matching funds;
               (8)  empower individuals who are uninsured to acquire
  health benefits coverage through the promotion of cost-effective
  coverage models that provide access to affordable primary,
  preventive, and other health care on a sliding scale, with fees paid
  at the point of service; and
               (9)  allow for the redesign of long-term care services
  and supports to increase access to patient-centered care in the
  most cost-effective manner. (Gov. Code, Sec. 537.002.)
         Sec. 532.0057.  FEES, CHARGES, AND RATES. (a) The executive
  commissioner shall adopt reasonable rules and standards governing
  the determination of fees, charges, and rates for Medicaid
  payments.
         (b)  In adopting rules and standards required by Subsection
  (a), the executive commissioner:
               (1)  may provide for payment of fees, charges, and
  rates in accordance with:
                     (A)  formulas, procedures, or methodologies
  commission rules prescribe;
                     (B)  state or federal law, policies, rules,
  regulations, or guidelines;
                     (C)  economic conditions that substantially and
  materially affect provider participation in Medicaid, as the
  executive commissioner determines; or
                     (D)  available levels of appropriated state and
  federal funds; and
               (2)  shall include financial performance standards
  that, in the event of a proposed rate reduction, provide private
  ICF-IID facilities and home and community-based services providers
  with flexibility in determining how to use Medicaid payments to
  provide services in the most cost-effective manner while continuing
  to meet state and federal Medicaid requirements.
         (c)  Notwithstanding any other provision of Chapter 32,
  Human Resources Code, Chapter 531 or revised provisions of Chapter
  531, as that chapter existed on March 31, 2025, or Chapter 540 or
  540A, the commission may adjust the fees, charges, and rates paid to
  Medicaid providers as necessary to achieve the objectives of
  Medicaid in a manner consistent with the considerations described
  by Subsection (b)(1).
         (d)  In adopting rates for Medicaid payments under
  Subsection (a), the executive commissioner may adopt reimbursement
  rates for appropriate nursing services provided to recipients with
  certain health conditions if those services are determined to
  provide a cost-effective alternative to hospitalization. A
  physician must certify that the nursing services are medically
  appropriate for the recipient for those services to qualify for
  reimbursement under this subsection.
         (e)  In adopting rates for Medicaid payments under
  Subsection (a), the executive commissioner may adopt
  cost-effective reimbursement rates for group appointments with
  Medicaid providers for certain diseases and medical conditions
  commission rules specify. (Gov. Code, Secs. 531.021(b-1), (c), (d),
  (e), (f), (g).)
         Sec. 532.0058.  ACUTE CARE BILLING COORDINATION SYSTEM;
  PENALTIES. (a) The acute care Medicaid billing coordination
  system for the fee-for-service and primary care case management
  delivery models for which the commission contracts must, on entry
  of a claim in the claims system:
               (1)  identify within 24 hours whether another entity
  has primary responsibility for paying the claim; and
               (2)  submit the claim to the entity the system
  determines is the primary payor.
         (b)  The billing coordination system may not increase
  Medicaid claims payment error rates.
         (c)  If cost-effective and feasible, the commission shall
  contract to expand the acute care Medicaid billing coordination
  system to process claims for all other Medicaid health care
  services in the manner the system processes claims for acute care
  services. This subsection does not apply to claims for Medicaid
  health care services if, before September 1, 2009, those claims
  were being processed by an alternative billing coordination system.
         (d)  If cost-effective, the executive commissioner shall
  adopt rules to enable the acute care Medicaid billing coordination
  system to identify an entity with primary responsibility for paying
  a claim that is processed by the system and establish reporting
  requirements for an entity that may have a contractual
  responsibility to pay for the types of services that are provided
  under Medicaid and the claims for which are processed by the system.
         (e)  An entity that holds a permit, license, or certificate
  of authority issued by a regulatory agency of this state:
               (1)  must allow a contractor under this section access
  to databases to allow the contractor to carry out the purposes of
  this section, subject to the contractor's contract with the
  commission and rules the executive commissioner adopts under this
  section; and
               (2)  is subject to an administrative penalty or other
  sanction as provided by the law applicable to the permit, license,
  or certificate of authority for the entity's violation of a rule the
  executive commissioner adopts under this section.
         (f)  Public funds may not be spent on an entity that is not in
  compliance with this section unless the executive commissioner and
  the entity enter into a memorandum of understanding.
         (g)  Information obtained under this section is
  confidential. The contractor may use the information only for the
  purposes authorized under this section. A person commits an
  offense if the person knowingly uses information obtained under
  this section for any purpose not authorized under this section. An
  offense under this subsection is a Class B misdemeanor and all other
  penalties may apply. (Gov. Code, Secs. 531.02413(a) (part), (a-1),
  (b), (c), (d), (e).)
         Sec. 532.0059.  RECOVERY OF CERTAIN THIRD-PARTY
  REIMBURSEMENTS. The commission shall obtain Medicaid
  reimbursement from each fiscal intermediary who makes a payment to
  a service provider on behalf of the Medicare program, including a
  reimbursement for a payment made to a home health services provider
  or nursing facility for services provided to an individual who is
  eligible to receive health care benefits under both Medicaid and
  the Medicare program. (Gov. Code, Sec. 531.0392.)
         Sec. 532.0060.  DENTAL DIRECTOR. The executive commissioner
  shall appoint a Medicaid dental director who is a licensed dentist
  under Subtitle D, Title 3, Occupations Code, and rules the State
  Board of Dental Examiners adopts under that subtitle. (Gov. Code,
  Sec. 531.02114.)
         Sec. 532.0061.  ALIGNMENT OF MEDICAID AND MEDICARE DIABETIC
  EQUIPMENT AND SUPPLIES WRITTEN ORDER PROCEDURES. (a) The
  commission shall review Medicaid forms and requirements regarding
  written orders for diabetic equipment and supplies to identify
  variations between permissible Medicaid ordering procedures and
  ordering procedures available to Medicare providers.
         (b)  To the extent practicable and in conformity with Chapter
  157, Occupations Code, and Chapter 483, Health and Safety Code,
  after the commission conducts a review under Subsection (a), the
  commission or executive commissioner, as appropriate, shall modify
  only Medicaid forms, rules, and procedures applicable to orders for
  diabetic equipment and supplies to provide for an ordering system
  that is comparable to the Medicare ordering system for diabetic
  equipment and supplies. The ordering system must permit a diabetic
  equipment or supplies supplier to complete forms by hand or enter
  medical information or supply orders electronically into a form as
  necessary to provide the information required to dispense diabetic
  equipment or supplies.
         (c)  A diabetic equipment and supplies provider may bill and
  collect payment for the provider's services if the provider has a
  copy of the form that meets the requirements of Subsection (b) and
  is signed by a medical provider licensed in this state to treat
  diabetic patients. Additional documentation may not be required.
  (Gov. Code, Sec. 531.099.)
  SUBCHAPTER C. FINANCING
         Sec. 532.0101.  FINANCING OPTIMIZATION. The commission
  shall ensure that the Medicaid finance system is optimized to:
               (1)  maximize this state's receipt of federal funds;
               (2)  create incentives for providers to use preventive
  care;
               (3)  increase and retain providers in the system to
  maintain an adequate provider network;
               (4)  more accurately reflect the costs borne by
  providers; and
               (5)  encourage improvement of the quality of care.
  (Gov. Code, Sec. 531.02113.)
         Sec. 532.0102.  RETENTION OF CERTAIN MONEY TO ADMINISTER
  CERTAIN PROGRAMS; ANNUAL REPORT REQUIRED. (a) In this section,
  "directed payment program" means a delivery system and provider
  patient initiative implemented by this state under 42 C.F.R.
  Section 438.6(c).
         (b)  This section applies only to money the commission
  receives from a source other than the general revenue fund to
  operate a waiver program established under Section 1115 of the
  Social Security Act (42 U.S.C. Section 1315) or a directed payment
  program or successor program as the commission determines.
         (c)  Subject to Subsection (d), the commission may retain
  from money to which this section applies an amount equal to the
  estimated costs necessary to administer the program for which the
  commission receives the money, but not to exceed $8 million for a
  state fiscal year.
         (d)  If the commission determines that the commission needs
  additional money to administer a program described by Subsection
  (b), the commission may retain an additional amount with the
  governor's and the Legislative Budget Board's approval, but not to
  exceed a total retained amount equal to 0.25 percent of the total
  estimated amount the commission receives for the program.
         (e)  The commission shall spend the retained money to assist
  in paying the costs necessary to administer the program for which
  the commission receives the money, except that the commission may
  not use the money to pay any type of administrative cost that,
  before June 1, 2019, was funded with general revenue.
         (f)  The commission shall submit an annual report to the
  governor and the Legislative Budget Board that:
               (1)  details the amount of money the commission
  retained and spent under this section during the preceding state
  fiscal year, including a separate detail of any increase in the
  amount of money the commission retained for a program under
  Subsection (d);
               (2)  contains a transparent description of how the
  commission used the money described by Subdivision (1); and
               (3)  assesses the extent to which the retained money
  covered the estimated costs to administer the applicable program
  and states whether, based on that assessment, the commission
  adjusted or considered adjustments to the amount retained.
         (g)  The executive commissioner shall adopt rules necessary
  to implement this section. (Gov. Code, Sec. 531.021135.)
         Sec. 532.0103.  BIENNIAL FINANCIAL REPORT. (a) The
  commission shall prepare a biennial Medicaid financial report
  covering each state agency that operates a part of Medicaid and each
  component of Medicaid those agencies operate.
         (b)  The report must include:
               (1)  for each state agency that operates a part of
  Medicaid:
                     (A)  a description of each of the Medicaid
  components the agency operates; and
                     (B)  an accounting of all funds related to
  Medicaid the agency received and disbursed during the period the
  report covers, including:
                           (i)  the amount of any federal Medicaid
  funds allocated to the agency for the support of each of the
  Medicaid components the agency operates;
                           (ii)  the amount of any funds the
  legislature appropriated to the agency for each of those
  components; and
                           (iii)  the amount of Medicaid payments and
  related expenditures made by or in connection with each of those
  components; and
               (2)  for each Medicaid component identified in the
  report:
                     (A)  the amount and source of funds or other
  revenue received by or made available to the agency for the
  component;
                     (B)  the amount spent on each type of service or
  benefit provided by or under the component;
                     (C)  the amount spent on component operations,
  including eligibility determination, claims processing, and case
  management; and
                     (D)  the amount spent on any other administrative
  costs.
         (c)  The report must cover the three-year period ending on
  the last day of the previous fiscal year.
         (d)  The commission may request from any appropriate state
  agency information necessary to complete the report. Each agency
  shall cooperate with the commission in providing information for
  the report.
         (e)  Not later than December 1 of each even-numbered year,
  the commission shall submit the report to the governor, the
  lieutenant governor, the speaker of the house of representatives,
  the presiding officer of each standing committee of the senate and
  house of representatives having jurisdiction over health and human
  services issues, and the state auditor. (Gov. Code, Sec.
  531.02111.)
  SUBCHAPTER D. PROVIDERS
         Sec. 532.0151.  STREAMLINING PROVIDER ENROLLMENT AND
  CREDENTIALING PROCESSES. (a) The commission shall streamline
  Medicaid provider enrollment and credentialing processes.
         (b)  In streamlining the Medicaid provider enrollment
  process, the commission shall establish a centralized Internet
  portal through which providers may enroll in Medicaid.
         (c)  In streamlining the Medicaid provider credentialing
  process, the commission may:
               (1)  designate a centralized credentialing entity;
               (2)  share information in the database established
  under Subchapter C, Chapter 32, Human Resources Code, with the
  centralized credentialing entity; and
               (3)  require all Medicaid managed care organizations to
  use the centralized credentialing entity as a hub for collecting
  and sharing information.
         (d)  The commission may:
               (1)  use the Internet portal created under Subsection
  (b) to create a single, consolidated Medicaid provider enrollment
  and credentialing process; and
               (2)  if cost-effective, contract with a third party to
  develop the single, consolidated process. (Gov. Code, Sec.
  531.02118.)
         Sec. 532.0152.  USE OF NATIONAL PROVIDER IDENTIFIER NUMBER.
  (a) In this section, "national provider identifier number" means
  the national provider identifier number required under Section
  1128J(e) of the Social Security Act (42 U.S.C. Section
  1320a-7k(e)).
         (b)  The commission shall transition from using a
  state-issued provider identifier number to using only a national
  provider identifier number in accordance with this section.
         (c)  The commission shall implement a Medicaid provider
  management and enrollment system and, following that
  implementation, use only a national provider identifier number to
  enroll a provider in Medicaid.
         (d)  The commission shall implement a modernized claims
  processing system and, following that implementation, use only a
  national provider identifier number to process claims for and
  authorize Medicaid services. (Gov. Code, Sec. 531.021182.)
         Sec. 532.0153.  ENROLLMENT OF CERTAIN EYE HEALTH CARE
  PROVIDERS. (a) This section applies only to:
               (1)  an optometrist who is licensed by the Texas
  Optometry Board;
               (2)  a therapeutic optometrist who is licensed by the
  Texas Optometry Board;
               (3)  an ophthalmologist who is licensed by the Texas
  Medical Board; and
               (4)  an institution of higher education that provides
  an accredited program for:
                     (A)  training as a doctor of optometry or an
  optometrist residency; or
                     (B)  training as an ophthalmologist or an
  ophthalmologist residency.
         (b)  The commission may not prevent a provider to whom this
  section applies from enrolling as a Medicaid provider if the
  provider:
               (1)  either:
                     (A)  joins an established practice of a health
  care provider or provider group that has a contract with a Medicaid
  managed care organization to provide health care services to
  recipients under Chapter 540 or 540A; or
                     (B)  is employed by or otherwise compensated for
  providing training at an institution of higher education described
  by Subsection (a)(4);
               (2)  applies to be an enrolled Medicaid provider;
               (3)  if applicable, complies with the requirements of
  the contract described by Subdivision (1)(A); and
               (4)  complies with all other applicable requirements
  related to being a Medicaid provider.
         (c)  The commission may not prevent an institution of higher
  education from enrolling as a Medicaid provider if the institution:
               (1)  has a contract with a managed care organization to
  provide health care services to recipients under Chapter 540 or
  540A;
               (2)  applies to be an enrolled Medicaid provider;
               (3)  complies with the requirements of the contract
  described by Subdivision (1); and
               (4)  complies with all other applicable requirements
  related to being a Medicaid provider. (Gov. Code, Sec. 531.021191.)
         Sec. 532.0154.  RURAL HEALTH CLINIC REIMBURSEMENT. The
  commission may not impose any condition on the reimbursement of a
  rural health clinic under Medicaid if the condition is more
  stringent than the conditions imposed by:
               (1)  the Rural Health Clinic Services Act of 1977 (Pub.
  L. No. 95-210); or
               (2)  the laws of this state regulating the practice of
  medicine, pharmacy, or professional nursing. (Gov. Code, Sec.
  531.02193.)
         Sec. 532.0155.  RURAL HOSPITAL REIMBURSEMENT. (a) In this
  section, "rural hospital" has the meaning assigned by commission
  rules for purposes of reimbursing hospitals for providing Medicaid
  inpatient or outpatient services.
         (b)  To the extent allowed by federal law and subject to
  limitations on appropriations, the executive commissioner by rule
  shall adopt a prospective reimbursement methodology for the payment
  of rural hospitals participating in Medicaid that ensures the rural
  hospitals are reimbursed on an individual basis for providing
  inpatient and general outpatient services to recipients by using
  the hospitals' most recent cost information concerning the costs
  incurred for providing the services.  The commission shall
  calculate the prospective cost-based reimbursement rates once
  every two years.
         (c)  In adopting rules under Subsection (b), the executive
  commissioner may:
               (1)  adopt a methodology that requires:
                     (A)  a Medicaid managed care organization to
  reimburse rural hospitals for services delivered through the
  Medicaid managed care program using a minimum fee schedule or other
  method for which federal matching money is available; or
                     (B)  both the commission and a Medicaid managed
  care organization to share in the total amount of reimbursement
  paid to rural hospitals; and
               (2)  require that the reimbursement amount paid to a
  rural hospital is subject to any applicable adjustments the
  commission makes for payments to or penalties imposed on the rural
  hospital that are based on a quality-based or performance-based
  requirement under the Medicaid managed care program.
         (d)  Not later than September 1 of each even-numbered year,
  the commission shall, for purposes of Subsection (b), determine the
  allowable costs incurred by a rural hospital participating in the
  Medicaid managed care program based on the rural hospital's cost
  reports submitted to the Centers for Medicare and Medicaid Services
  and other available information that the commission considers
  relevant in determining the hospital's allowable costs.
         (e)  Notwithstanding Subsection (b) and subject to
  Subsection (f), the executive commissioner shall adopt and the
  commission shall implement, beginning with the state fiscal year
  ending August 31, 2022, a true cost-based reimbursement methodology
  for inpatient and general outpatient services provided to
  recipients at rural hospitals that provides:
               (1)  prospective payments during a state fiscal year to
  the hospitals using the reimbursement methodology adopted under
  Subsection (b); and
               (2)  to the extent allowed by federal law, in the
  subsequent state fiscal year a cost settlement to provide
  additional reimbursement as necessary to reimburse the hospitals
  for the true costs incurred in providing inpatient and general
  outpatient services to recipients during the previous state fiscal
  year.
         (f)  If federal law does not permit the use of a true
  cost-based reimbursement methodology described by Subsection (e),
  the commission shall continue to use the prospective cost-based
  reimbursement methodology the executive commissioner adopts under
  Subsection (b) for the payment of rural hospitals for providing
  inpatient and general outpatient services to recipients.  (Gov.
  Code, Sec. 531.02194.)
         Sec. 532.0156.  REIMBURSEMENT SYSTEM FOR ELECTRONIC HEALTH
  INFORMATION REVIEW AND TRANSMISSION. If feasible and
  cost-effective, the executive commissioner by rule may develop and
  the commission may implement a system to provide Medicaid
  reimbursement to a health care provider, including a physician, for
  reviewing and transmitting electronic health information. (Gov.
  Code, Secs. 531.0162(g), (h) (part).)
  SUBCHAPTER E. DATA AND TECHNOLOGY
         Sec. 532.0201.  DATA COLLECTION SYSTEM. (a) The commission
  and each health and human services agency that administers a part of
  Medicaid shall jointly develop a system to coordinate and integrate
  state Medicaid databases to:
               (1)  facilitate the comprehensive analysis of Medicaid
  data; and
               (2)  detect fraud a program provider or recipient
  perpetrates.
         (b)  To minimize cost and duplication of activities, the
  commission shall assist and coordinate:
               (1)  the efforts of the agencies that are participating
  in developing the system; and
               (2)  the efforts of those agencies with the efforts of
  other agencies involved in a statewide health care data collection
  system provided for by Section 108.006, Health and Safety Code,
  including avoiding duplication of expenditure of state funds for
  computer hardware, staff, or services.
         (c)  On the executive commissioner's request, a state agency
  that administers any part of Medicaid shall assist the commission
  in developing the system.
         (d)  The commission shall develop the system in a manner that
  will enable a complete analysis of the use of prescription
  medications, including information relating to:
               (1)  recipients for whom more than three medications
  have been prescribed; and
               (2)  the medical effect denial of Medicaid coverage for
  more than three medications has had on recipients.
         (e)  The commission shall ensure that the system is used each
  month to match vital statistics unit death records with a list of
  individuals eligible for Medicaid, and that each individual who is
  deceased is promptly removed from the list of individuals eligible
  for Medicaid. (Gov. Code, Sec. 531.0214.)
         Sec. 532.0202.  INFORMATION COLLECTION AND ANALYSIS. (a)
  The commission shall:
               (1)  make every effort to improve data analysis and
  integrate available information associated with Medicaid;
               (2)  use the decision support system in the
  commission's center for analytics and decision support for the
  purpose described by Subdivision (1);
               (3)  modify or redesign the decision support system to
  allow for the data collected by Medicaid to be used more
  systematically and effectively for Medicaid evaluation and policy
  development; and
               (4)  develop or redesign the decision support system as
  necessary to ensure that the system:
                     (A)  incorporates currently collected Medicaid
  enrollment, utilization, and provider data;
                     (B)  allows data manipulation and quick analysis
  to address a large variety of questions concerning enrollment and
  utilization patterns and trends within Medicaid;
                     (C)  is able to obtain consistent and accurate
  answers to questions;
                     (D)  allows for analysis of multiple issues within
  Medicaid to determine whether any programmatic or policy issues
  overlap or are in conflict;
                     (E)  includes predefined data reports on
  utilization of high-cost services that allow Medicaid management to
  analyze and determine the reasons for an increase or decrease in
  utilization and immediately proceed with policy changes, if
  appropriate;
                     (F)  includes any encounter data with respect to
  recipients that a Medicaid managed care organization receives from
  a health care provider in the organization's provider network; and
                     (G)  links Medicaid and non-Medicaid data sets,
  including data sets related to:
                           (i)  Medicaid;
                           (ii)  the financial assistance program under
  Chapter 31, Human Resources Code;
                           (iii)  the special supplemental nutrition
  program for women, infants, and children authorized by 42 U.S.C.
  Section 1786;
                           (iv)  vital statistics; and
                           (v)  other public health programs.
         (b)  The commission shall ensure that all Medicaid data sets
  the decision support system creates or identifies are made
  available on the Internet to the extent not prohibited by federal or
  state laws regarding medical privacy or security. If privacy
  concerns exist or arise with respect to making the data sets
  available on the Internet, the system and the commission shall make
  every effort to make the data available on the Internet either by:
               (1)  removing individually identifiable information;
  or
               (2)  aggregating the data in a manner to prevent the
  association of individual records with particular individuals.
         (c)  The commission shall regularly evaluate data submitted
  by Medicaid managed care organizations to determine whether:
               (1)  the data continues to serve a useful purpose; and
               (2)  additional data is needed to oversee contracts or
  evaluate the effectiveness of Medicaid.
         (d)  The commission shall collect Medicaid managed care data
  that effectively captures the quality of services recipients
  receive.
         (e)  The commission shall develop a dashboard for agency
  leadership that is designed to assist leadership with overseeing
  Medicaid and comparing the performance of Medicaid managed care
  organizations. The dashboard must identify a concise number of
  important Medicaid indicators, including key data, performance
  measures, trends, and problems. (Gov. Code, Sec. 531.02141.)
         Sec. 532.0203.  PUBLIC ACCESS TO CERTAIN DATA. (a) To the
  extent permitted by federal law, the commission, in collaboration
  with the appropriate advisory committees related to Medicaid, shall
  make available to the public on the commission's Internet website
  in an easy-to-read format data relating to the quality of health
  care recipients received and the health outcomes of those
  recipients. Data the commission makes available to the public must
  be made available in a manner that does not identify or allow for
  the identification of individual recipients.
         (b)  In performing duties under this section, the commission
  may collaborate with an institution of higher education or another
  state agency with experience in analyzing and producing public use
  data. (Gov. Code, Sec. 531.02142.)
         Sec. 532.0204.  DATA REGARDING TREATMENT FOR PRENATAL
  ALCOHOL OR CONTROLLED SUBSTANCE EXPOSURE. (a) The commission
  shall collect hospital discharge data for recipients regarding
  treatment of a newborn child for prenatal exposure to alcohol or a
  controlled substance.
         (b)  The commission shall provide the collected data to the
  Department of Family and Protective Services. (Gov. Code, Sec.
  531.02143.)
         Sec. 532.0205.  MEDICAL TECHNOLOGY. The commission shall
  explore and evaluate new developments in medical technology and
  propose implementing the technology in Medicaid, if appropriate and
  cost-effective. Commission staff implementing this section must
  have skills and experience in research regarding health care
  technology. (Gov. Code, Sec. 531.0081.)
         Sec. 532.0206.  PILOT PROJECTS RELATING TO TECHNOLOGY
  APPLICATIONS. (a) Notwithstanding any other law, the commission
  may establish one or more pilot projects through which Medicaid
  reimbursement is made to demonstrate the applications of technology
  in providing Medicaid services.
         (b)  A pilot project under this section may relate to
  providing rehabilitation services, services for the aging or
  individuals with disabilities, or long-term care services,
  including community care services and supports.
         (c)  Notwithstanding an eligibility requirement prescribed
  by any other law or rule, the commission may establish requirements
  for an individual to receive services provided through a pilot
  project under this section.
         (d)  An individual's receipt of services provided through a
  pilot project under this section does not entitle the individual to
  other services under a government-funded health program.
         (e)  The commission may set a maximum enrollment limit for a
  pilot project under this section. (Gov. Code, Sec. 531.062.)
  SUBCHAPTER F. ELECTRONIC VISIT VERIFICATION SYSTEM
         Sec. 532.0251.  DEFINITION. In this subchapter, "electronic
  visit verification system" means the electronic visit verification
  system implemented under Section 532.0253. (New.)
         Sec. 532.0252.  IMPLEMENTATION OF CERTAIN PROVISIONS.
  Notwithstanding any other provision of this subchapter, the
  commission is required to implement a change in law made to former
  Section 531.024172 by Chapter 909 (S.B. 894), Acts of the 85th
  Legislature, Regular Session, 2017, only if the commission
  determines the implementation is appropriate based on the findings
  of the electronic visit verification system review conducted before
  April 1, 2018, under Section 531.024172(a) as that section existed
  before that date. (Gov. Code, Sec. 531.024172(a) (part).)
         Sec. 532.0253.  ELECTRONIC VISIT VERIFICATION SYSTEM
  IMPLEMENTATION. (a) Subject to Section 532.0258(a), the
  commission shall, in accordance with federal law, implement an
  electronic visit verification system to electronically verify that
  personal care services, attendant care services, or other services
  the commission identifies that are provided under Medicaid to
  recipients, including personal care services or attendant care
  services provided under the Texas Health Care Transformation and
  Quality Improvement Program waiver issued under Section 1115 of the
  Social Security Act (42 U.S.C. Section 1315) or any other Medicaid
  waiver program, are provided to recipients in accordance with a
  prior authorization or plan of care.
         (b)  The verification must be made through a telephone,
  global positioning, or computer-based system. (Gov. Code, Sec.
  531.024172(b) (part).)
         Sec. 532.0254.  INFORMATION TO BE VERIFIED. The electronic
  visit verification system must allow for verification of only the
  following information relating to the delivery of Medicaid
  services:
               (1)  the type of service provided;
               (2)  the name of the recipient to whom the service was
  provided;
               (3)  the date and times the provider began and ended the
  service delivery visit;
               (4)  the location, including the address, at which the
  service was provided;
               (5)  the name of the individual who provided the
  service; and
               (6)  other information the commission determines is
  necessary to ensure the accurate adjudication of Medicaid claims.
  (Gov. Code, Sec. 531.024172(b) (part).)
         Sec. 532.0255.  COMPLIANCE STANDARDS AND STANDARDIZED
  PROCESSES. (a) In implementing the electronic visit verification
  system:
               (1)  subject to Subsection (b), the executive
  commissioner shall adopt compliance standards for health care
  providers; and
               (2)  the commission shall ensure that:
                     (A)  the information required to be reported by
  health care providers is standardized across Medicaid managed care
  organizations and commission programs;
                     (B)  processes Medicaid managed care
  organizations require to retrospectively correct data are
  standardized and publicly accessible to health care providers;
                     (C)  standardized processes are established for
  addressing the failure of a Medicaid managed care organization to
  provide a timely authorization for delivering services necessary to
  ensure continuity of care; and
                     (D)  a health care provider is allowed to enter a
  variable schedule into the system.
         (b)  In establishing compliance standards for health care
  providers under Subsection (a), the executive commissioner shall
  consider:
               (1)  the administrative burdens placed on health care
  providers required to comply with the standards; and
               (2)  the benefits of using emerging technologies for
  ensuring compliance, including Internet-based, mobile
  telephone-based, and global positioning-based technologies. (Gov.
  Code, Secs. 531.024172(d), (e).)
         Sec. 532.0256.  RECIPIENT COMPLIANCE. The commission shall
  inform each recipient who receives personal care services,
  attendant care services, or other services the commission
  identifies that the health care provider providing the services and
  the recipient are each required to comply with the electronic visit
  verification system. A Medicaid managed care organization shall
  also inform recipients described by this section who are enrolled
  in a managed care plan offered by the organization of those
  requirements. (Gov. Code, Sec. 531.024172(c).)
         Sec. 532.0257.  HEALTH CARE PROVIDER COMPLIANCE. A health
  care provider that provides to recipients personal care services,
  attendant care services, or other services the commission
  identifies shall:
               (1)  use the electronic visit verification system or a
  proprietary system the commission allows as provided by Section
  532.0258 to document the provision of those services;
               (2)  comply with all documentation requirements the
  commission establishes;
               (3)  comply with federal and state laws regarding
  confidentiality of recipients' information;
               (4)  ensure that the commission or the Medicaid managed
  care organization with which a claim for reimbursement for a
  service is filed may review electronic visit verification system
  documentation related to the claim or obtain a copy of that
  documentation at no charge to the commission or the organization;
  and
               (5)  at any time, allow the commission or a Medicaid
  managed care organization with which a health care provider
  contracts to provide health care services to recipients enrolled in
  the organization's managed care plan to have direct, on-site access
  to the electronic visit verification system in use by the health
  care provider. (Gov. Code, Sec. 531.024172(f).)
         Sec. 532.0258.  HEALTH CARE PROVIDER: USE OF PROPRIETARY
  SYSTEM. (a) The commission may recognize a health care provider's
  proprietary electronic visit verification system, whether
  purchased or developed by the provider, as complying with this
  subchapter and allow the health care provider to use that system for
  a period the commission determines if the commission determines
  that the system:
               (1)  complies with all necessary data submission,
  exchange, and reporting requirements established under this
  subchapter; and
               (2)  meets all other standards and requirements
  established under this subchapter.
         (b)  If feasible, the executive commissioner shall ensure a
  health care provider is reimbursed for the use of the provider's
  proprietary electronic visit verification system the commission
  recognizes.
         (c)  For purposes of facilitating the use of proprietary
  electronic visit verification systems by health care providers and
  in consultation with industry stakeholders and the work group
  established under Section 532.0259, the commission or the executive
  commissioner, as appropriate, shall:
               (1)  develop an open model system that mitigates the
  administrative burdens providers required to use electronic visit
  verification identify;
               (2)  allow providers to use emerging technologies,
  including Internet-based, mobile telephone-based, and global
  positioning-based technologies, in the providers' proprietary
  electronic visit verification systems; and
               (3)  adopt rules governing data submission and provider
  reimbursement. (Gov. Code, Secs. 531.024172(g), (g-1), (g-2).)
         Sec. 532.0259.  STAKEHOLDER INPUT. The commission shall
  create a stakeholder work group composed of representatives of
  affected health care providers, Medicaid managed care
  organizations, and recipients. The commission shall periodically
  solicit from the work group input regarding the ongoing operation
  of the electronic visit verification system. (Gov. Code, Sec.
  531.024172(h).)
         Sec. 532.0260.  RULES. The executive commissioner may adopt
  rules necessary to implement this subchapter. (Gov. Code, Sec.
  531.024172(i).)
  SUBCHAPTER G. APPLICANTS AND RECIPIENTS
         Sec. 532.0301.  BILL OF RIGHTS AND BILL OF RESPONSIBILITIES.
  (a) The executive commissioner by rule shall adopt a bill of rights
  and a bill of responsibilities for each recipient.
         (b)  The bill of rights must address a recipient's right to:
               (1)  respect, dignity, privacy, confidentiality, and
  nondiscrimination;
               (2)  a reasonable opportunity to choose a health
  benefits plan and primary care provider and to change to another
  plan or provider in a reasonable manner;
               (3)  consent to or refuse treatment and actively
  participate in treatment decisions;
               (4)  ask questions and receive complete information
  relating to the recipient's medical condition and treatment
  options, including specialty care;
               (5)  access each available complaint process, receive a
  timely response to a complaint, and receive a fair hearing; and
               (6)  timely access to care that does not have any
  communication or physical access barriers.
         (c)  The bill of responsibilities must address a recipient's
  responsibility to:
               (1)  learn and understand each right the recipient has
  under Medicaid;
               (2)  abide by the health plan and Medicaid policies and
  procedures;
               (3)  share information relating to the recipient's
  health status with the primary care provider and become fully
  informed about service and treatment options; and
               (4)  actively participate in decisions relating to
  service and treatment options, make personal choices, and take
  action to maintain the recipient's health. (Gov. Code, Sec.
  531.0212.)
         Sec. 532.0302.  UNIFORM FAIR HEARING RULES. (a) The
  executive commissioner shall adopt uniform fair hearing rules for
  Medicaid-funded services.  The rules must provide:
               (1)  due process to a Medicaid applicant and to a
  recipient who seeks a Medicaid service, including a service that
  requires prior authorization; and
               (2)  the protections for applicants and recipients
  required by 42 C.F.R. Part 431, Subpart E, including requiring
  that:
                     (A)  the written notice to an individual of the
  individual's right to a hearing must:
                           (i)  contain an explanation of the
  circumstances under which Medicaid is continued if a hearing is
  requested; and
                           (ii)  be delivered by mail, and postmarked
  at least 10 business days, before the date the individual's
  Medicaid eligibility or service is scheduled to be terminated,
  suspended, or reduced, except as provided by 42 C.F.R. Section
  431.213 or 431.214; and
                     (B)  if a hearing is requested before the date a
  recipient's service, including a service that requires prior
  authorization, is scheduled to be terminated, suspended, or
  reduced, the agency may not take that proposed action before a
  decision is rendered after the hearing unless:
                           (i)  it is determined at the hearing that the
  sole issue is one of federal or state law or policy; and
                           (ii)  the agency promptly informs the
  recipient in writing that services are to be terminated, suspended,
  or reduced pending the hearing decision.
         (b)  The commission shall develop a process to address a
  situation in which:
               (1)  an individual does not receive adequate notice as
  required by Subsection (a)(2)(A); or
               (2)  the notice required by Subsection (a)(2)(A) is
  delivered without a postmark. (Gov. Code, Secs. 531.024(a) (part),
  (b), (c).)
         Sec. 532.0303.  SUPPORT AND INFORMATION SERVICES FOR
  RECIPIENTS. (a) The commission shall provide support and
  information services to a recipient or applicant for Medicaid who
  experiences barriers to receiving health care services. The
  commission shall give emphasis to assisting an individual with an
  urgent or immediate medical or support need.
         (b)  The commission shall provide the support and
  information services through a network of entities that are:
               (1)  coordinated by the commission's office of the
  ombudsman or other commission division the executive commissioner
  designates; and
               (2)  composed of:
                     (A)  the commission's office of the ombudsman or
  other commission division the executive commissioner designates to
  coordinate the network;
                     (B)  the office of the state long-term care
  ombudsman required under Subchapter F, Chapter 101A, Human
  Resources Code;
                     (C)  the commission division responsible for
  oversight of Medicaid managed care contracts;
                     (D)  area agencies on aging;
                     (E)  aging and disability resource centers
  established under the aging and disability resource center
  initiative funded in part by the Administration on Aging and the
  Centers for Medicare and Medicaid Services; and
                     (F)  any other entity the executive commissioner
  determines appropriate, including nonprofit organizations with
  which the commission contracts under Subsection (c).
         (c)  The commission may provide the support and information
  services by contracting with nonprofit organizations that are not
  involved in providing health care, health insurance, or health
  benefits.
         (d)  As a part of the support and information services, the
  commission shall:
               (1)  operate a statewide toll-free assistance
  telephone number that includes relay services for individuals with
  speech or hearing disabilities and assistance for individuals who
  speak Spanish;
               (2)  intervene promptly with the state Medicaid office,
  Medicaid managed care organizations and providers, and any other
  appropriate entity on behalf of an individual who has an urgent need
  for medical services;
               (3)  assist an individual who is experiencing barriers
  in the Medicaid application and enrollment process and refer the
  individual for further assistance if appropriate;
               (4)  educate individuals so that they:
                     (A)  understand the concept of managed care;
                     (B)  understand their rights under Medicaid,
  including grievance and appeal procedures; and
                     (C)  are able to advocate for themselves;
               (5)  collect and maintain statistical information on a
  regional basis regarding calls the assistance lines receive and
  publish quarterly reports that:
                     (A)  list the number of calls received by region;
                     (B)  identify trends in delivery and access
  problems;
                     (C)  identify recurring barriers in the Medicaid
  system; and
                     (D)  indicate other identified problems with
  Medicaid managed care;
               (6)  assist the state Medicaid office and Medicaid
  managed care organizations and providers in identifying and
  correcting problems, including site visits to affected regions if
  necessary;
               (7)  meet the needs of all current and future managed
  care recipients, including children receiving dental benefits and
  other recipients receiving benefits, under:
                     (A)  the STAR Medicaid managed care program;
                     (B)  the STAR+PLUS Medicaid managed care program,
  including the Texas Dual Eligible Integrated Care Demonstration
  Project provided under that program;
                     (C)  the STAR Kids managed care program
  established under Subchapter R, Chapter 540; and
                     (D)  the STAR Health program;
               (8)  incorporate support services for children
  enrolled in the child health plan program established under Chapter
  62, Health and Safety Code; and
               (9)  ensure that staff providing support and
  information services receive sufficient training, including
  training in the Medicare program for the purpose of assisting
  recipients who are dually eligible for Medicare and Medicaid, and
  have sufficient authority to resolve barriers experienced by
  recipients to health care and long-term services and supports.
         (e)  The commission's office of the ombudsman or other
  commission division the executive commissioner designates to
  coordinate the network of entities responsible for providing the
  support and information services must be sufficiently independent
  from other aspects of Medicaid managed care to represent the best
  interests of recipients in problem resolution. (Gov. Code, Sec.
  531.0213.)
         Sec. 532.0304.  NURSING SERVICES ASSESSMENTS. (a) In this
  section, "acute nursing services" means home health skilled nursing
  services, home health aide services, and private duty nursing
  services.
         (b)  If cost-effective, the commission shall develop an
  objective assessment process for use in assessing a recipient's
  need for acute nursing services. If the commission develops the
  objective assessment process, the commission shall require that:
               (1)  the assessment be conducted:
                     (A)  by a state employee or contractor who is a
  registered nurse licensed to practice in this state, and who is not:
                           (i)  the individual who will deliver any
  necessary services to the recipient; or
                           (ii)  affiliated with the person who will
  deliver those services; and
                     (B)  in a timely manner so as to protect the
  recipient's health and safety by avoiding unnecessary delays in
  service delivery; and
               (2)  the process include:
                     (A)  an assessment of specified criteria and
  documentation of the assessment results on a standard form;
                     (B)  an assessment of whether the recipient should
  be referred for additional assessments regarding the recipient's
  need for therapy services, as described by Section 532.0305,
  attendant care services, and durable medical equipment; and
                     (C)  completion by the individual conducting the
  assessment of any documents related to obtaining prior
  authorization for necessary nursing services.
         (c)  If the commission develops the objective assessment
  process under Subsection (b), the commission shall:
               (1)  implement the process within the Medicaid
  fee-for-service model and the primary care case management Medicaid
  managed care model; and
               (2)  take necessary actions, including modifying
  contracts with Medicaid managed care organizations to the extent
  allowed by law, to implement the process within the STAR and
  STAR+PLUS Medicaid managed care programs.
         (d)  Unless the commission determines that the assessment is
  feasible and beneficial, an assessment under Subsection (b)(2)(B)
  of whether a recipient should be referred for additional therapy
  services assessments shall be waived if the recipient's need for
  therapy services has been established by a recommendation from a
  therapist providing care before the recipient is discharged from a
  licensed hospital or nursing facility. The assessment may not be
  waived if the recommendation is made by a therapist who:
               (1)  will deliver any services to the recipient; or
               (2)  is affiliated with a person who will deliver those
  services after the recipient is discharged from the licensed
  hospital or nursing facility.
         (e)  The executive commissioner shall adopt rules providing
  for a process by which a provider of acute nursing services who
  disagrees with the results of the assessment conducted under
  Subsection (b) may request and obtain a review of those results.
  (Gov. Code, Sec. 531.02417.)
         Sec. 532.0305.  THERAPY SERVICES ASSESSMENTS. (a) In this
  section, "therapy services" includes occupational, physical, and
  speech therapy services.
         (b)  After implementing the objective assessment process for
  acute nursing services in accordance with Section 532.0304, the
  commission shall consider whether implementing age- and
  diagnosis-appropriate objective assessment processes for use in
  assessing a recipient's need for therapy services would be feasible
  and beneficial.
         (c)  If the commission determines that implementing age- and
  diagnosis-appropriate processes with respect to one or more types
  of therapy services is feasible and would be beneficial, the
  commission may implement the processes within:
               (1)  the Medicaid fee-for-service model;
               (2)  the primary care case management Medicaid managed
  care model; and
               (3)  the STAR and STAR+PLUS Medicaid managed care
  programs.
         (d)  An objective assessment process implemented under this
  section must include a process that allows a therapy services
  provider to request and obtain a review of the results of an
  assessment conducted as provided by this section. The review
  process must be comparable to the review process implemented under
  Section 532.0304(e). (Gov. Code, Sec. 531.024171.)
         Sec. 532.0306.  WELLNESS SCREENING PROGRAM. If
  cost-effective, the commission may implement a wellness screening
  program for recipients that is designed to evaluate a recipient's
  risk for having certain diseases and medical conditions to
  establish:
               (1)  a health baseline for each recipient that may be
  used to tailor the recipient's treatment plan; or
               (2)  the recipient's health goals. (Gov. Code, Sec.
  531.0981.)
         Sec. 532.0307.  FEDERALLY QUALIFIED HEALTH CENTER AND RURAL
  HEALTH CLINIC SERVICES. (a) In this section:
               (1)  "Federally qualified health center services" has
  the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(A).
               (2)  "Rural health clinic services" has the meaning
  assigned by 42 U.S.C. Section 1396d(l)(1).
         (b)  Notwithstanding any provision of this chapter, Chapter
  32, Human Resources Code, or any other law, the commission shall:
               (1)  promote recipient access to federally qualified
  health center services or rural health clinic services; and
               (2)  ensure that payment for federally qualified health
  center services or rural health clinic services is in accordance
  with 42 U.S.C. Section 1396a(bb).  (Gov. Code, Sec. 531.02192(a)
  (part), (b).)
  SUBCHAPTER H. PROGRAMS AND SERVICES FOR CERTAIN CATEGORIES OF
  MEDICAID POPULATION
         Sec. 532.0351.  TAILORED BENEFIT PACKAGES FOR CERTAIN
  CATEGORIES OF MEDICAID POPULATION. (a) The executive commissioner
  may seek a waiver under Section 1115 of the Social Security Act (42
  U.S.C. Section 1315) to develop and, subject to Subsection (c),
  implement tailored benefit packages designed to:
               (1)  provide Medicaid benefits that are customized to
  meet the health care needs of recipients within defined categories
  of the Medicaid population through a defined system of care;
               (2)  improve health outcomes and access to services for
  those recipients;
               (3)  achieve cost containment and efficiency; and
               (4)  reduce the administrative complexity of
  delivering Medicaid benefits.
         (b)  The commission:
               (1)  shall develop a tailored benefit package that is
  customized to meet the health care needs of recipients who are
  children with special health care needs, subject to approval of the
  waiver described by Subsection (a); and
               (2)  may develop tailored benefit packages that are
  customized to meet the health care needs of other categories of
  recipients.
         (c)  If the commission develops tailored benefit packages
  under Subsection (b)(2), the commission shall submit to the
  standing committees of the senate and house of representatives
  having primary jurisdiction over Medicaid a report that specifies
  in detail the categories of recipients to which each of those
  packages will apply and the services available under each package.
         (d)  Except as otherwise provided by this section and subject
  to the terms of the waiver authorized by this section, the
  commission has broad discretion to develop the tailored benefit
  packages and determine the respective categories of recipients to
  which the packages apply in a manner that preserves recipients'
  access to necessary services and is consistent with federal
  requirements.  In developing the tailored benefit packages, the
  commission shall consider similar benefit packages established in
  other states as a guide.
         (e)  Each tailored benefit package must include:
               (1)  a basic set of benefits that are provided under all
  tailored benefit packages;
               (2)  to the extent applicable to the category of
  recipients to which the package applies:
                     (A)  a set of benefits customized to meet the
  health care needs of recipients in that category; and
                     (B)  services to integrate the management of a
  recipient's acute and long-term care needs, to the extent feasible;
  and
               (3)  if the package applies to recipients who are
  children, at least the services required by federal law under the
  early and periodic screening, diagnosis, and treatment program.
         (f)  A tailored benefit package may include any service
  available under the state Medicaid plan or under any federal
  Medicaid waiver, including any preventive health or wellness
  service.
         (g)  A tailored benefit package must increase this state's
  flexibility with respect to the state's use of Medicaid funding and
  may not reduce the benefits available under the Medicaid state plan
  to any recipient population.
         (h)  The executive commissioner by rule shall define each
  category of recipients to which a tailored benefit package applies
  and a mechanism for appropriately placing recipients in specific
  categories. Recipient categories must include children with
  special health care needs and may include:
               (1)  individuals with disabilities or special health
  care needs;
               (2)  elderly individuals;
               (3)  children without special health care needs; and
               (4)  working-age parents and caretaker relatives.
  (Gov. Code, Sec. 531.097.)
         Sec. 532.0352.  WAIVER PROGRAM FOR CERTAIN INDIVIDUALS WITH
  CHRONIC HEALTH CONDITIONS. (a) If feasible and cost-effective,
  the commission may apply for a waiver from the Centers for Medicare
  and Medicaid Services or another appropriate federal agency to more
  efficiently leverage the use of state and local funds to maximize
  the receipt of federal Medicaid matching funds by providing
  Medicaid benefits to individuals who:
               (1)  meet established income and other eligibility
  criteria; and
               (2)  are eligible to receive services through the
  county for chronic health conditions.
         (b)  In establishing the waiver program, the commission
  shall:
               (1)  ensure that this state is a prudent purchaser of
  the health care services that are needed for the individuals
  described by Subsection (a);
               (2)  solicit broad-based input from interested
  persons;
               (3)  ensure that the benefits an individual receives
  through the county are not reduced once the individual is enrolled
  in the waiver program; and
               (4)  employ the use of intergovernmental transfers and
  other procedures to maximize the receipt of federal Medicaid
  matching funds. (Gov. Code, Sec. 531.0226.)
         Sec. 532.0353.  BUY-IN PROGRAMS FOR CERTAIN INDIVIDUALS WITH
  DISABILITIES. (a) The executive commissioner shall develop and
  implement:
               (1)  a Medicaid buy-in program for individuals with
  disabilities as authorized by the Ticket to Work and Work
  Incentives Improvement Act of 1999 (Pub. L. No. 106-170) or the
  Balanced Budget Act of 1997 (Pub. L. No. 105-33); and
               (2)  a Medicaid buy-in program for children with
  disabilities described by 42 U.S.C. Section 1396a(cc)(1) whose
  family incomes do not exceed 300 percent of the applicable federal
  poverty level, as authorized by the Deficit Reduction Act of 2005
  (Pub. L. No. 109-171).
         (b)  The executive commissioner shall adopt rules in
  accordance with federal law that provide for:
               (1)  eligibility requirements for each program
  described by Subsection (a); and
               (2)  requirements for program participants to pay
  premiums or cost-sharing payments, subject to Subsection (c).
         (c)  Rules the executive commissioner adopts under
  Subsection (b) with respect to the program for children with
  disabilities described by Subsection (a)(2) must require a
  participant to pay monthly premiums according to a sliding scale
  that is based on family income, subject to the requirements of 42
  U.S.C. Sections 1396o(i)(2) and (3). (Gov. Code, Sec. 531.02444.)
  SUBCHAPTER I. UTILIZATION REVIEW, PRIOR AUTHORIZATION, AND
  COVERAGE PROCESSES AND DETERMINATIONS
         Sec. 532.0401.  REVIEW OF PRIOR AUTHORIZATION AND
  UTILIZATION REVIEW PROCESSES. The commission shall:
               (1)  in accordance with an established schedule,
  periodically review the prior authorization and utilization review
  processes within the Medicaid fee-for-service delivery model to
  determine whether those processes need modification to reduce
  authorizations of unnecessary services and inappropriate use of
  services;
               (2)  monitor the prior authorization and utilization
  review processes within the Medicaid fee-for-service delivery
  model for anomalies and, on identification of an anomaly in a
  process, review the process for modification earlier than
  scheduled; and
               (3)  monitor Medicaid managed care organizations to
  ensure that the organizations are using prior authorization and
  utilization review processes to reduce authorizations of
  unnecessary services and inappropriate use of services. (Gov. Code,
  Sec. 531.076.)
         Sec. 532.0402.  ACCESSIBILITY OF INFORMATION REGARDING
  PRIOR AUTHORIZATION REQUIREMENTS. (a) The executive commissioner
  by rule shall require each Medicaid managed care organization or
  other entity responsible for authorizing coverage for health care
  services under Medicaid to ensure that the organization or entity
  maintains on the organization's or entity's Internet website in an
  easily searchable and accessible format:
               (1)  the applicable timelines for prior authorization
  requirements, including:
                     (A)  the time within which the organization or
  entity must make a determination on a prior authorization request;
                     (B)  a description of the notice the organization
  or entity provides to a provider and recipient on whose behalf the
  request was submitted regarding the documentation required to
  complete a determination on a prior authorization request; and
                     (C)  the deadline by which the organization or
  entity is required to submit the notice described by Paragraph (B);
  and
               (2)  an accurate and current catalog of coverage
  criteria and prior authorization requirements, including:
                     (A)  for a prior authorization requirement first
  imposed on or after September 1, 2019, the effective date of the
  requirement;
                     (B)  a list or description of any supporting or
  other documentation necessary to obtain prior authorization for a
  specified service; and
                     (C)  the date and results of each review of a prior
  authorization requirement conducted under Section 540.0304, if
  applicable.
         (b)  The executive commissioner by rule shall require each
  Medicaid managed care organization or other entity responsible for
  authorizing coverage for health care services under Medicaid to:
               (1)  adopt and maintain a process for a provider or
  recipient to contact the organization or entity to clarify prior
  authorization requirements or to assist the provider in submitting
  a prior authorization request; and
               (2)  ensure that the process described by Subdivision
  (1) is not arduous or overly burdensome to a provider or recipient.
  (Gov. Code, Sec. 531.024163.)
         Sec. 532.0403.  NOTICE REQUIREMENTS REGARDING COVERAGE OR
  PRIOR AUTHORIZATION DENIAL AND INCOMPLETE REQUESTS. (a) The
  commission shall ensure that a notice the commission or a Medicaid
  managed care organization sends to a recipient or Medicaid provider
  regarding the denial, partial denial, reduction, or termination of
  coverage or denial of prior authorization for a service includes:
               (1)  information required by federal and state law and
  regulations;
               (2)  for the recipient:
                     (A)  a clear and easy-to-understand explanation
  of the reason for the decision, including a clear explanation of the
  medical basis, applying the policy or accepted standard of medical
  practice to the recipient's particular medical circumstances;
                     (B)  a copy of the information the commission or
  organization sent to the provider; and
                     (C)  an educational component that includes:
                           (i)  a description of the recipient's
  rights;
                           (ii)  an explanation of the process related
  to appeals and Medicaid fair hearings; and
                           (iii)  a description of the role of an
  external medical review; and
               (3)  for the provider, a thorough and detailed clinical
  explanation of the reason for the decision, including, as
  applicable, information required under Subsection (b).
         (b)  The commission or a Medicaid managed care organization
  that receives from a provider a coverage or prior authorization
  request that contains insufficient or inadequate documentation to
  approve the request shall issue a notice to the provider and the
  recipient on whose behalf the request was submitted.  The notice
  must:
               (1)  include a section specifically for the provider
  that contains:
                     (A)  a clear and specific list and description of
  the documentation necessary for the commission or organization to
  make a final determination on the request;
                     (B)  the applicable timeline, based on the
  requested service, for the provider to submit the documentation and
  a description of the reconsideration process described by Section
  540.0306, if applicable; and
                     (C)  information on the manner through which a
  provider may contact a Medicaid managed care organization or other
  entity as required by Section 532.0402; and
               (2)  be sent:
                     (A)  to the provider:
                           (i)  using the provider's preferred method
  of communication, to the extent practicable using existing
  resources; and
                           (ii)  as applicable, through an electronic
  notification on an Internet portal; and
                     (B)  to the recipient using the recipient's
  preferred method of communication, to the extent practicable using
  existing resources. (Gov. Code, Sec. 531.024162.)
         Sec. 532.0404.  EXTERNAL MEDICAL REVIEW. (a) In this
  section, "external medical reviewer" means a third-party medical
  review organization that provides objective, unbiased medical
  necessity determinations conducted by clinical staff with
  education and practice in the same or similar practice area as the
  procedure for which an independent determination of medical
  necessity is sought in accordance with state law and rules.
         (b)  The commission shall contract with an independent
  external medical reviewer to conduct external medical reviews and
  review:
               (1)  the resolution of a recipient appeal related to a
  reduction in or denial of services on the basis of medical necessity
  in the Medicaid managed care program; or
               (2)  the commission's denial of eligibility for a
  Medicaid program in which eligibility is based on a recipient's
  medical and functional needs.
         (c)  A Medicaid managed care organization may not have a
  financial relationship with or ownership interest in the external
  medical reviewer with which the commission contracts.
         (d)  The external medical reviewer with which the commission
  contracts must:
               (1)  be overseen by a medical director who is a
  physician licensed in this state; and
               (2)  employ or be able to consult with staff with
  experience in providing private duty nursing services and long-term
  services and supports.
         (e)  The commission shall establish:
               (1)  a common procedure for external medical reviews
  that:
                     (A)  to the greatest extent possible, reduces:
                           (i)  administrative burdens on providers;
  and
                           (ii)  the submission of duplicative
  information or documents; and
                     (B)  bases a medical necessity determination on
  clinical criteria that is:
                           (i)  publicly available;
                           (ii)  current;
                           (iii)  evidence-based; and
                           (iv)  peer-reviewed; and
               (2)  a procedure and time frame for expedited reviews
  that allow the external medical reviewer to:
                     (A)  identify an appeal that requires an expedited
  resolution; and
                     (B)  resolve the review of the appeal within a
  specified period.
         (f)  The external medical reviewer shall conduct an external
  medical review within a period the commission specifies.
         (g)  A recipient or Medicaid applicant, or the recipient's or
  applicant's parent or legally authorized representative, must
  affirmatively request an external medical review. If requested:
               (1)  an external medical review described by Subsection
  (b)(1):
                     (A)  occurs after the internal Medicaid managed
  care organization appeal and before the Medicaid fair hearing; and
                     (B)  is granted when a recipient contests the
  internal appeal decision of the Medicaid managed care organization;
  and
               (2)  an external medical review described by Subsection
  (b)(2) occurs after the eligibility denial and before the Medicaid
  fair hearing.
         (h)  The external medical reviewer's determination of
  medical necessity establishes the minimum level of services a
  recipient must receive, except that the level of services may not
  exceed the level identified as medically necessary by the ordering
  health care provider.
         (i)  The external medical reviewer shall require a Medicaid
  managed care organization, in an external medical review relating
  to a reduction in services, to submit a detailed reason for the
  reduction and supporting documents.
         (j)  To the extent money is appropriated for this purpose,
  the commission shall publish data regarding prior authorizations
  the external medical reviewer reviewed, including the rate of prior
  authorization denials the external medical reviewer overturned and
  additional information the commission and the external medical
  reviewer determine appropriate. (Gov. Code, Sec. 531.024164.)
  SUBCHAPTER J. COST-SAVING INITIATIVES
         Sec. 532.0451.  HOSPITAL EMERGENCY ROOM USE REDUCTION
  INITIATIVES. (a)  The commission shall develop and implement a
  comprehensive plan to reduce recipients' use of hospital emergency
  room services. The plan may include:
               (1)  a pilot program that is designed to assist a
  program participant in accessing an appropriate level of health
  care and that may include as components:
                     (A)  providing a program participant access to
  bilingual health services providers; and
                     (B)  giving a program participant information on
  how to access primary care physicians, advanced practice registered
  nurses, and local health clinics;
               (2)  a pilot program under which a health care provider
  other than a hospital is given a financial incentive for treating a
  recipient outside of normal business hours to divert the recipient
  from a hospital emergency room;
               (3)  payment of a nominal referral fee to a hospital
  emergency room that performs an initial medical evaluation of a
  recipient and subsequently refers the recipient, if medically
  stable, to an appropriate level of health care, such as care
  provided by a primary care physician, advanced practice registered
  nurse, or local clinic;
               (4)  a program under which the commission or a Medicaid
  managed care organization contacts, by telephone or mail, a
  recipient who accesses a hospital emergency room three times during
  a six-month period and provides the recipient with information on
  ways the recipient may secure a medical home to avoid unnecessary
  treatment at a hospital emergency room;
               (5)  a health care literacy program under which the
  commission develops partnerships with other state agencies and
  private entities to:
                     (A)  assist the commission in developing
  materials that:
                           (i)  contain basic health care information
  for parents of young children who are recipients and who are
  participating in public or private child-care or prekindergarten
  programs, including federal Head Start programs; and
                           (ii)  are written in a language
  understandable to those parents and specifically tailored to be
  applicable to the needs of those parents;
                     (B)  distribute the materials developed under
  Paragraph (A) to those parents; and
                     (C)  otherwise teach those parents about their
  children's health care needs and ways to address those needs; and
               (6)  other initiatives developed and implemented in
  other states that have shown success in reducing the incidence of
  unnecessary treatment in a hospital emergency room.
         (b)  The commission shall coordinate with hospitals and
  other providers that receive supplemental payments under the
  uncompensated care payment program operated under the Texas Health
  Care Transformation and Quality Improvement Program waiver issued
  under Section 1115 of the Social Security Act (42 U.S.C. Section
  1315) to identify and implement initiatives based on best practices
  and models that are designed to reduce recipients' use of hospital
  emergency room services as a primary means of receiving health care
  benefits, including initiatives designed to improve recipients'
  access to and use of primary care providers. (Gov. Code, Sec.
  531.085.)
         Sec. 532.0452.  PHYSICIAN INCENTIVE PROGRAM TO REDUCE
  HOSPITAL EMERGENCY ROOM USE FOR NON-EMERGENT CONDITIONS. (a) If
  cost-effective, the executive commissioner by rule shall establish
  a physician incentive program designed to reduce recipients' use of
  hospital emergency room services for non-emergent conditions.
         (b)  In establishing the physician incentive program, the
  executive commissioner may include only the program components
  identified as cost-effective in the study conducted under former
  Section 531.086 before that section expired September 1, 2014.
         (c)  If the physician incentive program includes the payment
  of an enhanced reimbursement rate for routine after-hours
  appointments, the executive commissioner shall implement controls
  to ensure that the after-hours services billed are actually
  provided outside of normal business hours. (Gov. Code, Sec.
  531.0861.)
         Sec. 532.0453.  CONTINUED IMPLEMENTATION OF CERTAIN
  INTERVENTIONS AND BEST PRACTICES BY PROVIDERS; SEMIANNUAL REPORT.
  (a) The commission shall encourage Medicaid providers to continue
  implementing effective interventions and best practices associated
  with improvements in the health outcomes of recipients that were
  developed and achieved under the Delivery System Reform Incentive
  Payment (DSRIP) program previously operated under the Texas Health
  Care Transformation and Quality Improvement Program waiver issued
  under Section 1115 of the Social Security Act (42 U.S.C. Section
  1315), through:
               (1)  existing provider incentive programs and the
  creation of new provider incentive programs;
               (2)  the terms included in contracts with Medicaid
  managed care organizations;
               (3)  implementation of alternative payment models; or
               (4)  adoption of other cost-effective measures.
         (b)  The commission shall semiannually prepare and submit to
  the legislature a report that contains a summary of the
  commission's efforts under this section and Section 532.0451(b).
  (Gov. Code, Sec. 531.0862.)
         Sec. 532.0454.  HEALTH SAVINGS ACCOUNT PILOT PROGRAM. (a)
  If the commission determines that it is cost-effective and
  feasible, the commission shall develop and implement a Medicaid
  health savings account pilot program that is consistent with
  federal law to:
               (1)  encourage adult recipients' health care cost
  awareness and sensitivity; and
               (2)  promote adult recipients' appropriate use of
  Medicaid services.
         (b)  If the commission implements the pilot program, the
  commission:
               (1)  may include only adult recipients as program
  participants; and
               (2)  shall ensure that:
                     (A)  participation in the pilot program is
  voluntary; and
                     (B)  a recipient who participates in the pilot
  program may, at the recipient's option and subject to Subsection
  (c), discontinue participating and resume receiving benefits and
  services under the traditional Medicaid delivery model.
         (c)  A recipient who chooses to discontinue participating in
  the pilot program and resume receiving benefits and services under
  the traditional Medicaid delivery model before completion of the
  health savings account enrollment period forfeits any funds
  remaining in the recipient's health savings account. (Gov. Code,
  Sec. 531.0941.)
         Sec. 532.0455.  DURABLE MEDICAL EQUIPMENT REUSE PROGRAM.
  (a) In this section:
               (1)  "Complex rehabilitation technology equipment":
                     (A)  means equipment that is:
                           (i)  classified as durable medical equipment
  under the Medicare program on January 1, 2013;
                           (ii)  configured specifically for an
  individual to meet the individual's unique medical, physical, and
  functional needs and capabilities for basic and instrumental daily
  living activities; and
                           (iii)  medically necessary to prevent the
  individual's hospitalization or institutionalization; and
                     (B)  includes a complex rehabilitation power
  wheelchair, highly configurable manual wheelchair, adaptive
  seating and positioning system, standing frame, and gait trainer.
               (2)  "Durable medical equipment" means equipment,
  including repair and replacement parts for the equipment, but
  excluding complex rehabilitation technology equipment, that:
                     (A)  can withstand repeated use;
                     (B)  is primarily and customarily used to serve a
  medical purpose;
                     (C)  generally is not useful to an individual in
  the absence of illness or injury; and
                     (D)  is appropriate and safe for use in the home.
         (b)  If the commission determines that it is cost-effective,
  the executive commissioner by rule shall establish a program to
  facilitate the reuse of durable medical equipment provided to
  recipients.
         (c)  The program must include provisions for ensuring that:
               (1)  reused equipment meets applicable standards of
  functionality and sanitation; and
               (2)  a recipient's participation in the reuse program
  is voluntary.
         (d)  The program does not:
               (1)  waive any immunity from liability of the
  commission or a commission employee; or
               (2)  create a cause of action against the commission or
  a commission employee arising from the provision of reused durable
  medical equipment under the program. (Gov. Code, Secs. 531.0843(a), (b), (c), (d).)
 
  CHAPTER 540. MEDICAID MANAGED CARE PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 540.0001.  DEFINITIONS
  SUBCHAPTER B. ADMINISTRATION OF MEDICAID MANAGED CARE PROGRAM
  Sec. 540.0051.  PURPOSE AND IMPLEMENTATION
  Sec. 540.0052.  RECIPIENT DIRECTORY
  Sec. 540.0053.  STATEWIDE EFFORT TO PROMOTE MEDICAID
                   ELIGIBILITY MAINTENANCE
  Sec. 540.0054.  PROVIDER AND RECIPIENT EDUCATION
                   PROGRAMS
  Sec. 540.0055.  MARKETING GUIDELINES
  Sec. 540.0056.  GUIDELINES FOR COMMUNICATIONS WITH
                   RECIPIENTS
  Sec. 540.0057.  COORDINATION OF EXTERNAL OVERSIGHT
                   ACTIVITIES
  Sec. 540.0058.  INFORMATION FOR FRAUD CONTROL
  Sec. 540.0059.  MANAGED CARE CLINICAL IMPROVEMENT
                   PROGRAM
  Sec. 540.0060.  COMPLAINT SYSTEM GUIDELINES
  SUBCHAPTER C. FISCAL PROVISIONS
  Sec. 540.0101.  FISCAL SOLVENCY STANDARDS
  Sec. 540.0102.  PROFIT SHARING
  Sec. 540.0103.  TREATMENT OF STATE TAXES IN CALCULATING
                   EXPERIENCE REBATE OR PROFIT SHARING
  SUBCHAPTER D. STRATEGY FOR MANAGING AUDIT RESOURCES
  Sec. 540.0151.  DEFINITIONS
  Sec. 540.0152.  APPLICABILITY AND CONSTRUCTION OF
                   SUBCHAPTER
  Sec. 540.0153.  OVERALL STRATEGY FOR MANAGING AUDIT
                   RESOURCES
  Sec. 540.0154.  PERFORMANCE AUDIT SELECTION PROCESS AND
                   FOLLOW-UP
  Sec. 540.0155.  AGREED-UPON PROCEDURES ENGAGEMENTS AND
                   CORRECTIVE ACTION PLANS
  Sec. 540.0156.  AUDITS OF PHARMACY BENEFIT MANAGERS
  Sec. 540.0157.  COLLECTING COSTS FOR AUDIT-RELATED
                   SERVICES
  Sec. 540.0158.  COLLECTION ACTIVITIES RELATED TO PROFIT
                   SHARING
  Sec. 540.0159.  USING INFORMATION FROM EXTERNAL QUALITY
                   REVIEWS
  Sec. 540.0160.  SECURITY OF AND PROCESSING CONTROLS
                   OVER INFORMATION TECHNOLOGY SYSTEMS
  SUBCHAPTER E.  CONTRACT ADMINISTRATION
  Sec. 540.0201.  CONTRACT ADMINISTRATION IMPROVEMENT
                   EFFORTS
  Sec. 540.0202.  PUBLIC NOTICE OF REQUEST FOR CONTRACT
                   APPLICATIONS
  Sec. 540.0203.  CERTIFICATION BY COMMISSION
  Sec. 540.0204.  CONTRACT CONSIDERATIONS RELATING TO
                   MANAGED CARE ORGANIZATIONS
  Sec. 540.0205.  CONTRACT CONSIDERATIONS RELATING TO
                   PHARMACY BENEFIT MANAGERS
  Sec. 540.0206.  MANDATORY CONTRACTS
  Sec. 540.0207.  CONTRACTUAL OBLIGATIONS REVIEW
  Sec. 540.0208.  CONTRACT IMPLEMENTATION PLAN
  Sec. 540.0209.  COMPLIANCE AND READINESS REVIEW
  Sec. 540.0210.  INTERNET POSTING OF SANCTIONS IMPOSED
                   FOR CONTRACTUAL VIOLATIONS
  Sec. 540.0211.  PERFORMANCE MEASURES AND INCENTIVES FOR
                   VALUE-BASED CONTRACTS
  Sec. 540.0212.  MONITORING COMPLIANCE WITH BEHAVIORAL
                   HEALTH INTEGRATION
  SUBCHAPTER F. REQUIRED CONTRACT PROVISIONS
  Sec. 540.0251.  APPLICABILITY
  Sec. 540.0252.  ACCOUNTABILITY TO STATE
  Sec. 540.0253.  CAPITATION RATES
  Sec. 540.0254.  COST INFORMATION
  Sec. 540.0255.  FRAUD CONTROL
  Sec. 540.0256.  RECIPIENT OUTREACH AND EDUCATION
  Sec. 540.0257.  NOTICE OF MEDICAID CERTIFICATION DATE
  Sec. 540.0258.  PRIMARY CARE PROVIDER ASSIGNMENT
  Sec. 540.0259.  COMPLIANCE WITH PROVIDER NETWORK
                   REQUIREMENTS
  Sec. 540.0260.  COMPLIANCE WITH PROVIDER ACCESS
                   STANDARDS; REPORT
  Sec. 540.0261.  PROVIDER NETWORK SUFFICIENCY
  Sec. 540.0262.  QUALITY MONITORING PROGRAM FOR HEALTH
                   CARE SERVICES
  Sec. 540.0263.  OUT-OF-NETWORK PROVIDER USAGE AND
                   REIMBURSEMENT
  Sec. 540.0264.  PROVIDER REIMBURSEMENT RATE REDUCTION
  Sec. 540.0265.  PROMPT PAYMENT OF CLAIMS
  Sec. 540.0266.  REIMBURSEMENT FOR CERTAIN SERVICES
                   PROVIDED OUTSIDE REGULAR BUSINESS
                   HOURS
  Sec. 540.0267.  PROVIDER APPEALS PROCESS
  Sec. 540.0268.  ASSISTANCE RESOLVING RECIPIENT AND
                   PROVIDER ISSUES
  Sec. 540.0269.  USE OF ADVANCED PRACTICE REGISTERED
                   NURSES AND PHYSICIAN ASSISTANTS
  Sec. 540.0270.  MEDICAL DIRECTOR AVAILABILITY
  Sec. 540.0271.  PERSONNEL REQUIRED IN CERTAIN SERVICE
                   REGIONS
  Sec. 540.0272.  CERTAIN SERVICES PERMITTED IN LIEU OF
                   OTHER MENTAL HEALTH OR SUBSTANCE USE
                   DISORDER SERVICES; ANNUAL REPORT
  Sec. 540.0273.  OUTPATIENT PHARMACY BENEFIT PLAN
  Sec. 540.0274.  PHARMACY BENEFIT PLAN: REBATES AND
                   RECEIPT OF CONFIDENTIAL INFORMATION
                   PROHIBITED
  Sec. 540.0275.  PHARMACY BENEFIT PLAN: CERTAIN PHARMACY
                   BENEFITS FOR SEX OFFENDERS PROHIBITED
  Sec. 540.0276.  PHARMACY BENEFIT PLAN: RECIPIENT
                   SELECTION OF PHARMACEUTICAL SERVICES
                   PROVIDER
  Sec. 540.0277.  PHARMACY BENEFIT PLAN: PHARMACY BENEFIT
                   PROVIDERS
  Sec. 540.0278.  PHARMACY BENEFIT PLAN: PROMPT PAYMENT
                   OF PHARMACY BENEFIT CLAIMS
  Sec. 540.0279.  PHARMACY BENEFIT PLAN: MAXIMUM
                   ALLOWABLE COST PRICE AND LIST FOR
                   PHARMACY BENEFITS
  Sec. 540.0280.  PHARMACY BENEFIT PLAN: PHARMACY
                   BENEFITS FOR CHILD ENROLLED IN STAR
                   KIDS MANAGED CARE PROGRAM
  SUBCHAPTER G. PRIOR AUTHORIZATION AND UTILIZATION REVIEW
  PROCEDURES
  Sec. 540.0301.  INAPPLICABILITY OF CERTAIN OTHER LAW TO
                   MEDICAID MANAGED CARE UTILIZATION
                   REVIEWS
  Sec. 540.0302.  PRIOR AUTHORIZATION PROCEDURES FOR
                   HOSPITALIZED RECIPIENT
  Sec. 540.0303.  PRIOR AUTHORIZATION PROCEDURES FOR
                   NONHOSPITALIZED RECIPIENT
  Sec. 540.0304.  ANNUAL REVIEW OF PRIOR AUTHORIZATION
                   REQUIREMENTS
  Sec. 540.0305.  PHYSICIAN CONSULTATION BEFORE ADVERSE
                   PRIOR AUTHORIZATION DETERMINATION
  Sec. 540.0306.  RECONSIDERATION FOLLOWING ADVERSE
                   DETERMINATIONS ON CERTAIN PRIOR
                   AUTHORIZATION REQUESTS
  Sec. 540.0307.  MAXIMUM PERIOD FOR PRIOR AUTHORIZATION
                   DECISION; ACCESS TO CARE
  SUBCHAPTER H. PREMIUM PAYMENT RATES
  Sec. 540.0351.  PREMIUM PAYMENT RATE DETERMINATION
  Sec. 540.0352.  MAXIMUM PREMIUM PAYMENT RATES FOR
                   CERTAIN PROGRAMS
  Sec. 540.0353.  USE OF ENCOUNTER DATA IN DETERMINING
                   PREMIUM PAYMENT RATES AND OTHER
                   PAYMENT AMOUNTS
  SUBCHAPTER I. ENCOUNTER DATA
  Sec. 540.0401.  PROVIDER REPORTING OF ENCOUNTER DATA
  Sec. 540.0402.  CERTIFIER OF ENCOUNTER DATA
                   QUALIFICATIONS
  Sec. 540.0403.  ENCOUNTER DATA CERTIFICATION
  SUBCHAPTER J. MANAGED CARE PLAN REQUIREMENTS
  Sec. 540.0451.  MEDICAID MANAGED CARE PLAN
                   ACCREDITATION
  Sec. 540.0452.  MEDICAL DIRECTOR QUALIFICATIONS
  SUBCHAPTER K. MEDICAID MANAGED CARE PLAN ENROLLMENT AND
  DISENROLLMENT
  Sec. 540.0501.  RECIPIENT ENROLLMENT IN AND
                   DISENROLLMENT FROM MEDICAID MANAGED
                   CARE PLAN
  Sec. 540.0502.  AUTOMATIC ENROLLMENT IN MEDICAID
                   MANAGED CARE PLAN
  Sec. 540.0503.  ENROLLMENT OF CERTAIN RECIPIENTS IN
                   SAME MEDICAID MANAGED CARE PLAN
  Sec. 540.0504.  QUALITY-BASED ENROLLMENT INCENTIVE
                   PROGRAM FOR MEDICAID MANAGED CARE
                   ORGANIZATIONS
  Sec. 540.0505.  LIMITATIONS ON RECIPIENT DISENROLLMENT
                   FROM MEDICAID MANAGED CARE PLAN
  SUBCHAPTER L. CONTINUITY OF CARE AND COORDINATION OF BENEFITS
  Sec. 540.0551.  GUIDANCE REGARDING CONTINUATION OF
                   SERVICES UNDER CERTAIN CIRCUMSTANCES
  Sec. 540.0552.  COORDINATION OF BENEFITS; CONTINUITY OF
                   SPECIALTY CARE FOR CERTAIN RECIPIENTS
  SUBCHAPTER M. PROVIDER NETWORK ADEQUACY
  Sec. 540.0601.  MONITORING OF PROVIDER NETWORKS
  Sec. 540.0602.  REPORT ON OUT-OF-NETWORK PROVIDER
                   SERVICES
  Sec. 540.0603.  REPORT ON COMMISSION INVESTIGATION OF
                   PROVIDER COMPLAINT
  Sec. 540.0604.  ADDITIONAL REIMBURSEMENT FOLLOWING
                   PROVIDER COMPLAINT
  Sec. 540.0605.  CORRECTIVE ACTION PLAN FOR INADEQUATE
                   NETWORK AND PROVIDER REIMBURSEMENT
  Sec. 540.0606.  REMEDIES FOR NONCOMPLIANCE WITH
                   CORRECTIVE ACTION PLAN
  SUBCHAPTER N. PROVIDERS
  Sec. 540.0651.  INCLUSION OF CERTAIN PROVIDERS IN
                   MEDICAID MANAGED CARE ORGANIZATION
                   PROVIDER NETWORK
  Sec. 540.0652.  PROVIDER ACCESS STANDARDS; BIENNIAL
                   REPORT
  Sec. 540.0653.  PENALTIES AND OTHER REMEDIES FOR
                   FAILURE TO COMPLY WITH PROVIDER
                   ACCESS STANDARDS
  Sec. 540.0654.  PROVIDER NETWORK DIRECTORIES
  Sec. 540.0655.  PROVIDER PROTECTION PLAN
  Sec. 540.0656.  EXPEDITED CREDENTIALING PROCESS FOR
                   CERTAIN PROVIDERS
  Sec. 540.0657.  FREQUENCY OF PROVIDER RECREDENTIALING
  Sec. 540.0658.  PROVIDER INCENTIVES FOR PROMOTING
                   PREVENTIVE SERVICES
  Sec. 540.0659.  REIMBURSEMENT RATE FOR CERTAIN SERVICES
                   PROVIDED BY CERTAIN HEALTH CENTERS
                   AND CLINICS OUTSIDE REGULAR BUSINESS
                   HOURS
  SUBCHAPTER O. DELIVERY OF SERVICES: GENERAL PROVISIONS
  Sec. 540.0701.  ACUTE CARE SERVICE DELIVERY THROUGH
                   MOST COST-EFFECTIVE MODEL; MANAGED
                   CARE SERVICE DELIVERY AREAS
  Sec. 540.0702.  TRANSITION OF CASE MANAGEMENT FOR
                   CHILDREN AND PREGNANT WOMEN PROGRAM
                   RECIPIENTS TO MEDICAID MANAGED CARE
                   PROGRAM
  Sec. 540.0703.  BEHAVIORAL HEALTH AND PHYSICAL HEALTH
                   SERVICES
  Sec. 540.0704.  TARGETED CASE MANAGEMENT AND
                   PSYCHIATRIC REHABILITATIVE SERVICES
                   FOR CHILDREN, ADOLESCENTS, AND
                   FAMILIES
  Sec. 540.0705.  BEHAVIORAL HEALTH SERVICES PROVIDED
                   THROUGH THIRD PARTY OR SUBSIDIARY
  Sec. 540.0706.  PSYCHOTROPIC MEDICATION MONITORING
                   SYSTEM FOR CERTAIN CHILDREN
  Sec. 540.0707.  MEDICATION THERAPY MANAGEMENT
  Sec. 540.0708.  SPECIAL DISEASE MANAGEMENT
  Sec. 540.0709.  SPECIAL PROTOCOLS FOR INDIGENT
                   POPULATIONS
  Sec. 540.0710.  DIRECT ACCESS TO EYE HEALTH CARE
                   SERVICES
  Sec. 540.0711.  DELIVERY OF BENEFITS USING
                   TELECOMMUNICATIONS OR INFORMATION
                   TECHNOLOGY
  Sec. 540.0712.  PROMOTION AND PRINCIPLES OF
                   PATIENT-CENTERED MEDICAL HOME
  Sec. 540.0713.  VALUE-ADDED SERVICES
  SUBCHAPTER P. DELIVERY OF SERVICES: STAR+PLUS MEDICAID MANAGED CARE
  PROGRAM
  Sec. 540.0751.  DELIVERY OF ACUTE CARE SERVICES AND
                   LONG-TERM SERVICES AND SUPPORTS
  Sec. 540.0752.  DELIVERY OF MEDICAID BENEFITS TO
                   NURSING FACILITY RESIDENTS
  Sec. 540.0753.  DELIVERY OF BASIC ATTENDANT AND
                   HABILITATION SERVICES
  Sec. 540.0754.  EVALUATION OF CERTAIN PROGRAM SERVICES
  Sec. 540.0755.  UTILIZATION REVIEW; ANNUAL REPORT
  SUBCHAPTER Q. DELIVERY OF SERVICES: STAR HEALTH PROGRAM
  Sec. 540.0801.  TRAUMA-INFORMED CARE TRAINING
  Sec. 540.0802.  MENTAL HEALTH PROVIDERS
  Sec. 540.0803.  HEALTH SCREENING REQUIREMENTS AND
                   COMPLIANCE WITH TEXAS HEALTH STEPS
  Sec. 540.0804.  HEALTH CARE AND OTHER SERVICES FOR
                   CHILDREN IN SUBSTITUTE CARE
  Sec. 540.0805.  PLACEMENT CHANGE NOTICE AND CARE
                   COORDINATION
  Sec. 540.0806.  MEDICAID BENEFITS FOR CERTAIN CHILDREN
                   FORMERLY IN FOSTER CARE
  SUBCHAPTER R. DELIVERY OF SERVICES: STAR KIDS MANAGED CARE PROGRAM
  Sec. 540.0851.  STAR KIDS MANAGED CARE PROGRAM
  Sec. 540.0852.  CARE MANAGEMENT AND CARE NEEDS
                   ASSESSMENT
  Sec. 540.0853.  BENEFITS FOR CHILDREN IN MEDICALLY
                   DEPENDENT CHILDREN (MDCP) WAIVER
                   PROGRAM
  Sec. 540.0854.  BENEFITS TRANSITION FROM STAR KIDS TO
                   STAR+PLUS MEDICAID MANAGED CARE
                   PROGRAM
  Sec. 540.0855.  UTILIZATION REVIEW OF PRIOR
                   AUTHORIZATIONS
  CHAPTER 540. MEDICAID MANAGED CARE PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 540.0001.  DEFINITIONS. In this chapter:
               (1)  Notwithstanding Section 521.0001(2), "commission"
  means the Health and Human Services Commission or an agency
  operating part of the Medicaid managed care program, as
  appropriate.
               (2)  "Health care service region" or "region" means a
  Medicaid managed care service area the commission delineates.
               (3)  "Managed care organization" means a person that is
  authorized or otherwise permitted by law to arrange for or provide a
  managed care plan.
               (4)  "Managed care plan" means a plan under which a
  person undertakes to provide, arrange for, pay for, or reimburse
  any part of the cost of any health care service. A part of the plan
  must consist of arranging for or providing health care services as
  distinguished from indemnification against the cost of those
  services on a prepaid basis through insurance or otherwise. The
  term includes a primary care case management provider network. The
  term does not include a plan that indemnifies a person for the cost
  of health care services through insurance.
               (5)  "Potentially preventable event" has the meaning
  assigned by Section 543A.0001.
               (6)  "Recipient" means a Medicaid recipient.  (Gov.
  Code, Secs. 533.001(1), (4), (5), (6), (7), 533.00251(a)(4),
  533.00253(a)(3), 533.00256(a)(1) (part), 533.00511(a).)
  SUBCHAPTER B. ADMINISTRATION OF MEDICAID MANAGED CARE PROGRAM
         Sec. 540.0051.  PURPOSE AND IMPLEMENTATION. The commission
  shall implement the Medicaid managed care program by contracting
  with managed care organizations in a manner that, to the extent
  possible:
               (1)  improves the health of Texans by:
                     (A)  emphasizing prevention;
                     (B)  promoting continuity of care; and
                     (C)  providing a medical home for recipients;
               (2)  ensures each recipient receives high quality,
  comprehensive health care services in the recipient's local
  community;
               (3)  encourages training of and access to primary care
  physicians and providers;
               (4)  maximizes cooperation with existing public health
  entities, including local health departments;
               (5)  provides incentives to managed care organizations
  to improve the quality of health care services for recipients by
  providing value-added services; and
               (6)  reduces administrative and other nonfinancial
  barriers for recipients in obtaining health care services. (Gov.
  Code, Sec. 533.002.)
         Sec. 540.0052.  RECIPIENT DIRECTORY. The commission shall,
  in accordance with a single source of truth design:
               (1)  maintain an accurate electronic directory of
  contact information for each recipient enrolled in a Medicaid
  managed care plan offered by a managed care organization,
  including, to the extent feasible, each recipient's:
                     (A)  home, work, and mobile telephone numbers;
                     (B)  e-mail address; and
                     (C)  home and work addresses; and
               (2)  ensure that each Medicaid managed care
  organization and enrollment broker participating in the Medicaid
  managed care program update the electronic directory in real time.
  (Gov. Code, Sec. 533.00751.)
         Sec. 540.0053.  STATEWIDE EFFORT TO PROMOTE MEDICAID
  ELIGIBILITY MAINTENANCE. (a) The commission shall develop and
  implement a statewide effort to assist recipients who satisfy
  Medicaid eligibility requirements and who receive Medicaid
  services through a Medicaid managed care organization with:
               (1)  maintaining eligibility; and
               (2)  avoiding lapses in Medicaid coverage.
         (b)  As part of the commission's effort under Subsection (a),
  the commission shall:
               (1)  require each Medicaid managed care organization to
  assist the organization's recipients with maintaining eligibility;
               (2)  if the commission determines it is cost-effective,
  develop specific strategies for assisting recipients who receive
  Supplemental Security Income (SSI) benefits under 42 U.S.C. Section
  1381 et seq. with maintaining eligibility; and
               (3)  ensure information relevant to a recipient's
  eligibility status is provided to the recipient's Medicaid managed
  care organization.  (Gov. Code, Sec. 533.0077.)
         Sec. 540.0054.  PROVIDER AND RECIPIENT EDUCATION PROGRAMS.
  (a) In adopting rules to implement a Medicaid managed care program,
  the executive commissioner shall establish guidelines for, and
  require Medicaid managed care organizations to provide, education
  programs for providers and recipients using a variety of techniques
  and media.
         (b)  A provider education program must include information
  on:
               (1)  Medicaid policies, procedures, eligibility
  standards, and benefits;
               (2)  recipients' specific problems and needs; and
               (3)  recipients' rights and responsibilities under the
  bill of rights and the bill of responsibilities prescribed by
  Section 532.0301.
         (c)  A recipient education program must present information
  in a manner that is easy to understand. A program must include
  information on:
               (1)  a recipient's rights and responsibilities under
  the bill of rights and the bill of responsibilities prescribed by
  Section 532.0301;
               (2)  how to access health care services;
               (3)  how to access complaint procedures and the
  recipient's right to bypass the Medicaid managed care
  organization's internal complaint system and use the notice and
  appeal procedures otherwise required by Medicaid;
               (4)  Medicaid policies, procedures, eligibility
  standards, and benefits;
               (5)  the Medicaid managed care organization's policies
  and procedures; and
               (6)  the importance of prevention, early intervention,
  and appropriate use of services.  (Gov. Code, Sec. 531.0211.)
         Sec. 540.0055.  MARKETING GUIDELINES. (a) The commission
  shall establish marketing guidelines for Medicaid managed care
  organizations, including guidelines that prohibit:
               (1)  door-to-door marketing to a recipient by a
  Medicaid managed care organization or the organization's agent;
               (2)  using marketing materials with inaccurate or
  misleading information;
               (3)  making a misrepresentation to a recipient or
  provider;
               (4)  offering a recipient a material or financial
  incentive to choose a Medicaid managed care plan, other than a
  nominal gift or free health screening the commission approves that
  the Medicaid managed care organization offers to all recipients
  regardless of whether the recipients enroll in the plan;
               (5)  using a marketing agent who is paid solely by
  commission; and
               (6)  face-to-face marketing at a public assistance
  office by a Medicaid managed care organization or the
  organization's agent.
         (b)  This section does not prohibit:
               (1)  distributing approved marketing materials at a
  public assistance office; or
               (2)  providing information directly to a recipient
  under marketing guidelines the commission establishes. (Gov. Code,
  Secs. 533.008(a), (b).)
         Sec. 540.0056.  GUIDELINES FOR COMMUNICATIONS WITH
  RECIPIENTS.  The executive commissioner shall adopt and publish
  guidelines for Medicaid managed care organizations regarding how an
  organization may communicate by text message or e-mail with a
  recipient enrolled in the organization's Medicaid managed care plan
  using the contact information provided in the recipient's
  application for Medicaid benefits under Section 32.025(g)(2),
  Human Resources Code, including updated information provided to the
  organization in accordance with Section 32.025(h), Human Resources
  Code. (Gov. Code, Sec. 533.008(c).)
         Sec. 540.0057.  COORDINATION OF EXTERNAL OVERSIGHT
  ACTIVITIES. (a) To the extent possible, the commission shall
  coordinate all external oversight activities to minimize
  duplicating oversight of Medicaid managed care plans and disrupting
  operations under those plans.
         (b)  The executive commissioner, after consulting with the
  commission's office of inspector general, shall by rule define the
  commission's and office's roles in, jurisdiction over, and
  frequency of audits of Medicaid managed care organizations that are
  conducted by the commission and the office.
         (c)  In accordance with Section 544.0109, the commission
  shall share with the commission's office of inspector general, at
  the office's request, the results of any informal audit or on-site
  visit that could inform the office's risk assessment when
  determining:
               (1)  whether to conduct an audit of a Medicaid managed
  care organization; or
               (2)  the scope of the audit.  (Gov. Code, Sec. 533.015.)
         Sec. 540.0058.  INFORMATION FOR FRAUD CONTROL. (a) Each
  Medicaid managed care organization shall submit at no cost to the
  commission and, on request, the office of the attorney general:
               (1)  a description of any financial or other business
  relationship between the organization and any subcontractor
  providing health care services under the contract between the
  organization and the commission;
               (2)  a copy of each type of contract between the
  organization and a subcontractor relating to the delivery of or
  payment for health care services;
               (3)  a description of the fraud control program any
  subcontractor that delivers health care services uses; and
               (4)  a description and breakdown of all funds paid to or
  by the organization, including a health maintenance organization,
  primary care case management provider, pharmacy benefit manager,
  and exclusive provider organization, necessary for the commission
  to determine the actual cost of administering the Medicaid managed
  care plan.
         (b)  The information under this section must be:
               (1)  submitted in the form the commission or the office
  of the attorney general, as applicable, requires; and
               (2)  updated as the commission or the office of the
  attorney general, as applicable, requires.
         (c)  The commission's office of inspector general or the
  office of the attorney general, as applicable, shall review the
  information a Medicaid managed care organization submits under this
  section as appropriate in investigating fraud in the Medicaid
  managed care program.
         (d)  Information a Medicaid managed care organization
  submits to the commission or the office of the attorney general
  under Subsection (a)(1) is confidential and not subject to
  disclosure under Chapter 552.  (Gov. Code, Sec. 533.012.)
         Sec. 540.0059.  MANAGED CARE CLINICAL IMPROVEMENT PROGRAM.
  (a) In consultation with appropriate stakeholders with an interest
  in the provision of acute care services and long-term services and
  supports under the Medicaid managed care program, the commission
  shall:
               (1)  establish a clinical improvement program to
  identify goals designed to:
                     (A)  improve quality of care and care management;
  and
                     (B)  reduce potentially preventable events; and
               (2)  require Medicaid managed care organizations to
  develop and implement collaborative program improvement strategies
  to address the goals.
         (b)  Goals established under this section may be set by
  geographic region and program type.  (Gov. Code, Secs. 533.00256(a)
  (part), (b).)
         Sec. 540.0060.  COMPLAINT SYSTEM GUIDELINES. (a)  The Texas
  Department of Insurance, in conjunction with the commission, shall
  establish complaint system guidelines for Medicaid managed care
  organizations.
         (b)  The guidelines must require that information regarding
  a Medicaid managed care organization's complaint process be made
  available to a recipient in an appropriate communication format
  when the recipient enrolls in the Medicaid managed care program.  
  (Gov. Code, Secs. 533.020(a) (part), (b).)
  SUBCHAPTER C. FISCAL PROVISIONS
         Sec. 540.0101.  FISCAL SOLVENCY STANDARDS.  The Texas
  Department of Insurance, in conjunction with the commission, shall
  establish fiscal solvency standards for Medicaid managed care
  organizations.  (Gov. Code, Sec. 533.020(a) (part).)
         Sec. 540.0102.  PROFIT SHARING. (a)  The executive
  commissioner shall adopt rules regarding the sharing of profits
  earned by a Medicaid managed care organization through a Medicaid
  managed care plan.
         (b)  Except as provided by Subsection (c), any amount this
  state receives under this section shall be deposited in the general
  revenue fund.
         (c)  If cost-effective, the commission may use amounts this
  state receives under this section to provide incentives to specific
  Medicaid managed care organizations to promote quality of care,
  encourage payment reform, reward local service delivery reform,
  increase efficiency, and reduce inappropriate or preventable
  service utilization.  (Gov. Code, Sec. 533.014.)
         Sec. 540.0103.  TREATMENT OF STATE TAXES IN CALCULATING
  EXPERIENCE REBATE OR PROFIT SHARING. The commission shall ensure
  that any experience rebate or profit sharing for Medicaid managed
  care organizations is calculated by treating premium, maintenance,
  and other taxes under the Insurance Code and any other taxes payable
  to this state as allowable expenses to determine the amount of the
  experience rebate or profit sharing.  (Gov. Code, Sec. 533.0132.)
  SUBCHAPTER D. STRATEGY FOR MANAGING AUDIT RESOURCES
         Sec. 540.0151.  DEFINITIONS.  In this subchapter:
               (1)  "Accounts receivable tracking system" means the
  system the commission uses to track experience rebates and other
  payments collected from managed care organizations.
               (2)  "Agreed-upon procedures engagement" means an
  evaluation of a managed care organization's financial statistical
  reports or other data conducted by an independent auditing firm the
  commission engages as agreed in the managed care organization's
  contract with the commission.
               (3)  "Experience rebate" means the amount a managed
  care organization is required to pay this state according to the
  graduated rebate method described in the organization's contract
  with the commission.
               (4)  "External quality review organization" means an
  organization that performs an external quality review of a managed
  care organization in accordance with 42 C.F.R. Section 438.350.  
  (Gov. Code, Sec. 533.051.)
         Sec. 540.0152.  APPLICABILITY AND CONSTRUCTION OF
  SUBCHAPTER. This subchapter does not apply to and may not be
  construed as affecting the conduct of audits by the commission's
  office of inspector general under the authority provided by
  Subchapter C, Chapter 544, including an audit of a managed care
  organization the office conducts after coordinating the office's
  audit and oversight activities with the commission as required by
  Section 544.0109(c).  (Gov. Code, Sec. 533.052.)
         Sec. 540.0153.  OVERALL STRATEGY FOR MANAGING AUDIT
  RESOURCES.  The commission shall develop and implement an overall
  strategy for planning, managing, and coordinating audit resources
  that the commission uses to verify the accuracy and reliability of
  program and financial information managed care organizations
  report.  (Gov. Code, Sec. 533.053.)
         Sec. 540.0154.  PERFORMANCE AUDIT SELECTION PROCESS AND
  FOLLOW-UP. (a)  To improve the commission's processes for
  performance audits of managed care organizations, the commission
  shall:
               (1)  document the process by which the commission
  selects organizations to audit;
               (2)  include previous audit coverage as a risk factor
  in selecting organizations to audit; and
               (3)  prioritize the highest risk organizations to
  audit.
         (b)  To verify that managed care organizations correct
  negative performance audit findings, the commission shall:
               (1)  establish a process to:
                     (A)  document how the commission follows up on
  those findings; and
                     (B)  verify that organizations implement
  performance audit recommendations; and
               (2)  establish and implement policies and procedures
  to:
                     (A)  determine under what circumstances the
  commission must issue a corrective action plan to an organization
  based on a performance audit; and
                     (B)  follow up on the organization's
  implementation of the plan.  (Gov. Code, Sec. 533.054.)
         Sec. 540.0155.  AGREED-UPON PROCEDURES ENGAGEMENTS AND
  CORRECTIVE ACTION PLANS. To enhance the commission's use of
  agreed-upon procedures engagements to identify managed care
  organizations' performance and compliance issues, the commission
  shall:
               (1)  ensure that financial risks identified in
  agreed-upon procedures engagements are adequately and consistently
  addressed; and
               (2)  establish policies and procedures to determine
  under what circumstances the commission must issue a corrective
  action plan based on an agreed-upon procedures engagement.  (Gov.
  Code, Sec. 533.055.)
         Sec. 540.0156.  AUDITS OF PHARMACY BENEFIT MANAGERS. To
  obtain greater assurance about the effectiveness of pharmacy
  benefit managers' internal controls and compliance with state
  requirements, the commission shall:
               (1)  periodically audit each pharmacy benefit manager
  that contracts with a managed care organization; and
               (2)  develop, document, and implement a monitoring
  process to ensure that managed care organizations correct and
  resolve negative findings reported in performance audits or
  agreed-upon procedures engagements of pharmacy benefit managers.  
  (Gov. Code, Sec. 533.056.)
         Sec. 540.0157.  COLLECTING COSTS FOR AUDIT-RELATED
  SERVICES. The commission shall develop, document, and implement
  billing processes in the commission's Medicaid and CHIP services
  department to ensure that managed care organizations reimburse the
  commission for audit-related services as required by contract.  
  (Gov. Code, Sec. 533.057.)
         Sec. 540.0158.  COLLECTION ACTIVITIES RELATED TO PROFIT
  SHARING. To strengthen the commission's process for collecting
  shared profits from managed care organizations, the commission
  shall develop, document, and implement monitoring processes in the
  commission's Medicaid and CHIP services department to ensure that
  the commission:
               (1)  identifies experience rebates deposited in the
  commission's suspense account and timely transfers those rebates to
  the appropriate accounts; and
               (2)  timely follows up on and resolves disputes over
  experience rebates managed care organizations claim.  (Gov. Code,
  Sec. 533.058.)
         Sec. 540.0159.  USING INFORMATION FROM EXTERNAL QUALITY
  REVIEWS. (a) To enhance the commission's monitoring of managed
  care organizations, the commission shall use the information
  provided by the external quality review organization, including:
               (1)  detailed data from results of surveys of:
                     (A)  recipients and, if applicable, child health
  plan program enrollees;
                     (B)  caregivers of those recipients and
  enrollees; and
                     (C)  Medicaid and, as applicable, child health
  plan program providers; and
               (2)  the validation results of matching paid claims
  data with medical records.
         (b)  The commission shall document how the commission uses
  the information described by Subsection (a) to monitor managed care
  organizations.  (Gov. Code, Sec. 533.059.)
         Sec. 540.0160.  SECURITY OF AND PROCESSING CONTROLS OVER
  INFORMATION TECHNOLOGY SYSTEMS. The commission shall:
               (1)  strengthen user access controls for the
  commission's accounts receivable tracking system and network
  folders that the commission uses to manage the collection of
  experience rebates;
               (2)  document daily reconciliations of deposits
  recorded in the accounts receivable tracking system to the
  transactions processed in:
                     (A)  the commission's cost accounting system for
  all health and human services agencies; and
                     (B)  the uniform statewide accounting system; and
               (3)  develop, document, and implement a process to
  ensure that the commission formally documents:
                     (A)  all programming changes made to the accounts
  receivable tracking system; and
                     (B)  the authorization and testing of the changes
  described by Paragraph (A).  (Gov. Code, Sec. 533.060.)
  SUBCHAPTER E.  CONTRACT ADMINISTRATION
         Sec. 540.0201.  CONTRACT ADMINISTRATION IMPROVEMENT
  EFFORTS. The commission shall make every effort to improve the
  administration of contracts with managed care organizations. To
  improve contract administration, the commission shall:
               (1)  ensure that the commission has appropriate
  expertise and qualified staff to effectively manage contracts with
  managed care organizations under the Medicaid managed care program;
               (2)  evaluate options for Medicaid payment recovery
  from a managed care organization if an enrolled recipient:
                     (A)  dies;
                     (B)  is incarcerated;
                     (C)  is enrolled in more than one state program;
  or
                     (D)  is covered by another liable third party
  insurer;
               (3)  maximize Medicaid payment recovery options by
  contracting with private vendors to assist in recovering capitation
  payments, payments from other liable third parties, and other
  payments made to a managed care organization with respect to an
  enrolled recipient who leaves the managed care program;
               (4)  decrease the administrative burdens of managed
  care for this state, managed care organizations, and providers in
  managed care networks to the extent that those changes are
  compatible with state law and existing Medicaid managed care
  contracts, including by:
                     (A)  where possible, decreasing duplicate
  administrative reporting and process requirements for managed care
  organizations and providers, such as requirements for submitting:
                           (i)  encounter data;
                           (ii)  quality reports;
                           (iii)  historically underutilized business
  reports; and
                           (iv)  claims payment summary reports;
                     (B)  allowing a managed care organization to
  provide updated address information directly to the commission for
  correction in the state system;
                     (C)  promoting consistency and uniformity among
  managed care organization policies, including policies relating
  to:
                           (i)  the preauthorization process;
                           (ii)  lengths of hospital stays;
                           (iii)  filing deadlines;
                           (iv)  levels of care; and
                           (v)  case management services;
                     (D)  reviewing the appropriateness of primary
  care case management requirements in the admission and clinical
  criteria process, such as requirements relating to:
                           (i)  including a separate cover sheet for
  all communications;
                           (ii)  submitting handwritten communications
  instead of electronic or typed review processes; and
                           (iii)  admitting patients listed on separate
  notices; and
                     (E)  providing a portal through which a provider
  in any managed care organization's provider network may submit
  acute care services and long-term services and supports claims; and
               (5)  reserve the right to amend a managed care
  organization's process for resolving provider appeals of denials
  based on medical necessity to include an independent review process
  the commission establishes for final determination of these
  disputes. (Gov. Code, Sec. 533.0071.)
         Sec. 540.0202.  PUBLIC NOTICE OF REQUEST FOR CONTRACT
  APPLICATIONS. Not later than the 30th day before the date the
  commission plans to issue a request for applications to enter into a
  contract with the commission to provide health care services to
  recipients in a region, the commission shall publish notice of and
  make available for public review the request for applications and
  all related nonproprietary documents, including the proposed
  contract. (Gov. Code, Sec. 533.011.)
         Sec. 540.0203.  CERTIFICATION BY COMMISSION. (a)  Before
  the commission may award a contract under this chapter to a managed
  care organization, the commission shall evaluate and certify that
  the organization is reasonably able to fulfill the contract terms,
  including all federal and state law requirements.  Notwithstanding
  any other law, the commission may not award a contract under this
  chapter to an organization that does not receive the required
  certification.
         (b)  A managed care organization may appeal the commission's
  denial of certification.  (Gov. Code, Sec. 533.0035.)
         Sec. 540.0204.  CONTRACT CONSIDERATIONS RELATING TO MANAGED
  CARE ORGANIZATIONS. In awarding contracts to managed care
  organizations, the commission shall:
               (1)  give preference to an organization that has
  significant participation in the organization's provider network
  from each health care provider in the region who has traditionally
  provided care to Medicaid and charity care patients;
               (2)  give extra consideration to an organization that
  agrees to assure continuity of care for at least three months beyond
  a recipient's Medicaid eligibility period;
               (3)  consider the need to use different managed care
  plans to meet the needs of different populations; and
               (4)  consider the ability of an organization to process
  Medicaid claims electronically. (Gov. Code, Sec. 533.003(a)
  (part).)
         Sec. 540.0205.  CONTRACT CONSIDERATIONS RELATING TO
  PHARMACY BENEFIT MANAGERS. In considering approval of a
  subcontract between a managed care organization and a pharmacy
  benefit manager to provide Medicaid prescription drug benefits, the
  commission shall review and consider whether in the preceding three
  years the pharmacy benefit manager has been:
               (1)  convicted of:
                     (A)  an offense involving a material
  misrepresentation or an act of fraud; or
                     (B)  another violation of state or federal
  criminal law;
               (2)  adjudicated to have committed a breach of
  contract; or
               (3)  assessed a penalty or fine of $500,000 or more in a
  state or federal administrative proceeding. (Gov. Code, Sec.
  533.003(b).)
         Sec. 540.0206.  MANDATORY CONTRACTS. (a)  Subject to the
  certification required under Section 540.0203 and the
  considerations required under Section 540.0204, in providing
  health care services through Medicaid managed care to recipients in
  a health care service region, the commission shall contract with a
  managed care organization in that region that holds a certificate
  of authority issued under Chapter 843, Insurance Code, to provide
  health care in that region and that is:
               (1)  wholly owned and operated by a hospital district
  in that region;
               (2)  created by a nonprofit corporation that:
                     (A)  has a contract, agreement, or other
  arrangement with a hospital district in that region or with a
  municipality in that region that owns a hospital licensed under
  Chapter 241, Health and Safety Code, and has an obligation to
  provide health care to indigent patients; and
                     (B)  under the contract, agreement, or other
  arrangement, assumes the obligation to provide health care to
  indigent patients and leases, manages, or operates a hospital
  facility the hospital district or municipality owns; or
               (3)  created by a nonprofit corporation that has a
  contract, agreement, or other arrangement with a hospital district
  in that region under which the nonprofit corporation acts as an
  agent of the district and assumes the district's obligation to
  arrange for services under the Medicaid expansion for children as
  authorized by Chapter 444 (S.B. 10), Acts of the 74th Legislature,
  Regular Session, 1995.
         (b)  A managed care organization described by Subsection (a)
  is subject to all terms to which other managed care organizations
  are subject, including all contractual, regulatory, and statutory
  provisions relating to participation in the Medicaid managed care
  program.
         (c)  The commission shall make the awarding and renewal of a
  mandatory contract under this section to a managed care
  organization affiliated with a hospital district or municipality
  contingent on the district or municipality entering into a matching
  funds agreement to expand Medicaid for children as authorized by
  Chapter 444 (S.B. 10), Acts of the 74th Legislature, Regular
  Session, 1995. The commission shall make compliance with the
  matching funds agreement a condition of the continuation of the
  contract with the managed care organization to provide health care
  services to recipients.
         (d)  Subsection (c) does not apply if:
               (1)  the commission does not expand Medicaid for
  children as authorized by Chapter 444, Acts of the 74th
  Legislature, Regular Session, 1995; or
               (2)  a waiver from a federal agency necessary for the
  expansion is not granted.
         (e)  In providing health care services through Medicaid
  managed care to recipients in a health care service region, with the
  exception of the Harris service area for the STAR Medicaid managed
  care program, as the commission defined as of September 1, 1999, the
  commission shall also contract with a managed care organization in
  that region that holds a certificate of authority as a health
  maintenance organization issued under Chapter 843, Insurance Code,
  and that:
               (1)  is certified under Section 162.001, Occupations
  Code;
               (2)  is created by The University of Texas Medical
  Branch at Galveston; and
               (3)  has obtained a certificate of authority as a
  health maintenance organization to serve one or more counties in
  that region from the Texas Department of Insurance before September
  2, 1999. (Gov. Code, Sec. 533.004.)
         Sec. 540.0207.  CONTRACTUAL OBLIGATIONS REVIEW. The
  commission shall review each Medicaid managed care organization to
  determine whether the organization is prepared to meet the
  organization's contractual obligations. (Gov. Code, Sec.
  533.007(a).)
         Sec. 540.0208.  CONTRACT IMPLEMENTATION PLAN.  (a) Each
  Medicaid managed care organization that contracts to provide health
  care services to recipients in a health care service region shall
  submit an implementation plan not later than the 90th day before the
  date the organization plans to begin providing those services in
  that region through managed care. The implementation plan must
  include:
               (1)  specific staffing patterns by function for all
  operations, including enrollment, information systems, member
  services, quality improvement, claims management, case management,
  and provider and recipient training; and
               (2)  specific time frames for demonstrating
  preparedness for implementation before the date the organization
  plans to begin providing those services in that region through
  managed care.
         (b)  The commission shall respond to an implementation plan
  not later than the 10th day after the date a Medicaid managed care
  organization submits the plan if the plan does not adequately meet
  preparedness guidelines.
         (c)  Each Medicaid managed care organization that contracts
  to provide health care services to recipients in a health care
  service region shall submit status reports on the implementation
  plan:
               (1)  not later than the 60th day and the 30th day before
  the date the organization plans to begin providing those services
  in that region through managed care; and
               (2)  every 30th day after that date until the 180th day
  after that date. (Gov. Code, Secs. 533.007(b), (c), (d).)
         Sec. 540.0209.  COMPLIANCE AND READINESS REVIEW. (a) The
  commission shall conduct a compliance and readiness review of each
  Medicaid managed care organization:
               (1)  not later than the 15th day before the date the
  process of enrolling recipients in a managed care plan the
  organization issues is to begin in a region; and
               (2)  not later than the 15th day before the date the
  organization plans to begin providing health care services to
  recipients in that region through managed care.
         (b)  The compliance and readiness review must include an
  on-site inspection and tests of service authorization and claims
  payment systems, including:
               (1)  the Medicaid managed care organization's ability
  to process claims electronically;
               (2)  the Medicaid managed care organization's complaint
  processing systems; and
               (3)  any other process or system the contract between
  the Medicaid managed care organization and the commission requires.
         (c)  The commission may delay recipient enrollment in a
  managed care plan a Medicaid managed care organization issues if
  the compliance and readiness review reveals that the organization
  is not prepared to meet the organization's contractual obligations.
  The commission shall notify the organization of a decision to delay
  enrollment in a plan the organization issues. (Gov. Code, Secs.
  533.007(e), (f).)
         Sec. 540.0210.  INTERNET POSTING OF SANCTIONS IMPOSED FOR
  CONTRACTUAL VIOLATIONS.  (a) The commission shall prepare and
  maintain a record of each enforcement action the commission
  initiates that results in a sanction, including a penalty, being
  imposed against a managed care organization for failure to comply
  with the terms of a contract to provide health care services to
  recipients through a Medicaid managed care plan the organization
  issues.
         (b)  The record must include:
               (1)  the managed care organization's name and address;
               (2)  a description of the contractual obligation the
  organization failed to meet;
               (3)  the date of determination of noncompliance;
               (4)  the date the sanction was imposed;
               (5)  the maximum sanction that may be imposed under the
  contract for the violation; and
               (6)  the actual sanction imposed against the
  organization.
         (c)  The commission shall:
               (1)  post and maintain on the commission's Internet
  website the records required by this section:
                     (A)  in English and Spanish; and
                     (B)  in a format that is readily accessible to and
  understandable by the public; and
               (2)  update the list of records on the website at least
  quarterly.
         (d)  The commission may not post information under this
  section that relates to a sanction while the sanction is the subject
  of an administrative appeal or judicial review.
         (e)  A record prepared under this section may not include
  information that is excepted from disclosure under Chapter 552.
         (f)  The executive commissioner shall adopt rules as
  necessary to implement this section. (Gov. Code, Sec. 533.0072.)
         Sec. 540.0211.  PERFORMANCE MEASURES AND INCENTIVES FOR
  VALUE-BASED CONTRACTS. (a) The commission shall establish
  outcome-based performance measures and incentives to include in
  each contract between the commission and a health maintenance
  organization to provide health care services to recipients that is
  procured and managed under a value-based purchasing model. The
  performance measures and incentives must:
               (1)  be designed to facilitate and increase recipient
  access to appropriate health care services; and
               (2)  to the extent possible, align with other state and
  regional quality care improvement initiatives.
         (b)  Subject to Subsection (c), the commission shall include
  the performance measures and incentives in each contract described
  by Subsection (a) in addition to all other contract provisions
  required by this chapter and Chapter 540A.
         (c)  The commission may use a graduated approach to including
  the performance measures and incentives in contracts described by
  Subsection (a) to ensure incremental and continued improvements
  over time.
         (d)  Subject to Subsection (e), the commission shall assess
  the feasibility and cost-effectiveness of including provisions in a
  contract described by Subsection (a) that require the health
  maintenance organization to provide to the providers in the
  organization's provider network pay-for-performance opportunities
  that support quality improvements in recipient care.
  Pay-for-performance opportunities may include incentives for
  providers to:
               (1)  provide care after normal business hours;
               (2)  participate in the early and periodic screening,
  diagnosis, and treatment program; and
               (3)  participate in other activities that improve
  recipient access to care.
         (e)  The commission shall, to the extent possible, base an
  assessment of feasibility and cost-effectiveness under Subsection
  (d) on publicly available, scientifically valid, evidence-based
  criteria appropriate for assessing the Medicaid population.
         (f)  In assessing feasibility and cost-effectiveness under
  Subsection (d), the commission may consult with participating
  Medicaid providers, including providers with expertise in quality
  improvement and performance measurement.
         (g)  If the commission determines that the provisions
  described by Subsection (d) are feasible and may be cost-effective,
  the commission shall develop and implement a pilot program in at
  least one health care service region under which the commission
  will include the provisions in contracts with health maintenance
  organizations offering Medicaid managed care plans in the region.
         (h)  The commission shall post the financial statistical
  report on the commission's Internet website in a comprehensive and
  understandable format. (Gov. Code, Sec. 533.0051.)
         Sec. 540.0212.  MONITORING COMPLIANCE WITH BEHAVIORAL
  HEALTH INTEGRATION. (a) In this section, "behavioral health
  services" has the meaning assigned by Section 540.0703.
         (b)  In monitoring contracts the commission enters into with
  Medicaid managed care organizations under this chapter, the
  commission shall:
               (1)  ensure the organizations fully integrate
  behavioral health services into a recipient's primary care
  coordination;
               (2)  use performance audits and other oversight tools
  to improve monitoring of the provision and coordination of
  behavioral health services; and
               (3)  establish performance measures that may be used to
  determine the effectiveness of the behavioral health services
  integration.
         (c)  In monitoring a Medicaid managed care organization's
  compliance with behavioral health services integration
  requirements under this section, the commission shall give
  particular attention to an organization that provides behavioral
  health services through a contract with a third party. (Gov. Code,
  Sec. 533.002551.)
  SUBCHAPTER F. REQUIRED CONTRACT PROVISIONS
         Sec. 540.0251.  APPLICABILITY. This subchapter applies to a
  contract between a Medicaid managed care organization and the
  commission to provide health care services to recipients. (Gov.
  Code, Sec. 533.005(a) (part).)
         Sec. 540.0252.  ACCOUNTABILITY TO STATE. A contract to
  which this subchapter applies must contain procedures to ensure
  accountability to this state for providing health care services,
  including procedures for:
               (1)  financial reporting;
               (2)  quality assurance;
               (3)  utilization review; and
               (4)  assurance of contract and subcontract compliance.
  (Gov. Code, Sec. 533.005(a)(1).)
         Sec. 540.0253.  CAPITATION RATES. A contract to which this
  subchapter applies must contain capitation rates that:
               (1)  include acuity and risk adjustment methodologies
  that consider the costs of providing acute care services and
  long-term services and supports, including private duty nursing
  services, provided under the Medicaid managed care plan; and
               (2)  ensure the cost-effective provision of quality
  health care.  (Gov. Code, Sec. 533.005(a)(2).)
         Sec. 540.0254.  COST INFORMATION. A contract to which this
  subchapter applies must require the contracting Medicaid managed
  care organization and any entity with which the organization
  contracts to perform services under a Medicaid managed care plan to
  disclose at no cost to the commission and, on request, the office of
  the attorney general all agreements affecting the net cost of goods
  or services provided under the plan, including:
               (1) discounts;
               (2) incentives;
               (3) rebates;
               (4) fees;
               (5) free goods; and
               (6) bundling arrangements.  (Gov. Code, Sec.
  533.005(a)(24).)
         Sec. 540.0255.  FRAUD CONTROL. A contract to which this
  subchapter applies must require the contracting Medicaid managed
  care organization to:
               (1)  provide the information required by Section
  540.0058; and
               (2)  otherwise comply and cooperate with the
  commission's office of inspector general and the office of the
  attorney general. (Gov. Code, Sec. 533.005(a)(10).)
         Sec. 540.0256.  RECIPIENT OUTREACH AND EDUCATION. A
  contract to which this subchapter applies must:
               (1)  require the contracting Medicaid managed care
  organization to provide:
                     (A)  information about the availability of and
  referral to educational, social, and other community services that
  could benefit a recipient; and
                     (B)  special programs and materials for
  recipients with limited English proficiency or low literacy skills;
  and
               (2)  contain procedures for recipient outreach and
  education. (Gov. Code, Secs. 533.005(a)(5), (6), (18).)
         Sec. 540.0257.  NOTICE OF MEDICAID CERTIFICATION DATE. A
  contract to which this subchapter applies must require the
  commission to inform the contracting Medicaid managed care
  organization, on the date of a recipient's enrollment in a Medicaid
  managed care plan the organization issues, of the recipient's
  Medicaid certification date. (Gov. Code, Sec. 533.005(a)(8).)
         Sec. 540.0258.  PRIMARY CARE PROVIDER ASSIGNMENT. A
  contract to which this subchapter applies must require the
  contracting Medicaid managed care organization to make initial and
  subsequent primary care provider assignments and changes. (Gov.
  Code, Sec. 533.005(a)(26).)
         Sec. 540.0259.  COMPLIANCE WITH PROVIDER NETWORK
  REQUIREMENTS. A contract to which this subchapter applies must
  require the contracting Medicaid managed care organization to
  comply with Sections 540.0651(a)(1) and (2) and (b) as a condition
  of contract retention and renewal. (Gov. Code, Sec. 533.005(a)(9).)
         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. (Gov. Code, Sec. 533.005(a)(20).)
         Sec. 540.0261.  PROVIDER NETWORK SUFFICIENCY. A contract to
  which this subchapter applies must require the contracting Medicaid
  managed care organization to demonstrate to the commission, before
  the organization begins providing health care services to
  recipients, that, subject to the provider access standards the
  commission establishes under Section 540.0652:
               (1)  the organization's provider network has the
  capacity to serve the number of recipients expected to enroll in a
  Medicaid managed care plan the organization offers;
               (2)  the organization's provider network includes:
                     (A)  a sufficient number of primary care
  providers;
                     (B)  a sufficient variety of provider types;
                     (C)  a sufficient number of long-term services and
  supports providers and specialty pediatric care providers of home
  and community-based services; and
                     (D)  providers located throughout the region in
  which the organization will provide health care services; and
               (3)  health care services will be accessible to
  recipients through the organization's provider network to a
  comparable extent that health care services would be available to
  recipients under a fee-for-service model or primary care case
  management Medicaid managed care model. (Gov. Code, Sec.
  533.005(a)(21).)
         Sec. 540.0262.  QUALITY MONITORING PROGRAM FOR HEALTH CARE
  SERVICES. A contract to which this subchapter applies must require
  the contracting Medicaid managed care organization to develop a
  monitoring program for measuring the quality of the health care
  services provided by the organization's provider network that:
               (1)  incorporates the National Committee for Quality
  Assurance's Healthcare Effectiveness Data and Information Set
  (HEDIS) measures or, as applicable, the national core indicators
  adult consumer survey and the national core indicators child family
  survey for individuals with an intellectual or developmental
  disability;
               (2)  focuses on measuring outcomes; and
               (3)  includes collecting and analyzing clinical data
  relating to prenatal care, preventive care, mental health care, and
  the treatment of acute and chronic health conditions and substance
  use disorder. (Gov. Code, Sec. 533.005(a)(22).)
         Sec. 540.0263.  OUT-OF-NETWORK PROVIDER USAGE AND
  REIMBURSEMENT.  (a)  A contract to which this subchapter applies
  must require that:
               (1)  the contracting Medicaid managed care
  organization's usages of out-of-network providers or groups of
  out-of-network providers may not exceed limits the commission
  determines for those usages relating to total inpatient admissions,
  total outpatient services, and emergency room admissions; and
               (2)  the organization reimburse an out-of-network
  provider for health care services at a rate that is equal to the
  allowable rate for those services as determined under Sections
  32.028 and 32.0281, Human Resources Code, if the commission finds
  that the organization violated Subdivision (1).
         (b)  In accordance with Subsection (a)(2), a Medicaid
  managed care organization must reimburse an out-of-network
  provider of poststabilization services for providing the services
  at the allowable rate for those services until the organization
  arranges for the recipient's timely transfer, as the recipient's
  attending physician determines, to a provider in the organization's
  provider network. The organization may not refuse to reimburse an
  out-of-network provider for emergency or poststabilization
  services provided as a result of the organization's failure to
  arrange for and authorize a recipient's timely transfer. (Gov.
  Code, Secs. 533.005(a)(11), (12), (b).)
         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. (Gov. Code, Secs. 533.005(a)(25),
  (a-3).)
         Sec. 540.0265.  PROMPT PAYMENT OF CLAIMS.  (a) A contract to
  which this subchapter applies must require the contracting Medicaid
  managed care organization to pay a physician or provider for health
  care services provided to a recipient under a Medicaid managed care
  plan on any claim for payment the organization receives with
  documentation reasonably necessary for the organization to process
  the claim:
               (1)  not later than:
                     (A)  the 10th day after the date the organization
  receives the claim if the claim relates to services a nursing
  facility, intermediate care facility, or group home provided;
                     (B)  the 30th day after the date the organization
  receives the claim if the claim relates to the provision of
  long-term services and supports not subject to Paragraph (A); and
                     (C)  the 45th day after the date the organization
  receives the claim if the claim is not subject to Paragraph (A) or
  (B); or
               (2)  within a period, not to exceed 60 days, specified
  by a written agreement between the physician or provider and the
  organization.
         (b)  A contract to which this subchapter applies must require
  the contracting Medicaid managed care organization to demonstrate
  to the commission that the organization pays claims described by
  Subsection (a)(1)(B) on average not later than the 21st day after
  the date the organization receives the claim. (Gov. Code, Secs.
  533.005(a)(7), (7-a).)
         Sec. 540.0266.  REIMBURSEMENT FOR CERTAIN SERVICES PROVIDED
  OUTSIDE REGULAR BUSINESS HOURS. (a)  A contract to which this
  subchapter applies must require the contracting Medicaid managed
  care organization to reimburse a federally qualified health center
  or rural health clinic for health care services provided to a
  recipient outside of regular business hours, including on a weekend
  or holiday, at a rate that is equal to the allowable rate for those
  services as determined under Section 32.028, Human Resources Code,
  if the recipient does not have a referral from the recipient's
  primary care physician.
         (b)  The executive commissioner shall adopt rules regarding
  the days, times of days, and holidays that are considered to be
  outside of regular business hours for purposes of Subsection (a).
  (Gov. Code, Secs. 533.005(a)(14), (c).)
         Sec. 540.0267.  PROVIDER APPEALS PROCESS. (a)  A contract to
  which this subchapter applies must require the contracting Medicaid
  managed care organization to develop, implement, and maintain a
  system for tracking and resolving provider appeals related to
  claims payment.  The system must include a process that requires:
               (1)  a tracking mechanism to document the status and
  final disposition of each provider's claims payment appeal;
               (2)  contracting with physicians who are not network
  providers and who are of the same or related specialty as the
  appealing physician to resolve claims disputes that:
                     (A)  relate to denial on the basis of medical
  necessity; and
                     (B)  remain unresolved after a provider appeal;
               (3)  the determination of the physician resolving the
  dispute to be binding on the organization and provider; and
               (4)  the organization to allow a provider to initiate
  an appeal of a claim that has not been paid before the time
  prescribed by Section 540.0265(a)(1)(B).
         (b)  A contract to which this subchapter applies must require
  the contracting Medicaid managed care organization to develop and
  establish a process for responding to provider appeals in the
  region in which the organization provides health care services.
  (Gov. Code, Secs. 533.005(a)(15), (19).)
         Sec. 540.0268.  ASSISTANCE RESOLVING RECIPIENT AND PROVIDER
  ISSUES. A contract to which this subchapter applies must require
  the contracting Medicaid managed care organization to provide ready
  access to a person who assists:
               (1)  a recipient in resolving issues relating to
  enrollment, plan administration, education and training, access to
  services, and grievance procedures; and
               (2)  a provider in resolving issues relating to
  payment, plan administration, education and training, and
  grievance procedures. (Gov. Code, Secs. 533.005(a)(3), (4).)
         Sec. 540.0269.  USE OF ADVANCED PRACTICE REGISTERED NURSES
  AND PHYSICIAN ASSISTANTS. (a)  A contract to which this subchapter
  applies must require the contracting Medicaid managed care
  organization, notwithstanding any other law, including Sections
  843.312 and 1301.052, Insurance Code, to:
               (1)  use advanced practice registered nurses and
  physician assistants as primary care providers in addition to
  physicians to increase the availability of primary care providers
  in the organization's provider network; and
               (2)  treat advanced practice registered nurses and
  physician assistants in the same manner as primary care physicians
  with regard to:
                     (A)  selection and assignment as primary care
  providers;
                     (B)  inclusion as primary care providers in the
  organization's provider network; and
                     (C)  inclusion as primary care providers in any
  provider network directory the organization maintains.
         (b)  For purposes of this section, an advanced practice
  registered nurse may be included as a primary care provider in a
  Medicaid managed care organization's provider network regardless
  of whether the physician supervising the advanced practice
  registered nurse is in the provider network.  This subsection may
  not be construed as authorizing a Medicaid managed care
  organization to supervise or control the practice of medicine as
  prohibited by Subtitle B, Title 3, Occupations Code. (Gov. Code,
  Secs. 533.005(a)(13), (d).)
         Sec. 540.0270.  MEDICAL DIRECTOR AVAILABILITY. A contract
  to which this subchapter applies must require that a medical
  director who is authorized to make medical necessity determinations
  be available to the region in which the contracting Medicaid
  managed care organization provides health care services. (Gov.
  Code, Sec. 533.005(a)(16).)
         Sec. 540.0271.  PERSONNEL REQUIRED IN CERTAIN SERVICE
  REGIONS. A contract to which this subchapter applies must require a
  contracting Medicaid managed care organization that provides a
  Medicaid managed care plan in the South Texas service region to
  ensure the following personnel are located in that region:
               (1)  a medical director;
               (2)  patient care coordinators; and
               (3)  provider and recipient support services
  personnel. (Gov. Code, Sec. 533.005(a)(17).)
         Sec. 540.0272.  CERTAIN SERVICES PERMITTED IN LIEU OF OTHER
  MENTAL HEALTH OR SUBSTANCE USE DISORDER SERVICES; ANNUAL REPORT. A
  contract to which this subchapter applies must contain language
  permitting the contracting Medicaid managed care organization to
  offer medically appropriate, cost-effective, evidence-based
  services from a list approved by the state Medicaid managed care
  advisory committee and included in the contract in lieu of mental
  health or substance use disorder services specified in the state
  Medicaid plan. A recipient is not required to use a service from the
  list included in the contract in lieu of another mental health or
  substance use disorder service specified in the state Medicaid
  plan. The commission shall:
               (1)  prepare and submit to the legislature an annual
  report on the number of times during the preceding year a service
  from the list included in the contract is used; and
               (2)  consider the actual cost and use of any services
  from the list included in the contract that are offered by a
  Medicaid managed care organization when setting the capitation
  rates for that organization under the contract. (Gov. Code, Sec.
  533.005(h).)
         Sec. 540.0273.  OUTPATIENT PHARMACY BENEFIT PLAN. (a)
  Subject to Subsection (b), a contract to which this subchapter
  applies must require the contracting Medicaid managed care
  organization to develop, implement, and maintain an outpatient
  pharmacy benefit plan for the organization's enrolled recipients
  that:
               (1)  except as provided by Section 540.0280(2),
  exclusively employs the vendor drug program formulary and preserves
  this state's ability to reduce Medicaid fraud, waste, and abuse;
               (2)  adheres to the applicable preferred drug list the
  commission adopts under Subchapter E, Chapter 549;
               (3)  except as provided by Section 540.0280(1),
  includes the prior authorization procedures and requirements
  prescribed by or implemented under Sections 549.0257(a) and (c) and
  549.0259 for the vendor drug program;
               (4)  does not require a clinical, nonpreferred, or
  other prior authorization for any antiretroviral drug, as defined
  by Section 549.0252, or a step therapy or other protocol, that could
  restrict or delay the dispensing of the drug except to minimize
  fraud, waste, or abuse; and
               (5)  does not require prior authorization for a
  nonpreferred antipsychotic drug prescribed to an adult recipient if
  the requirements of Section 549.0253(a) are met.
         (b)  The requirements imposed by Subsections (a)(1)-(3) do
  not apply, and may not be enforced, on and after August 31, 2023.
  (Gov. Code, Secs. 533.005(a)(23)(A), (B), (C), (C-1), (C-2),
  (a-1).)
         Sec. 540.0274.  PHARMACY BENEFIT PLAN: REBATES AND RECEIPT
  OF CONFIDENTIAL INFORMATION PROHIBITED. A Medicaid managed care
  organization, for purposes of the organization's outpatient
  pharmacy benefit plan required by Section 540.0273 in a contract to
  which this subchapter applies, may not:
               (1)  negotiate or collect rebates associated with
  pharmacy products on the vendor drug program formulary; or
               (2)  receive drug rebate or pricing information that is
  confidential under Subchapter D, Chapter 549. (Gov. Code, Sec.
  533.005(a)(23)(D).)
         Sec. 540.0275.  PHARMACY BENEFIT PLAN: CERTAIN PHARMACY
  BENEFITS FOR SEX OFFENDERS PROHIBITED. A Medicaid managed care
  organization's pharmacy benefit plan required by Section 540.0273
  in a contract to which this subchapter applies must comply with the
  prohibition under Section 549.0004. (Gov. Code, Sec.
  533.005(a)(23)(E).)
         Sec. 540.0276.  PHARMACY BENEFIT PLAN: RECIPIENT SELECTION
  OF PHARMACEUTICAL SERVICES PROVIDER. A Medicaid managed care
  organization, under the organization's pharmacy benefit plan
  required by Section 540.0273 in a contract to which this subchapter
  applies, may not prohibit, limit, or interfere with a recipient's
  selection of a pharmacy or pharmacist of the recipient's choice to
  provide pharmaceutical services under the plan by imposing
  different copayments. (Gov. Code, Sec. 533.005(a)(23)(F).)
         Sec. 540.0277.  PHARMACY BENEFIT PLAN: PHARMACY BENEFIT
  PROVIDERS. (a)  A Medicaid managed care organization's pharmacy
  benefit plan required by Section 540.0273 in a contract to which
  this subchapter applies must allow the organization or any
  subcontracted pharmacy benefit manager to contract with a
  pharmacist or pharmacy providers separately for specialty pharmacy
  services, except that:
               (1)  the organization and pharmacy benefit manager are
  prohibited from allowing exclusive contracts with a specialty
  pharmacy owned wholly or partly by the pharmacy benefit manager
  responsible for administering the pharmacy benefit program; and
               (2)  the organization and pharmacy benefit manager must
  adopt policies and procedures for reclassifying prescription drugs
  from retail to specialty drugs that:
                     (A)  are consistent with rules the executive
  commissioner adopts; and
                     (B)  include notice to network pharmacy providers
  from the organization.
         (b)  A Medicaid managed care organization, under the
  organization's pharmacy benefit plan required by Section 540.0273
  in a contract to which this subchapter applies:
               (1)  may not prevent a pharmacy or pharmacist from
  participating as a provider if the pharmacy or pharmacist agrees to
  comply with the financial terms, as well as other reasonable
  administrative and professional terms, of the contract;
               (2)  may include mail-order pharmacies in the
  organization's networks, but may not require enrolled recipients to
  use those pharmacies; and
               (3)  may not charge an enrolled recipient who opts to
  use a mail-order pharmacy a fee, including a postage or handling
  fee. (Gov. Code, Secs. 533.005(a)(23)(G), (H), (I).)
         Sec. 540.0278.  PHARMACY BENEFIT PLAN: PROMPT PAYMENT OF
  PHARMACY BENEFIT CLAIMS. A Medicaid managed care organization or
  pharmacy benefit manager, as applicable, under the organization's
  pharmacy benefit plan required by Section 540.0273 in a contract to
  which this subchapter applies, must pay claims in accordance with
  Section 843.339, Insurance Code. (Gov. Code, Sec.
  533.005(a)(23)(J).)
         Sec. 540.0279.  PHARMACY BENEFIT PLAN: MAXIMUM ALLOWABLE
  COST PRICE AND LIST FOR PHARMACY BENEFITS. (a)  A Medicaid managed
  care organization or pharmacy benefit manager, as applicable, under
  the organization's pharmacy benefit plan required by Section
  540.0273 in a contract to which this subchapter applies, must:
               (1)  ensure that, to place a drug on a maximum allowable
  cost list:
                     (A)  the drug is listed as "A" or "B" rated in the
  most recent version of the United States Food and Drug
  Administration's Approved Drug Products with Therapeutic
  Equivalence Evaluations, also known as the Orange Book, has an "NR"
  or "NA" rating or a similar rating by a nationally recognized
  reference; and
                     (B)  the drug is generally available for purchase
  by pharmacies in this state from national or regional wholesalers
  and is not obsolete;
               (2)  review and update maximum allowable cost price
  information at least once every seven days to reflect any maximum
  allowable cost pricing modification;
               (3)  in formulating a drug's maximum allowable cost
  price, use only the price of the drug and drugs listed as
  therapeutically equivalent in the most recent version of the United
  States Food and Drug Administration's Approved Drug Products with
  Therapeutic Equivalence Evaluations, also known as the Orange Book;
               (4)  establish a process for eliminating products from
  the maximum allowable cost list or modifying maximum allowable cost
  prices in a timely manner to remain consistent with pricing changes
  and product availability in the marketplace; and
               (5)  notify the commission not later than the 21st day
  after implementing a practice of using a maximum allowable cost
  list for drugs dispensed at retail but not by mail.
         (b)  A Medicaid managed care organization or pharmacy
  benefit manager, as applicable, under the organization's pharmacy
  benefit plan required by Section 540.0273 in a contract to which
  this subchapter applies, must:
               (1)  provide a procedure for a network pharmacy
  provider to challenge a drug's listed maximum allowable cost price;
               (2)  respond to a challenge not later than the 15th day
  after the date the provider makes the challenge;
               (3)  if the challenge is successful, adjust the drug
  price effective on the date the challenge is resolved and make the
  adjustment applicable to all similarly situated network pharmacy
  providers, as the Medicaid managed care organization or pharmacy
  benefit manager, as appropriate, determines;
               (4)  if the challenge is denied, provide the reason for
  the denial; and
               (5)  report to the commission every 90 days the total
  number of challenges that were made and denied in the preceding
  90-day period for each maximum allowable cost list drug for which a
  challenge was denied during the period.
         (c)  A Medicaid managed care organization or pharmacy
  benefit manager, as applicable, under the organization's pharmacy
  benefit plan required by Section 540.0273 in a contract to which
  this subchapter applies, must provide:
               (1)  to a network pharmacy provider, at the time the
  organization or pharmacy benefit manager enters into or renews a
  contract with the provider, the sources used to determine the
  maximum allowable cost pricing for the maximum allowable cost list
  specific to that provider; and
               (2)  a process for each network pharmacy provider to
  readily access the maximum allowable cost list specific to that
  provider.
         (d)  Except as provided by Subsection (c)(2), a maximum
  allowable cost list specific to a provider that a Medicaid managed
  care organization or pharmacy benefit manager maintains is
  confidential. (Gov. Code, Secs. 533.005(a)(23)(K), (a-2).)
         Sec. 540.0280.  PHARMACY BENEFIT PLAN: PHARMACY BENEFITS FOR
  CHILD ENROLLED IN STAR KIDS MANAGED CARE PROGRAM. A Medicaid
  managed care organization or pharmacy benefit manager, as
  applicable, under the organization's pharmacy benefit plan
  required by Section 540.0273 in a contract to which this subchapter
  applies:
               (1)  may not require a prior authorization, other than
  a clinical prior authorization or a prior authorization the
  commission imposes to minimize the opportunity for fraud, waste, or
  abuse, for or impose any other barriers to a drug that is prescribed
  to a child enrolled in the STAR Kids managed care program for a
  particular disease or treatment and that is on the vendor drug
  program formulary or require additional prior authorization for a
  drug included in the preferred drug list the commission adopts
  under Subchapter E, Chapter 549;
               (2)  must provide continued access to a drug prescribed
  to a child enrolled in the STAR Kids managed care program,
  regardless of whether the drug is on the vendor drug program
  formulary or, if applicable on or after August 31, 2023, the
  organization's formulary;
               (3)  may not use a protocol that requires a child
  enrolled in the STAR Kids managed care program to use a prescription
  drug or sequence of prescription drugs other than the drug the
  child's physician recommends for the child's treatment before the
  organization will cover the recommended drug; and
               (4)  must pay liquidated damages to the commission for
  each failure, as the commission determines, to comply with this
  section in an amount that is a reasonable forecast of the damages
  caused by the noncompliance. (Gov. Code, Sec. 533.005(a)(23)(L).)
  SUBCHAPTER G. PRIOR AUTHORIZATION AND UTILIZATION REVIEW
  PROCEDURES
         Sec. 540.0301.  INAPPLICABILITY OF CERTAIN OTHER LAW TO
  MEDICAID MANAGED CARE UTILIZATION REVIEWS. Section
  4201.304(a)(2), Insurance Code, does not apply to a Medicaid
  managed care organization or a utilization review agent who
  conducts utilization reviews for a Medicaid managed care
  organization. (Gov. Code, Sec. 533.00282(a).)
         Sec. 540.0302.  PRIOR AUTHORIZATION PROCEDURES FOR
  HOSPITALIZED RECIPIENT. (a) This section applies only to a prior
  authorization request submitted with respect to a recipient who is
  hospitalized at the time of the request.
         (b)  In addition to the requirements of Subchapter F, a
  contract between a Medicaid managed care organization and the
  commission to which that subchapter applies must require that,
  notwithstanding any other law, the organization review and issue a
  determination on a prior authorization request to which this
  section applies according to the following time frames:
               (1)  within one business day after the organization
  receives the request, except as provided by Subdivisions (2) and
  (3);
               (2)  within 72 hours after the organization receives
  the request if a provider of acute care inpatient services submits
  the request and the request is for services or equipment necessary
  to discharge the recipient from an inpatient facility; or
               (3)  within one hour after the organization receives
  the request if the request is related to poststabilization care or a
  life-threatening condition. (Gov. Code, Sec. 533.002821.)
         Sec. 540.0303.  PRIOR AUTHORIZATION PROCEDURES FOR
  NONHOSPITALIZED RECIPIENT. (a) This section applies only to a
  prior authorization request submitted with respect to a recipient
  who is not hospitalized at the time of the request.
         (b)  In addition to the requirements of Subchapter F, a
  contract between a Medicaid managed care organization and the
  commission to which that subchapter applies must require that the
  organization review and issue a determination on a prior
  authorization request to which this section applies according to
  the following time frames:
               (1)  within three business days after the organization
  receives the request; or
               (2)  within the time frame and following the process
  the commission establishes if the organization receives a prior
  authorization request that does not include sufficient or adequate
  documentation.
         (c)  In consultation with the state Medicaid managed care
  advisory committee, the commission shall establish a process for
  use by a Medicaid managed care organization that receives a prior
  authorization request to which this section applies that does not
  include sufficient or adequate documentation. The process must
  provide a time frame within which a provider may submit the
  necessary documentation. The time frame must be longer than the
  time frame specified by Subsection (b)(1). (Gov. Code, Secs.
  533.00282(b) (part), (c).)
         Sec. 540.0304.  ANNUAL REVIEW OF PRIOR AUTHORIZATION
  REQUIREMENTS. (a) Each Medicaid managed care organization, in
  consultation with the organization's provider advisory group
  required by contract, shall develop and implement a process for
  conducting an annual review of the organization's prior
  authorization requirements. The annual review process does not
  apply to a prior authorization requirement prescribed by or
  implemented under Subchapter F, Chapter 549, for the vendor drug
  program.
         (b)  In conducting an annual review, a Medicaid managed care
  organization must:
               (1)  solicit, receive, and consider input from
  providers in the organization's provider network; and
               (2)  ensure that each prior authorization requirement
  is based on accurate, up-to-date, evidence-based, and
  peer-reviewed clinical criteria that, as appropriate, distinguish
  between categories of recipients for whom prior authorization
  requests are submitted, including age categories.
         (c)  A Medicaid managed care organization may not impose a
  prior authorization requirement, other than a prior authorization
  requirement prescribed by or implemented under Subchapter F,
  Chapter 549, for the vendor drug program, unless the organization
  reviewed the requirement during the most recent annual review.
         (d)  The commission shall periodically review each Medicaid
  managed care organization to ensure the organization's compliance
  with this section. (Gov. Code, Sec. 533.00283.)
         Sec. 540.0305.  PHYSICIAN CONSULTATION BEFORE ADVERSE PRIOR
  AUTHORIZATION DETERMINATION. In addition to the requirements of
  Subchapter F, a contract between a Medicaid managed care
  organization and the commission to which that subchapter applies
  must require that, before issuing an adverse determination on a
  prior authorization request, the organization provide the
  physician requesting the prior authorization with a reasonable
  opportunity to discuss the request with another physician who:
               (1)  practices in the same or a similar specialty, but
  not necessarily the same subspecialty; and
               (2)  has experience in treating the same category of
  population as the recipient on whose behalf the physician submitted
  the request. (Gov. Code, Sec. 533.00282(b) (part).)
         Sec. 540.0306.  RECONSIDERATION FOLLOWING ADVERSE
  DETERMINATIONS ON CERTAIN PRIOR AUTHORIZATION REQUESTS. (a) In
  consultation with the state Medicaid managed care advisory
  committee, the commission shall establish a uniform process and
  timeline for a Medicaid managed care organization to reconsider an
  adverse determination on a prior authorization request that
  resulted solely from the submission of insufficient or inadequate
  documentation. In addition to the requirements of Subchapter F, a
  contract between a Medicaid managed care organization and the
  commission to which that subchapter applies must include a
  requirement that the organization implement the process and
  timeline.
         (b)  The process and timeline must:
               (1)  allow a provider to submit any documentation
  identified as insufficient or inadequate in the notice provided
  under Section 532.0403;
               (2)  allow the provider requesting the prior
  authorization to discuss the request with another provider who:
                     (A)  practices in the same or a similar specialty,
  but not necessarily the same subspecialty; and
                     (B)  has experience in treating the same category
  of population as the recipient on whose behalf the provider
  submitted the request; and
               (3)  require the Medicaid managed care organization to
  amend the determination on the prior authorization request as
  necessary, considering the additional documentation.
         (c)  An adverse determination on a prior authorization
  request is considered a denial of services in an evaluation of the
  Medicaid managed care organization only if the determination is not
  amended under Subsection (b)(3) to approve the request.
         (d)  The process and timeline for reconsidering an adverse
  determination on a prior authorization request under this section
  do not affect:
               (1)  any related timelines, including the timeline for
  an internal appeal, a Medicaid fair hearing, or a review conducted
  by an external medical reviewer; or
               (2)  any rights of a recipient to appeal a
  determination on a prior authorization request. (Gov. Code, Sec.
  533.00284.)
         Sec. 540.0307.  MAXIMUM PERIOD FOR PRIOR AUTHORIZATION
  DECISION; ACCESS TO CARE. The combined amount of time provided for
  the time frames prescribed by the utilization review and prior
  authorization procedures described by Sections 540.0301, 540.0303,
  and 540.0305 and the timeline for reconsidering an adverse
  determination on a prior authorization described by Section
  540.0306 may not exceed the time frame for a decision under
  federally prescribed time frames. It is the intent of the
  legislature that these provisions allow sufficient time to provide
  necessary documentation and avoid unnecessary denials without
  delaying access to care. (Gov. Code, Sec. 533.002841.)
  SUBCHAPTER H. PREMIUM PAYMENT RATES
         Sec. 540.0351.  PREMIUM PAYMENT RATE DETERMINATION. (a)  In
  determining premium payment rates paid to a managed care
  organization under a managed care plan, the commission shall
  consider:
               (1)  the regional variation in health care service
  costs;
               (2)  the range and type of health care services that
  premium payment rates are to cover;
               (3)  the number of managed care plans in a region;
               (4)  the current and projected number of recipients in
  each region, including the current and projected number for each
  category of recipient;
               (5)  the managed care plan's ability to meet operating
  costs under the proposed premium payment rates;
               (6)  the requirements of the Balanced Budget Act of
  1997 (Pub. L. No. 105-33) and implementing regulations that require
  adequacy of premium payments to Medicaid managed care
  organizations;
               (7)  the adequacy of the management fee paid for
  assisting enrollees of Supplemental Security Income (SSI) (42
  U.S.C. Section 1381 et seq.) who are voluntarily enrolled in the
  managed care plan;
               (8)  the impact of reducing premium payment rates for
  the category of pregnant recipients; and
               (9)  the managed care plan's ability under the proposed
  premium payment rates to pay inpatient and outpatient hospital
  provider payment rates that are comparable to the inpatient and
  outpatient hospital provider payment rates the commission pays
  under a primary care case management model or a partially capitated
  model.
         (b)  The premium payment rates paid to a managed care
  organization that holds a certificate of authority issued under
  Chapter 843, Insurance Code, must be established by a competitive
  bid process but may not exceed the maximum premium payment rates the
  commission establishes under Section 540.0352(b).
         (c)  The commission shall pursue and, if appropriate,
  implement premium rate-setting strategies that encourage provider
  payment reform and more efficient service delivery and provider
  practices. In pursuing the strategies, the commission shall review
  and consider strategies employed or under consideration by other
  states.  If necessary, the commission may request a waiver or other
  authorization from a federal agency to implement strategies the
  commission identifies under this subsection. (Gov. Code, Secs.
  533.013(a), (c), (e).)
         Sec. 540.0352.  MAXIMUM PREMIUM PAYMENT RATES FOR CERTAIN
  PROGRAMS. (a) This section applies only to a Medicaid managed care
  organization that holds a certificate of authority issued under
  Chapter 843, Insurance Code, and with respect to Medicaid managed
  care pilot programs, Medicaid behavioral health pilot programs, and
  Medicaid STAR+PLUS pilot programs implemented in a health care
  service region after June 1, 1999.
         (b)  In determining the maximum premium payment rates paid to
  a Medicaid managed care organization to which this section applies,
  the commission shall consider and adjust for the regional variation
  in costs of services under the traditional fee-for-service
  component of Medicaid, utilization patterns, and other factors that
  influence the potential for cost savings. For a service area with a
  service area factor of .93 or less, or another appropriate service
  area factor, as the commission determines, the commission may not
  discount premium payment rates in an amount that is more than the
  amount necessary to meet federal budget neutrality requirements for
  projected fee-for-service costs unless:
               (1)  a historical review of managed care financial
  results among managed care organizations in the service area the
  organization serves demonstrates that additional savings are
  warranted; or
               (2)  a review of Medicaid fee-for-service delivery in
  the service area the organization serves has historically shown:
                     (A)  significant recipient overutilization of
  certain services covered by the premium payment rates in comparison
  to utilization patterns throughout the rest of this state; or
                     (B)  an above-market cost for services for which
  there is substantial evidence that Medicaid managed care delivery
  will reduce the cost of those services.  (Gov. Code, Secs.
  533.013(b), (d).)
         Sec. 540.0353.  USE OF ENCOUNTER DATA IN DETERMINING PREMIUM
  PAYMENT RATES AND OTHER PAYMENT AMOUNTS. (a) In determining
  premium payment rates and other amounts paid to managed care
  organizations under a managed care plan, the commission may not
  base or derive the rates or amounts on or from encounter data, or
  incorporate in the determination an analysis of encounter data,
  unless a certifier of encounter data certifies that:
               (1)  the encounter data for the most recent state
  fiscal year is complete, accurate, and reliable; and
               (2)  there is no statistically significant variability
  in the encounter data attributable to incompleteness, inaccuracy,
  or another deficiency as compared to equivalent data for similar
  populations and when evaluated against professionally accepted
  standards.
         (b)  In determining whether data is equivalent data for
  similar populations under Subsection (a)(2), a certifier of
  encounter data shall, at a minimum, consider:
               (1)  the regional variation in recipient utilization
  patterns and health care service costs;
               (2)  the range and type of health care services premium
  payment rates are to cover;
               (3)  the number of managed care plans in the region; and
               (4)  the current number of recipients in each region,
  including the number for each recipient category. (Gov. Code, Sec.
  533.0131.)
  SUBCHAPTER I. ENCOUNTER DATA
         Sec. 540.0401.  PROVIDER REPORTING OF ENCOUNTER DATA. The
  commission shall collaborate with Medicaid managed care
  organizations and health care providers in the organizations'
  provider networks to develop incentives and mechanisms to encourage
  providers to report complete and accurate encounter data to the
  organizations in a timely manner. (Gov. Code, Sec. 533.016.)
         Sec. 540.0402.  CERTIFIER OF ENCOUNTER DATA QUALIFICATIONS.
  (a) The state Medicaid director shall appoint a person as the
  certifier of encounter data.
         (b)  The certifier of encounter data must have:
               (1)  demonstrated expertise in estimating premium
  payment rates paid to a managed care organization under a managed
  care plan; and
               (2)  access to actuarial expertise, including
  expertise in estimating premium payment rates paid to a managed
  care organization under a managed care plan.
         (c)  A person may not be appointed as the certifier of
  encounter data if the person participated with the commission in
  developing premium payment rates for managed care organizations
  under managed care plans in this state during the three-year period
  before the date the certifier is appointed.  (Gov. Code, Sec.
  533.017.)
         Sec. 540.0403.  ENCOUNTER DATA CERTIFICATION. (a) The
  certifier of encounter data shall certify the completeness,
  accuracy, and reliability of encounter data for each state fiscal
  year.
         (b)  The commission shall make available to the certifier of
  encounter data all records and data the certifier considers
  appropriate for evaluating whether to certify the encounter data.
  The commission shall provide to the certifier selected resources
  and assistance in obtaining, compiling, and interpreting the
  records and data. (Gov. Code, Sec. 533.018.)
  SUBCHAPTER J. MANAGED CARE PLAN REQUIREMENTS
         Sec. 540.0451.  MEDICAID MANAGED CARE PLAN ACCREDITATION.
  (a)  A Medicaid managed care plan must be accredited by a nationally
  recognized accreditation organization. The commission may:
               (1)  require all Medicaid managed care plans to be
  accredited by the same organization; or
               (2)  allow for accreditation by different
  organizations.
         (b)  The commission may use the data, scoring, and other
  information provided to or received from an accreditation
  organization in the commission's contract oversight process.  (Gov.
  Code, Sec. 533.0031.)
         Sec. 540.0452.  MEDICAL DIRECTOR QUALIFICATIONS. An
  individual who serves as a medical director for a managed care plan
  must be a physician licensed to practice medicine in this state
  under Subtitle B, Title 3, Occupations Code.  (Gov. Code, Sec.
  533.0073.)
  SUBCHAPTER K. MEDICAID MANAGED CARE PLAN ENROLLMENT AND
  DISENROLLMENT
         Sec. 540.0501.  RECIPIENT ENROLLMENT IN AND DISENROLLMENT
  FROM MEDICAID MANAGED CARE PLAN. The commission shall:
               (1)  encourage recipients to choose appropriate
  Medicaid 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 a
  Medicaid managed care organization plans to begin providing 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 the commission establishes under Section
  540.0055(a) after the commission approves the information or
  activities;
               (2)  in assigning plans and providers to recipients who
  fail to choose plans and providers, consider:
                     (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 enrolling recipients in
  and disenrolling recipients from 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 plans; and
               (5)  ensure immediate access to prenatal services and
  newborn care for pregnant women and newborn infants enrolled in
  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. (Gov. Code, Sec. 533.0075.)
         Sec. 540.0502.  AUTOMATIC ENROLLMENT IN MEDICAID MANAGED
  CARE PLAN. (a) If the commission determines that it is feasible
  and notwithstanding any other law, the commission may implement an
  automatic enrollment process under which an applicant determined
  eligible for Medicaid is automatically enrolled in a Medicaid
  managed care plan the applicant chooses.
         (b)  The commission may elect to implement the automatic
  enrollment process for certain recipient populations. (Gov. Code,
  Sec. 533.0025(h).)
         Sec. 540.0503.  ENROLLMENT OF CERTAIN RECIPIENTS IN SAME
  MEDICAID MANAGED CARE PLAN. The commission shall ensure that all
  recipients who are children and who reside in the same household
  may, at the family's election, be enrolled in the same Medicaid
  managed care plan. (Gov. Code, Sec. 533.0027.)
         Sec. 540.0504.  QUALITY-BASED ENROLLMENT INCENTIVE PROGRAM
  FOR MEDICAID MANAGED CARE ORGANIZATIONS. The commission shall
  create an incentive program that automatically enrolls in a
  Medicaid managed care plan a greater percentage of recipients who
  did not actively choose a plan, based on:
               (1)  the quality of care provided through the Medicaid
  managed care organization offering the plan;
               (2)  the organization's ability to efficiently and
  effectively provide services, considering the acuity of
  populations the organization primarily serves; and
               (3)  the organization's performance with respect to
  exceeding or failing to achieve appropriate outcome and process
  measures the commission develops, including measures based on
  potentially preventable events.  (Gov. Code, Sec. 533.00511(b).)
         Sec. 540.0505.  LIMITATIONS ON RECIPIENT DISENROLLMENT FROM
  MEDICAID MANAGED CARE PLAN. (a) Except as provided by Subsections
  (b) and (c) and to the extent permitted by federal law, a recipient
  enrolled in a Medicaid managed care plan may not disenroll from that
  plan and enroll in another Medicaid managed care plan during the
  12-month period after the date the recipient initially enrolls in a
  plan.
         (b)  At any time before the 91st day after the date of a
  recipient's initial enrollment in a Medicaid managed care plan, the
  recipient may disenroll from that plan for any reason and enroll in
  another Medicaid managed care plan.
         (c)  The commission shall allow a recipient who is enrolled
  in a Medicaid managed care plan to disenroll from that plan and
  enroll in another Medicaid managed care plan:
               (1)  at any time for cause in accordance with federal
  law; and
               (2)  once for any reason after the periods described by
  Subsections (a) and (b). (Gov. Code, Sec. 533.0076.)
  SUBCHAPTER L. CONTINUITY OF CARE AND COORDINATION OF BENEFITS
         Sec. 540.0551.  GUIDANCE REGARDING CONTINUATION OF SERVICES
  UNDER CERTAIN CIRCUMSTANCES. The commission shall provide guidance
  and additional education to Medicaid managed care organizations
  regarding federal law requirements to continue providing services
  during an internal appeal, a Medicaid fair hearing, or any other
  review.  (Gov. Code, Sec. 533.005(g).)
         Sec. 540.0552.  COORDINATION OF BENEFITS; CONTINUITY OF
  SPECIALTY CARE FOR CERTAIN RECIPIENTS. (a) In this section,
  "Medicaid wrap-around benefit" means a Medicaid-covered service,
  including a pharmacy or medical benefit, that is provided to a
  recipient who has primary health benefit plan coverage in addition
  to Medicaid coverage when:
               (1)  the recipient has exceeded the primary health
  benefit plan coverage limit; or
               (2)  the service is not covered by the primary health
  benefit plan issuer.
         (b)  The commission, in coordination with Medicaid managed
  care organizations and in consultation with the STAR Kids Managed
  Care Advisory Committee, shall develop and adopt a clear policy for
  a Medicaid managed care organization to ensure the coordination and
  timely delivery of Medicaid wrap-around benefits for recipients who
  have primary health benefit plan coverage in addition to Medicaid
  coverage. In developing the policy, the commission shall consider
  requiring a Medicaid managed care organization to allow,
  notwithstanding Subchapter F, Chapter 549, Section 540.0273, and
  Section 540.0280 or any other law, a recipient using a prescription
  drug for which the recipient's primary health benefit plan issuer
  previously provided coverage to continue receiving the
  prescription drug without requiring additional prior
  authorization.
         (c)  If the commission determines that a recipient's primary
  health benefit plan issuer should have been the primary payor of a
  claim, the Medicaid managed care organization that paid the claim
  shall:
               (1)  work with the commission on the recovery process;
  and
               (2)  make every attempt to reduce health care provider
  and recipient abrasion.
         (d)  The executive commissioner may seek a waiver from the
  federal government as needed to:
               (1)  address federal policies related to coordination
  of benefits and third-party liability; and
               (2)  maximize federal financial participation for
  recipients who have primary health benefit plan coverage in
  addition to Medicaid coverage.
         (e)  The commission may include in the Medicaid managed care
  eligibility files an indication of whether a recipient has primary
  health benefit plan coverage or is enrolled in a group health
  benefit plan for which the commission provides premium assistance
  under the health insurance premium payment program. For a recipient
  with that coverage or for whom that premium assistance is provided,
  the files may include the following up-to-date, accurate
  information related to primary health benefit plan coverage to the
  extent the information is available to the commission:
               (1)  the primary health benefit plan issuer's name and
  address;
               (2)  the recipient's policy number;
               (3)  the primary health benefit plan coverage start and
  end dates; and
               (4)  the primary health benefit plan coverage benefits,
  limits, copayment, and coinsurance information.
         (f)  To the extent allowed by federal law, the commission
  shall maintain processes and policies to allow a health care
  provider who is primarily providing services to a recipient through
  primary health benefit plan coverage to receive Medicaid
  reimbursement for services ordered, referred, or prescribed,
  regardless of whether the provider is enrolled as a Medicaid
  provider. The commission shall allow a provider who is not enrolled
  as a Medicaid provider to order, refer, or prescribe services to a
  recipient based on the provider's national provider identifier
  number and may not require an additional state provider identifier
  number to receive reimbursement for the services. The commission
  may seek a waiver of Medicaid provider enrollment requirements for
  providers of recipients with primary health benefit plan coverage
  to implement this subsection.
         (g)  The commission shall develop a clear and easy process,
  to be implemented through a contract, that allows a recipient with
  complex medical needs who has established a relationship with a
  specialty provider to continue receiving care from that provider,
  regardless of whether the recipient has primary health benefit plan
  coverage in addition to Medicaid coverage.
         (h)  If a recipient who has complex medical needs wants to
  continue to receive care from a specialty provider that is not in
  the provider network of the Medicaid managed care organization
  offering the Medicaid managed care plan in which the recipient is
  enrolled, the organization shall develop a simple, timely, and
  efficient process to, and shall make a good-faith effort to,
  negotiate a single-case agreement with the specialty provider.
  Until the organization and the specialty provider enter into the
  single-case agreement, the specialty provider shall be reimbursed
  in accordance with the applicable reimbursement methodology
  specified in commission rules, including 1 T.A.C. Section 353.4.
         (i)  A single-case agreement entered into under this section
  is not considered accessing an out-of-network provider for the
  purposes of Medicaid managed care organization network adequacy
  requirements. (Gov. Code, Sec. 533.038.)
  SUBCHAPTER M. PROVIDER NETWORK ADEQUACY
         Sec. 540.0601.  MONITORING OF PROVIDER NETWORKS. The
  commission shall establish and implement a process for the direct
  monitoring of a Medicaid managed care organization's provider
  network and providers in the network. The process:
               (1)  must be used to ensure compliance with contractual
  obligations related to:
                     (A)  the number of providers accepting new
  patients under the Medicaid managed care program; and
                     (B)  the length of time a recipient must wait
  between scheduling an appointment with a provider and receiving
  treatment from the provider;
               (2)  may use reasonable methods to ensure compliance
  with contractual obligations, including telephone calls made at
  random times without notice to assess the availability of providers
  and services to new and existing recipients; and
               (3)  may be implemented directly by the commission or
  through a contractor. (Gov. Code, Sec. 533.007(l).)
         Sec. 540.0602.  REPORT ON OUT-OF-NETWORK PROVIDER SERVICES.
  To ensure appropriate access to an adequate provider network, each
  Medicaid managed care organization providing health care services
  to recipients in a health care service region shall submit to the
  commission, in the format and manner the commission prescribes, a
  report detailing the number, type, and scope of services
  out-of-network providers provide to recipients enrolled in a
  Medicaid managed care plan the organization provides. (Gov. Code,
  Sec. 533.007(g) (part).)
         Sec. 540.0603.  REPORT ON COMMISSION INVESTIGATION OF
  PROVIDER COMPLAINT. Not later than the 60th day after the date a
  provider files a complaint with the commission regarding
  reimbursement for or overuse of out-of-network providers by a
  Medicaid managed care organization, the commission shall provide to
  the provider a report regarding the conclusions of the commission's
  investigation. The report must include:
               (1)  a description of any corrective action required of
  the organization that was the subject of the complaint; and
               (2)  if applicable, a conclusion regarding the amount
  of reimbursement owed to an out-of-network provider. (Gov. Code,
  Sec. 533.007(i).)
         Sec. 540.0604.  ADDITIONAL REIMBURSEMENT FOLLOWING PROVIDER
  COMPLAINT. (a) If, after an investigation, the commission
  determines that a Medicaid managed care organization owes
  additional reimbursement to a provider, the organization shall, not
  later than the 90th day after the date the provider filed the
  complaint, pay the additional reimbursement or provide to the
  provider a reimbursement payment plan under which the organization
  must pay the entire amount of the additional reimbursement not
  later than the 120th day after the date the provider filed the
  complaint.
         (b)  The commission may require a Medicaid managed care
  organization to pay interest on any amount of the additional
  reimbursement that is not paid on or before the 90th day after the
  date the provider to whom the amount is owed filed the complaint.  
  If the commission requires the organization to pay interest,
  interest accrues at a rate of 18 percent simple interest per year on
  the unpaid amount beginning on the 90th day after the date the
  provider to whom the amount is owed filed the complaint and accrues
  until the date the organization pays the entire reimbursement
  amount. (Gov. Code, Sec. 533.007(j).)
         Sec. 540.0605.  CORRECTIVE ACTION PLAN FOR INADEQUATE
  NETWORK AND PROVIDER REIMBURSEMENT. (a) The commission shall
  initiate a corrective action plan requiring a Medicaid managed care
  organization to maintain an adequate provider network, provide
  reimbursement to support that network, and educate recipients
  enrolled in Medicaid managed care plans provided by the
  organization regarding the proper use of the plan's provider
  network, if:
               (1)  as the commission determines, the organization
  exceeds maximum limits the commission established for
  out-of-network access to health care services; or
               (2)  based on the commission's investigation of a
  provider complaint regarding reimbursement, the commission
  determines that the organization did not reimburse an
  out-of-network provider based on a reasonable reimbursement
  methodology.
         (b)  The corrective action plan required by Subsection (a)
  must include at least one of the following elements:
               (1)  a requirement that reimbursements the Medicaid
  managed care organization pays to out-of-network providers for a
  health care service provided to a recipient enrolled in a Medicaid
  managed care plan provided by the organization equal the allowable
  rate for the service, as determined under Sections 32.028 and
  32.0281, Human Resources Code, for all health care services
  provided during the period the organization:
                     (A)  is not in compliance with the utilization
  benchmarks the commission determines; or
                     (B)  is not reimbursing out-of-network providers
  based on a reasonable methodology, as the commission determines;
               (2)  an immediate freeze on the enrollment of
  additional recipients in a Medicaid managed care plan the
  organization provides that continues until the commission
  determines that the provider network under the plan can adequately
  meet the needs of additional recipients; and
               (3)  other actions the commission determines are
  necessary to ensure that recipients enrolled in a Medicaid managed
  care plan the organization provides have access to appropriate
  health care services and that providers are properly reimbursed for
  providing medically necessary health care services to those
  recipients. (Gov. Code, Secs. 533.007(g) (part), (h).)
         Sec. 540.0606.  REMEDIES FOR NONCOMPLIANCE WITH CORRECTIVE
  ACTION PLAN. The commission shall pursue any appropriate remedy
  authorized in the contract between the Medicaid managed care
  organization and the commission if the organization fails to comply
  with a corrective action plan under Section 540.0605(a). (Gov.
  Code, Sec. 533.007(k).)
  SUBCHAPTER N. PROVIDERS
         Sec. 540.0651.  INCLUSION OF CERTAIN PROVIDERS IN MEDICAID
  MANAGED CARE ORGANIZATION PROVIDER NETWORK. (a) The commission
  shall require that each managed care organization that contracts
  with the commission under any managed care model or arrangement to
  provide health care services to recipients in a region:
               (1)  seek participation in the organization's provider
  network from:
                     (A)  each health care provider in the region who
  has traditionally provided care to recipients;
                     (B)  each hospital in the region that has been
  designated as a disproportionate share hospital under Medicaid; and
                     (C)  each specialized pediatric laboratory in the
  region, including a laboratory located in a children's hospital;
               (2)  include in the organization's provider network for
  at least three years:
                     (A)  each health care provider in the region who:
                           (i)  previously provided care to Medicaid
  and charity care recipients at a significant level as the
  commission prescribes;
                           (ii)  agrees to accept the organization's
  prevailing provider contract rate; and
                           (iii)  has the credentials the organization
  requires, provided that lack of board certification or
  accreditation by The Joint Commission may not be the sole ground for
  exclusion from the provider network;
                     (B)  each accredited primary care residency
  program in the region; and
                     (C)  each disproportionate share hospital the
  commission designates as a statewide significant traditional
  provider; and
               (3)  subject to Section 32.047, Human Resources Code,
  and notwithstanding any other law, include in the organization's
  provider network each optometrist, therapeutic optometrist, and
  ophthalmologist described by Section 532.0153(b)(1)(A) or (B) who,
  and an institution of higher education described by Section
  532.0153(a)(4) in the region that:
                     (A)  agrees to comply with the organization's
  terms;
                     (B)  agrees to accept the organization's
  prevailing provider contract rate;
                     (C)  agrees to abide by the organization's
  required standards of care; and
                     (D)  is an enrolled Medicaid provider.
         (b)  A contract between a Medicaid managed care organization
  and the commission for the organization to provide health care
  services to recipients in a health care service region that
  includes a rural area must require the organization to include in
  the organization's provider network rural hospitals, physicians,
  home and community support services agencies, and other rural
  health care providers who:
               (1)  are sole community providers;
               (2)  provide care to Medicaid and charity care
  recipients at a significant level as the commission prescribes;
               (3)  agree to accept the organization's prevailing
  provider contract rate; and
               (4)  have the credentials the organization requires,
  provided that lack of board certification or accreditation by The
  Joint Commission may not be the sole ground for exclusion from the
  provider network. (Gov. Code, Secs. 533.006, 533.0067.)
         Sec. 540.0652.  PROVIDER ACCESS STANDARDS; BIENNIAL REPORT.
  (a) The commission shall establish minimum provider access
  standards for a Medicaid managed care organization's provider
  network. The provider access standards must ensure that a Medicaid
  managed care organization provides recipients sufficient access
  to:
               (1)  preventive care;
               (2)  primary care;
               (3)  specialty care;
               (4)  after-hours urgent care;
               (5)  chronic care;
               (6)  long-term services and supports;
               (7)  nursing services;
               (8)  therapy services, including services provided in a
  clinical setting or in a home or community-based setting; and
               (9)  any other services the commission identifies.
         (b)  To the extent feasible, the provider access standards
  must:
               (1)  distinguish between access to providers in urban
  and rural settings;
               (2)  consider the number and geographic distribution of
  Medicaid-enrolled providers in a particular service delivery area;
  and
               (3)  subject to Section 548.0054(a) and consistent with
  Section 111.007, Occupations Code, consider and include the
  availability of telehealth services and telemedicine medical
  services in a Medicaid managed care organization's provider
  network.
         (c)  The commission shall biennially submit to the
  legislature and make available to the public a report that
  contains:
               (1)  information and statistics on:
                     (A)  recipient access to providers through
  Medicaid managed care organizations' provider networks; and
                     (B)  Medicaid managed care organization
  compliance with contractual obligations related to provider access
  standards;
               (2)  a compilation and analysis of information Medicaid
  managed care organizations submit to the commission under Section
  540.0260(4);
               (3)  for both primary care providers and specialty
  providers, information on provider-to-recipient ratios in a
  Medicaid managed care organization's provider network and
  benchmark ratios to indicate whether deficiencies exist in a given
  network; and
               (4)  a description of, and analysis of the results
  from, the commission's monitoring process established under
  Section 540.0601. (Gov. Code, Sec. 533.0061.)
         Sec. 540.0653.  PENALTIES AND OTHER REMEDIES FOR FAILURE TO
  COMPLY WITH PROVIDER ACCESS STANDARDS. If a Medicaid managed care
  organization fails to comply with one or more provider access
  standards the commission establishes under Section 540.0652 and the
  commission determines the organization has not made substantial
  efforts to mitigate or remedy the noncompliance, the commission:
               (1)  may:
                     (A)  elect to not retain or renew the commission's
  contract with the organization; or
                     (B)  require the organization to pay liquidated
  damages in accordance with Section 540.0260(3); and
               (2)  if the organization's noncompliance occurs in a
  given service delivery area for two consecutive calendar quarters,
  shall suspend default enrollment to the organization in that
  service delivery area for at least one calendar quarter. (Gov.
  Code, Sec. 533.0062.)
         Sec. 540.0654.  PROVIDER NETWORK DIRECTORIES. (a) The
  commission shall ensure that a Medicaid managed care organization:
               (1)  posts on the organization's Internet website:
                     (A)  the organization's provider network
  directory; and
                     (B)  a direct telephone number and e-mail address
  through which a recipient enrolled in the organization's managed
  care plan or the recipient's provider may contact the organization
  to receive assistance with:
                           (i)  identifying in-network providers and
  services available to the recipient; and
                           (ii)  scheduling an appointment for the
  recipient with an available in-network provider or to access
  available in-network services; and
               (2)  updates the online directory required under
  Subdivision (1)(A) at least monthly.
         (b)  A Medicaid managed care organization is required to send
  a paper form of the organization's provider network directory for
  the program only to a recipient who requests to receive the
  directory in paper form. (Gov. Code, Sec. 533.0063.)
         Sec. 540.0655.  PROVIDER PROTECTION PLAN. (a) The
  commission shall develop and implement a provider protection plan
  designed to:
               (1)  reduce administrative burdens on providers
  participating in a Medicaid managed care model or arrangement
  implemented under this chapter or Chapter 540A; and
               (2)  ensure efficient provider enrollment and
  reimbursement.
         (b)  To the greatest extent possible, the commission shall
  incorporate the measures in the provider protection plan into each
  contract between a managed care organization and the commission to
  provide health care services to recipients.
         (c)  The provider protection plan must provide for:
               (1)  a Medicaid managed care organization's prompt
  payment to and proper reimbursement of providers;
               (2)  prompt and accurate claim adjudication through:
                     (A)  educating providers on properly submitting
  clean claims and on appeals;
                     (B)  accepting uniform forms, including HCFA
  Forms 1500 and UB-92 and subsequent versions of those forms,
  through an electronic portal; and
                     (C)  establishing standards for claims payments
  in accordance with a provider's contract;
               (3)  adequate and clearly defined provider network
  standards that:
                     (A)  are specific to provider type, including
  physicians, general acute care facilities, and other provider types
  defined in the commission's network adequacy standards in effect on
  January 1, 2013; and
                     (B)  ensure choice among multiple providers to the
  greatest extent possible;
               (4)  a prompt credentialing process for providers;
               (5)  uniform efficiency standards and requirements for
  Medicaid managed care organizations for submitting and tracking
  preauthorization requests for Medicaid services;
               (6)  establishing an electronic process, including the
  use of an Internet portal, through which providers in any managed
  care organization's provider network may:
                     (A)  submit electronic claims, prior
  authorization requests, claims appeals and reconsiderations,
  clinical data, and other documents that the organization requests
  for prior authorization and claims processing; and
                     (B)  obtain electronic remittance advice,
  explanation of benefits statements, and other standardized
  reports;
               (7)  measuring Medicaid managed care organization
  retention rates of significant traditional providers;
               (8)  creating a work group to review and make
  recommendations to the commission concerning any requirement under
  this subsection for which immediate implementation is not feasible
  at the time the plan is otherwise implemented, including the
  required process for submitting and accepting attachments for
  claims processing and prior authorization requests through an
  electronic process under Subdivision (6) and, for any requirement
  that is not implemented immediately, recommendations regarding the
  expected:
                     (A)  fiscal impact of implementing the
  requirement; and
                     (B)  timeline for implementing the requirement;
  and
               (9)  any other provision the commission determines will
  ensure efficiency or reduce administrative burdens on providers
  participating in a Medicaid managed care model or arrangement.
  (Gov. Code, Sec. 533.0055.)
         Sec. 540.0656.  EXPEDITED CREDENTIALING PROCESS FOR CERTAIN
  PROVIDERS. (a) In this section, "applicant provider" means a
  physician or other health care provider applying for expedited
  credentialing.
         (b)  Notwithstanding any other law and subject to Subsection
  (c), a Medicaid managed care organization shall establish and
  implement an expedited credentialing process that allows an
  applicant provider to provide services to recipients on a
  provisional basis.
         (c)  The commission shall identify the types of providers for
  which a Medicaid managed care organization must establish and
  implement an expedited credentialing process.
         (d)  To qualify for expedited credentialing and payment
  under Subsection (e), an applicant provider must:
               (1)  be a member of an established health care provider
  group that has a current contract with a Medicaid managed care
  organization;
               (2)  be a Medicaid-enrolled provider;
               (3)  agree to comply with the terms of the contract
  described by Subdivision (1); and
               (4)  submit all documentation and other information the
  Medicaid managed care organization requires as necessary to enable
  the organization to begin the credentialing process the
  organization requires to include a provider in the organization's
  provider network.
         (e)  On an applicant provider's submission of the
  information the Medicaid managed care organization requires under
  Subsection (d), and for Medicaid reimbursement purposes only, the
  organization shall treat the provider as if the provider were in the
  organization's provider network when the provider provides
  services to recipients, subject to Subsections (f) and (g).
         (f)  Except as provided by Subsection (g), a Medicaid managed
  care organization that determines on completion of the
  credentialing process that an applicant provider does not meet the
  organization's credentialing requirements may recover from the
  provider the difference between payments for in-network benefits
  and out-of-network benefits.
         (g)  A Medicaid managed care organization that determines on
  completion of the credentialing process that an applicant provider
  does not meet the organization's credentialing requirements and
  that the provider made fraudulent claims in the provider's
  application for credentialing may recover from the provider the
  entire amount the organization paid the provider. (Gov. Code, Sec.
  533.0064.)
         Sec. 540.0657.  FREQUENCY OF PROVIDER RECREDENTIALING. (a)
  A Medicaid managed care organization shall formally recredential a
  physician or other provider with the frequency required by the
  single, consolidated Medicaid provider enrollment and
  credentialing process, if that process is created under Section
  532.0151.
         (b)  Notwithstanding any other law, the required frequency
  of recredentialing may be less frequent than once in any three-year
  period. (Gov. Code, Sec. 533.0065.)
         Sec. 540.0658.  PROVIDER INCENTIVES FOR PROMOTING
  PREVENTIVE SERVICES. To the extent possible, the commission shall
  work to ensure that a Medicaid managed care organization provides
  payment incentives to a health care provider in the organization's
  provider network whose performance in promoting recipient use of
  preventive services exceeds minimum established standards. (Gov.
  Code, Sec. 533.0066.)
         Sec. 540.0659.  REIMBURSEMENT RATE FOR CERTAIN SERVICES
  PROVIDED BY CERTAIN HEALTH CENTERS AND CLINICS OUTSIDE REGULAR
  BUSINESS HOURS. (a) This section applies only to a recipient
  receiving benefits through a Medicaid managed care model or
  arrangement.
         (b)  The commission shall ensure that a federally qualified
  health center, rural health clinic, or municipal health
  department's public clinic is reimbursed for health care services
  provided to a recipient outside of regular business hours,
  including on a weekend or holiday, at a rate that is equal to the
  allowable rate for those services as determined under Section
  32.028, Human Resources Code, regardless of whether the recipient
  has a referral from the recipient's primary care provider.
         (c)  The executive commissioner shall adopt rules regarding
  the days, times of days, and holidays that are considered to be
  outside of regular business hours for purposes of Subsection (b).
  (Gov. Code, Sec. 533.01315.)
  SUBCHAPTER O. DELIVERY OF SERVICES: GENERAL PROVISIONS
         Sec. 540.0701.  ACUTE CARE SERVICE DELIVERY THROUGH MOST
  COST-EFFECTIVE MODEL; MANAGED CARE SERVICE DELIVERY AREAS. (a)
  Except as otherwise provided by this section and notwithstanding
  any other law, the commission shall provide Medicaid acute care
  services through the most cost-effective model of Medicaid
  capitated managed care as the commission determines. The
  commission shall require mandatory participation in a Medicaid
  capitated managed care program for all individuals eligible for
  Medicaid acute care benefits, but may implement alternative models
  or arrangements, including a traditional fee-for-service
  arrangement, if the commission determines the alternative would be
  more cost-effective or efficient.
         (b)  In determining whether a model or arrangement described
  by Subsection (a) is more cost-effective, the executive
  commissioner must consider:
               (1)  the scope, duration, and types of health benefits
  or services to be provided in a certain part of this state or to a
  certain recipient population;
               (2)  administrative costs necessary to meet federal and
  state statutory and regulatory requirements;
               (3)  the anticipated effect of market competition
  associated with the configuration of Medicaid service delivery
  models the commission determines; and
               (4)  the gain or loss to this state of a tax collected
  under Chapter 222, Insurance Code.
         (c)  If the commission determines that it is not more
  cost-effective to use a Medicaid managed care model to provide
  certain types of Medicaid acute care in a certain area or to certain
  recipients as prescribed by this section, the commission shall
  provide Medicaid acute care through a traditional fee-for-service
  arrangement.
         (d)  The commission shall determine the most cost-effective
  alignment of managed care service delivery areas. The executive
  commissioner may consider:
               (1)  the number of lives impacted;
               (2)  the usual source of health care services for
  residents in an area; and
               (3)  other factors that impact health care service
  delivery in the area. (Gov. Code, Secs. 533.0025(b), (c), (d),
  (e).)
         Sec. 540.0702.  TRANSITION OF CASE MANAGEMENT FOR CHILDREN
  AND PREGNANT WOMEN PROGRAM RECIPIENTS TO MEDICAID MANAGED CARE
  PROGRAM. (a)  In this section, "children and pregnant women
  program" means the Medicaid benefits program administered by the
  Department of State Health Services that provides case management
  services to children who have a health condition or health risk and
  pregnant women who have a high-risk condition.
         (b)  The commission shall transition to a Medicaid managed
  care model all case management services provided to children and
  pregnant women program recipients.  In transitioning the services,
  the commission shall ensure a recipient is provided case management
  services through the Medicaid managed care plan in which the
  recipient is enrolled.
         (c)  In implementing this section, the commission shall
  ensure that:
               (1)  there is a seamless transition in case management
  services for children and pregnant women program recipients; and
               (2)  case management services provided under the
  program are not interrupted. (Gov. Code, Sec. 533.002555.)
         Sec. 540.0703.  BEHAVIORAL HEALTH AND PHYSICAL HEALTH
  SERVICES. (a) In this section, "behavioral health services" means
  mental health and substance use disorder services.
         (b)  To the greatest extent possible, the commission shall
  integrate the following services into the Medicaid managed care
  program:
               (1)  behavioral health services, including targeted
  case management and psychiatric rehabilitation services; and
               (2)  physical health services.
         (c)  A Medicaid managed care organization shall:
               (1)  develop a network of public and private behavioral
  health services providers; and
               (2)  ensure adults with serious mental illness and
  children with serious emotional disturbance have access to a
  comprehensive array of services.
         (d)  In implementing this section, the commission shall
  ensure that:
               (1)  an appropriate assessment tool is used to
  authorize services;
               (2)  providers are well-qualified and able to provide
  an appropriate array of services;
               (3)  appropriate performance and quality outcomes are
  measured;
               (4)  two health home pilot programs are established in
  two health service areas, representing two distinct regions of this
  state, for individuals who are diagnosed with:
                     (A)  a serious mental illness; and
                     (B)  at least one other chronic health condition;
               (5)  a health home established under a pilot program
  under Subdivision (4) complies with the principles for
  patient-centered medical homes described in Section 540.0712; and
               (6)  all behavioral health services provided under this
  section are based on an approach to treatment in which the expected
  outcome of treatment is recovery.
         (e)  If the commission determines that it is cost-effective
  and beneficial to recipients, the commission shall include a peer
  specialist as a benefit to recipients or as a provider type.
         (f)  To the extent of any conflict between this section and
  any other law relating to behavioral health services, this section
  prevails.
         (g)  The executive commissioner shall adopt rules necessary
  to implement this section. (Gov. Code, Sec. 533.00255.)
         Sec. 540.0704.  TARGETED CASE MANAGEMENT AND PSYCHIATRIC
  REHABILITATIVE SERVICES FOR CHILDREN, ADOLESCENTS, AND FAMILIES.
  (a) A provider in the provider network of a Medicaid managed care
  organization that contracts with the commission to provide
  behavioral health services under Section 540.0703 may contract with
  the organization to provide targeted case management and
  psychiatric rehabilitative services to children, adolescents, and
  their families.
         (b)  Commission rules and guidelines concerning contract and
  training requirements applicable to the provision of behavioral
  health services may apply to a provider that contracts with a
  Medicaid managed care organization under Subsection (a) only to the
  extent those contract and training requirements are specific to the
  provision of targeted case management and psychiatric
  rehabilitative services to children, adolescents, and their
  families.
         (c)  Commission rules and guidelines applicable to a
  provider that contracts with a Medicaid managed care organization
  under Subsection (a) may not require the provider to provide a
  behavioral health crisis hotline or a mobile crisis team that
  operates 24 hours per day and seven days per week. This subsection
  does not prohibit a Medicaid managed care organization that
  contracts with the commission to provide behavioral health services
  under Section 540.0703 from specifically contracting with a
  provider for the provision of a behavioral health crisis hotline or
  a mobile crisis team that operates 24 hours per day and seven days
  per week.
         (d)  Commission rules and guidelines applicable to a
  provider that contracts with a Medicaid managed care organization
  to provide targeted case management and psychiatric rehabilitative
  services specific to children and adolescents who are at risk of
  juvenile justice involvement, expulsion from school, displacement
  from the home, hospitalization, residential treatment, or serious
  injury to self, others, or animals may not require the provider to
  also provide less intensive psychiatric rehabilitative services
  specified by commission rules and guidelines as applicable to the
  provision of targeted case management and psychiatric
  rehabilitative services to children, adolescents, and their
  families, if that provider has a referral arrangement to provide
  access to those less intensive psychiatric rehabilitative
  services.
         (e)  Commission rules and guidelines applicable to a
  provider that contracts with a Medicaid managed care organization
  under Subsection (a) may not require the provider to provide
  services not covered under Medicaid. (Gov. Code, Sec. 533.002552.)
         Sec. 540.0705.  BEHAVIORAL HEALTH SERVICES PROVIDED THROUGH
  THIRD PARTY OR SUBSIDIARY. (a) In this section, "behavioral health
  services" has the meaning assigned by Section 540.0703.
         (b)  For a Medicaid managed care organization that provides
  behavioral health services through a contract with a third party or
  an arrangement with a subsidiary of the organization, the
  commission shall:
               (1)  require the effective sharing and integration of
  care coordination, service authorization, and utilization
  management data between the organization and the third party or
  subsidiary;
               (2)  encourage the colocation of physical health and
  behavioral health care coordination staff, to the extent feasible;
               (3)  require warm call transfers between physical
  health and behavioral health care coordination staff;
               (4)  require the organization and the third party or
  subsidiary to implement joint rounds for physical health and
  behavioral health services network providers or some other
  effective means for sharing clinical information; and
               (5)  ensure that the organization makes available a
  seamless provider portal for both physical health and behavioral
  health services network providers, to the extent allowed by federal
  law. (Gov. Code, Sec. 533.002553.)
         Sec. 540.0706.  PSYCHOTROPIC MEDICATION MONITORING SYSTEM
  FOR CERTAIN CHILDREN. (a) In this section, "psychotropic
  medication" has the meaning assigned by Section 266.001, Family
  Code.
         (b)  The commission shall implement a system under which the
  commission will use Medicaid prescription drug data to monitor the
  prescribing of psychotropic medications for:
               (1)  children who are in the conservatorship of the
  Department of Family and Protective Services and enrolled in the
  STAR Health program or eligible for both Medicaid and Medicare; and
               (2)  children who are under the supervision of the
  Department of Family and Protective Services through an agreement
  under the Interstate Compact on the Placement of Children under
  Subchapter B, Chapter 162, Family Code.
         (c)  The commission shall include as a component of the
  monitoring system a medical review of a prescription to which
  Subsection (b) applies when that review is appropriate. (Gov. Code,
  Sec. 533.0161.)
         Sec. 540.0707.  MEDICATION THERAPY MANAGEMENT. The
  executive commissioner shall collaborate with Medicaid managed
  care organizations to implement medication therapy management
  services to lower costs and improve quality outcomes for recipients
  by reducing adverse drug events. (Gov. Code, Sec. 533.00515.)
         Sec. 540.0708.  SPECIAL DISEASE MANAGEMENT. (a) The
  commission shall ensure that a Medicaid managed care organization
  develops and implements special disease management programs to
  manage a disease or other chronic health condition with respect to
  which disease management would be cost-effective for populations
  the commission identifies. The special disease management programs
  may manage a disease or other chronic health condition such as:
               (1)  heart disease;
               (2)  chronic kidney disease and related medical
  complications;
               (3)  respiratory illness, including asthma;
               (4)  diabetes;
               (5)  end-stage renal disease;
               (6)  HIV infection; or
               (7)  AIDS.
         (b)  A Medicaid managed care plan must provide, in the manner
  the commission requires, disease management services including:
               (1)  patient self-management education;
               (2)  provider education;
               (3)  evidence-based models and minimum standards of
  care;
               (4)  standardized protocols and participation
  criteria; and
               (5)  physician-directed or physician-supervised care.
         (c)  The executive commissioner by rule shall prescribe the
  minimum requirements that a Medicaid managed care organization must
  meet in providing a special disease management program to be
  eligible to receive a contract under this section. The
  organization must at a minimum be required to:
               (1)  provide disease management services that have
  performance measures for particular diseases that are comparable to
  the relevant performance measures applicable to a provider of
  disease management services under Section 32.057, Human Resources
  Code;
               (2)  show evidence of ability to manage complex
  diseases in the Medicaid population; and
               (3)  if a special disease management program the
  organization provides has low active participation rates, identify
  the reason for the low rates and develop an approach to increase
  active participation in special disease management programs for
  high-risk recipients.
         (d)  If a Medicaid managed care organization implements a
  special disease management program to manage chronic kidney disease
  and related medical complications as provided by Subsection (a) and
  the organization develops a program to provide screening for and
  diagnosis and treatment of chronic kidney disease and related
  medical complications to recipients under the organization's
  Medicaid managed care plan, the program for screening, diagnosis,
  and treatment must use generally recognized clinical practice
  guidelines and laboratory assessments that identify chronic kidney
  disease on the basis of impaired kidney function or the presence of
  kidney damage. (Gov. Code, Sec. 533.009.)
         Sec. 540.0709.  SPECIAL PROTOCOLS FOR INDIGENT POPULATIONS.
  In conjunction with an academic center, the commission may study
  the treatment of indigent populations to develop special protocols
  for use by Medicaid managed care organizations in providing health
  care services to recipients.  (Gov. Code, Sec. 533.010.)
         Sec. 540.0710.  DIRECT ACCESS TO EYE HEALTH CARE SERVICES.
  (a) Notwithstanding any other law, the commission shall ensure
  that a Medicaid managed care plan offered by a Medicaid managed care
  organization and any other Medicaid managed care model or
  arrangement implemented under this chapter allow a recipient
  receiving services through the plan or other model or arrangement
  to, in the manner and to the extent required by Section 32.072,
  Human Resources Code:
               (1)  select an in-network ophthalmologist or
  therapeutic optometrist in the managed care network to provide eye
  health care services other than surgery; and
               (2)  have direct access to the selected in-network
  ophthalmologist or therapeutic optometrist for the nonsurgical
  services.
         (b)  This section does not affect the obligation of an
  ophthalmologist or therapeutic optometrist in a managed care
  network to comply with the terms of the Medicaid managed care plan.
  (Gov. Code, Sec. 533.0026.)
         Sec. 540.0711.  DELIVERY OF BENEFITS USING
  TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY. (a)  The commission
  shall establish policies and procedures to improve access to care
  under the Medicaid managed care program by encouraging the use
  under the program of:
               (1)  telehealth services;
               (2)  telemedicine medical services;
               (3)  home telemonitoring services; and
               (4)  other telecommunications or information
  technology.
         (b)  To the extent allowed by federal law, the executive
  commissioner by rule shall establish policies and procedures that
  allow a Medicaid managed care organization to conduct assessments
  and provide care coordination services using telecommunications or
  information technology.  In establishing the policies and
  procedures, the executive commissioner shall consider:
               (1)  the extent to which a Medicaid managed care
  organization determines using the telecommunications or
  information technology is appropriate;
               (2)  whether the recipient requests that the assessment
  or service be provided using telecommunications or information
  technology;
               (3)  whether the recipient consents to receiving the
  assessment or service using telecommunications or information
  technology;
               (4)  whether conducting the assessment, including an
  assessment for an initial waiver eligibility determination, or
  providing the service in person is not feasible because of the
  existence of an emergency or state of disaster, including a public
  health emergency or natural disaster; and
               (5)  whether the commission determines using the
  telecommunications or information technology is appropriate under
  the circumstances.
         (c)  If a Medicaid managed care organization conducts an
  assessment of or provides care coordination services to a recipient
  using telecommunications or information technology, the
  organization shall:
               (1)  monitor the health care services provided to the
  recipient for evidence of fraud, waste, and abuse; and
               (2)  determine whether additional social services or
  supports are needed.
         (d)  To the extent allowed by federal law, the commission
  shall allow a recipient who is assessed or provided with care
  coordination services by a Medicaid managed care organization using
  telecommunications or information technology to provide consent or
  other authorizations to receive services verbally instead of in
  writing.
         (e)  The commission shall determine categories of recipients
  of home and community-based services who must receive in-person
  visits.  Except during circumstances described by Subsection
  (b)(4), a Medicaid managed care organization shall, for a recipient
  of home and community-based services for which the commission
  requires in-person visits, conduct:
               (1)  at least one in-person visit with the recipient to
  make an initial waiver eligibility determination; and
               (2)  additional in-person visits with the recipient if
  necessary, as determined by the organization.
         (f)  Notwithstanding this section, the commission may, on a
  case-by-case basis, require a Medicaid managed care organization to
  discontinue the use of telecommunications or information
  technology for assessment or care coordination services if the
  commission determines that the discontinuation is in the
  recipient's best interest. (Gov. Code, Sec. 533.039.)
         Sec. 540.0712.  PROMOTION AND PRINCIPLES OF
  PATIENT-CENTERED MEDICAL HOME. (a) In this section,
  "patient-centered medical home" means a medical relationship:
               (1)  between a primary care physician and a patient in
  which the physician:
                     (A)  provides comprehensive primary care to the
  patient; and
                     (B)  facilitates partnerships between the
  physician, the patient, any acute care and other care providers,
  and, when appropriate, the patient's family; and
               (2)  that encompasses the following primary
  principles:
                     (A)  the patient has an ongoing relationship with
  the physician, who is trained to be the first contact for and to
  provide continuous and comprehensive care to the patient;
                     (B)  the physician leads a team of individuals at
  the practice level who are collectively responsible for the
  patient's ongoing care;
                     (C)  the physician is responsible for providing
  all of the care the patient needs or for coordinating with other
  qualified providers to provide care to the patient throughout the
  patient's life, including preventive care, acute care, chronic
  care, and end-of-life care;
                     (D)  the patient's care is coordinated across
  health care facilities and the patient's community and is
  facilitated by registries, information technology, and health
  information exchange systems to ensure that the patient receives
  care when and where the patient wants and needs the care and in a
  culturally and linguistically appropriate manner; and
                     (E)  quality and safe care is provided.
         (b)  The commission shall, to the extent possible, work to
  ensure that Medicaid managed care organizations:
               (1)  promote the development of patient-centered
  medical homes for recipients; and
               (2)  provide payment incentives for providers that meet
  the requirements of a patient-centered medical home. (Gov. Code,
  Sec. 533.0029.)
         Sec. 540.0713.  VALUE-ADDED SERVICES. The commission shall
  actively encourage Medicaid managed care organizations to offer
  benefits, including health care services or benefits or other types
  of services, that:
               (1)  are in addition to the services ordinarily covered
  by the Medicaid managed care plan the organization offers; and
               (2)  have the potential to improve the health status of
  recipients enrolled in the plan. (Gov. Code, Sec. 533.019.)
  SUBCHAPTER P. DELIVERY OF SERVICES: STAR+PLUS MEDICAID MANAGED CARE
  PROGRAM
         Sec. 540.0751.  DELIVERY OF ACUTE CARE SERVICES AND
  LONG-TERM SERVICES AND SUPPORTS. Subject to Sections 540.0701 and
  540.0753, the commission shall expand the STAR+PLUS Medicaid
  managed care program to all areas of this state to serve individuals
  eligible for Medicaid acute care services and long-term services
  and supports. (Gov. Code, Sec. 533.00251(b).)
         Sec. 540.0752.  DELIVERY OF MEDICAID BENEFITS TO NURSING
  FACILITY RESIDENTS. (a) In this section:
               (1)  "Clean claim" means a claim that meets the same
  criteria the commission uses for a clean claim in reimbursing
  nursing facility claims.
               (2)  "Nursing facility" means a convalescent or nursing
  home or related institution licensed under Chapter 242, Health and
  Safety Code, that provides long-term services and supports to
  recipients.
         (b)  Subject to Section 540.0701 and notwithstanding any
  other law, the commission shall provide Medicaid benefits through
  the STAR+PLUS Medicaid managed care program to recipients who
  reside in nursing facilities. In implementing this subsection, the
  commission shall ensure that:
               (1)  a nursing facility is paid not later than the 10th
  day after the date the facility submits a clean claim;
               (2)  services are used appropriately, consistent with
  criteria the commission establishes;
               (3)  the incidence of potentially preventable events
  and unnecessary institutionalizations is reduced;
               (4)  a Medicaid managed care organization providing
  services under the program:
                     (A)  provides discharge planning, transitional
  care, and other education programs to physicians and hospitals
  regarding all available long-term care settings;
                     (B)  assists in collecting applied income from
  recipients; and
                     (C)  provides payment incentives to nursing
  facility providers that:
                           (i)  reward reductions in preventable acute
  care costs; and
                           (ii)  encourage transformative efforts in
  the delivery of nursing facility services, including efforts to
  promote a resident-centered care culture through facility design
  and services provided;
               (5)  a portal is established that complies with state
  and federal regulations, including standard coding requirements,
  through which nursing facility providers participating in the
  program may submit claims to any participating Medicaid managed
  care organization;
               (6)  rules and procedures relating to certifying and
  decertifying nursing facility beds under Medicaid are not affected;
               (7)  a Medicaid managed care organization providing
  services under the program, to the greatest extent possible, offers
  nursing facility providers access to:
                     (A)  acute care professionals; and
                     (B)  telemedicine, when feasible and in
  accordance with state law, including rules adopted by the Texas
  Medical Board; and
               (8)  the commission approves the staff rate enhancement
  methodology for the staff rate enhancement paid to a nursing
  facility that qualifies for the enhancement under the program.
         (c)  The commission shall establish credentialing and
  minimum performance standards for nursing facility providers
  seeking to participate in the STAR+PLUS Medicaid managed care
  program that are consistent with adopted federal and state
  standards. A Medicaid managed care organization may refuse to
  contract with a nursing facility provider if the nursing facility
  does not meet the minimum performance standards the commission
  establishes under this section.
         (d)  In addition to the minimum performance standards the
  commission establishes for nursing facility providers seeking to
  participate in the STAR+PLUS Medicaid managed care program, the
  executive commissioner shall adopt rules establishing minimum
  performance standards applicable to nursing facility providers
  that participate in the program. The commission is responsible for
  monitoring provider performance in accordance with the standards
  and requiring corrective actions, as the commission determines
  necessary, from providers that do not meet the standards. The
  commission shall share data regarding the requirements of this
  subsection with STAR+PLUS Medicaid managed care organizations as
  appropriate.
         (e)  A managed care organization may not require prior
  authorization for a nursing facility resident in need of emergency
  hospital services. (Gov. Code, Secs. 533.00251(a)(2), (3), (c) as
  eff. Sept. 1, 2023, (e), (f), (h).)
         Sec. 540.0753.  DELIVERY OF BASIC ATTENDANT AND HABILITATION
  SERVICES. Subject to Section 542.0152, the commission shall:
               (1)  implement the option for the delivery of basic
  attendant and habilitation services to individuals with
  disabilities under the STAR+PLUS Medicaid managed care program
  that:
                     (A)  is the most cost-effective; and
                     (B)  maximizes federal funding for the delivery of
  services for that program and other similar programs; and
               (2)  provide voluntary training to individuals
  receiving services under the STAR+PLUS Medicaid managed care
  program or their legally authorized representatives regarding how
  to select, manage, and dismiss a personal attendant providing basic
  attendant and habilitation services under the program. (Gov. Code,
  Sec. 533.0025(i).)
         Sec. 540.0754.  EVALUATION OF CERTAIN PROGRAM SERVICES. The
  external quality review organization shall periodically conduct
  studies and surveys to assess the quality of care and satisfaction
  with health care services provided to recipients who are:
               (1)  enrolled in the STAR+PLUS Medicaid managed care
  program; and
               (2)  eligible to receive health care benefits under
  both Medicaid and the Medicare program. (Gov. Code, Sec. 533.0028.)
         Sec. 540.0755.  UTILIZATION REVIEW; ANNUAL REPORT. (a) The
  commission's office of contract management shall establish an
  annual utilization review process for Medicaid managed care
  organizations participating in the STAR+PLUS Medicaid managed care
  program. The commission shall determine the topics to be examined
  in the review process.  The review process must include a thorough
  investigation of each Medicaid managed care organization's
  procedures for determining whether a recipient should be enrolled
  in the STAR+PLUS home and community-based services (HCBS) waiver
  program, including the conduct of functional assessments for that
  purpose and records relating to those assessments.
         (b)  The office of contract management shall use the
  utilization review process to review each fiscal year:
               (1)  every Medicaid managed care organization
  participating in the STAR+PLUS Medicaid managed care program; or
               (2)  only the Medicaid managed care organizations that,
  using a risk-based assessment process, the office determines have a
  higher likelihood of inappropriate recipient placement in the
  STAR+PLUS home and community-based services (HCBS) waiver program.
         (c)  Not later than December 1 of each year and in
  conjunction with the commission's office of contract management,
  the commission shall provide a report to the standing committees of
  the senate and house of representatives with jurisdiction over
  Medicaid. The report must:
               (1)  summarize the results of the utilization reviews
  conducted under this section during the preceding fiscal year;
               (2)  provide analysis of errors committed by each
  reviewed Medicaid managed care organization; and
               (3)  extrapolate those findings and make
  recommendations for improving the STAR+PLUS Medicaid managed care
  program's efficiency.
         (d)  If a utilization review conducted under this section
  results in a determination to recoup money from a Medicaid managed
  care organization, a service provider who contracts with the
  organization may not be held liable for providing services in good
  faith based on the organization's authorization. (Gov. Code, Sec.
  533.00281.)
  SUBCHAPTER Q. DELIVERY OF SERVICES: STAR HEALTH PROGRAM
         Sec. 540.0801.  TRAUMA-INFORMED CARE TRAINING. (a) A STAR
  Health program managed care contract between a Medicaid managed
  care organization and the commission must require that
  trauma-informed care training be offered to each contracted
  physician or provider.
         (b)  The commission shall encourage each Medicaid managed
  care organization providing health care services to recipients
  under the STAR Health program to make training in post-traumatic
  stress disorder and attention-deficit/hyperactivity disorder
  available to a contracted physician or provider within a reasonable
  time after the date the physician or provider begins providing
  services under the Medicaid managed care plan the organization
  offers. (Gov. Code, Sec. 533.0052.)
         Sec. 540.0802.  MENTAL HEALTH PROVIDERS. A STAR Health
  program managed care contract between a Medicaid managed care
  organization and the commission must require the organization to
  ensure that the organization maintains a network of mental and
  behavioral health providers, including child psychiatrists and
  other appropriate providers, in all Department of Family and
  Protective Services regions in this state, regardless of whether
  community-based care has been implemented in any region. (Gov.
  Code, Sec. 533.00522.)
         Sec. 540.0803.  HEALTH SCREENING REQUIREMENTS AND
  COMPLIANCE WITH TEXAS HEALTH STEPS. (a) A Medicaid managed care
  organization providing health care services to a recipient under
  the STAR Health program must ensure that the recipient receives a
  complete early and periodic screening, diagnosis, and treatment
  checkup in accordance with the requirements specified in the
  managed care contract between the organization and the commission.
         (b)  The commission shall encourage each Medicaid managed
  care organization providing health care services to a recipient
  under the STAR Health program to ensure that the organization's
  network providers comply with the regimen of care prescribed by the
  Texas Health Steps program under Section 32.056, Human Resources
  Code, if applicable, including the requirement to provide a mental
  health screening during each of the recipient's Texas Health Steps
  medical exams a network provider conducts.
         (c)  The commission shall include a provision in a STAR
  Health program managed care contract between a Medicaid managed
  care organization and the commission specifying progressive
  monetary penalties for the organization's failure to comply with
  Subsection (a). (Gov. Code, Secs. 533.0053, 533.0054.)
         Sec. 540.0804.  HEALTH CARE AND OTHER SERVICES FOR CHILDREN
  IN SUBSTITUTE CARE. (a) The commission shall annually evaluate the
  use of benefits offered to children in foster care under the STAR
  Health program and provide recommendations to the Department of
  Family and Protective Services and each single source continuum
  contractor in this state to better coordinate the provision of
  health care and use of those benefits for those children.
         (b)  In conducting the evaluation, the commission shall:
               (1)  collaborate with residential child-care providers
  regarding any unmet needs of children in foster care and the
  development of capacity for providing quality medical, behavioral
  health, and other services for those children; and
               (2)  identify options to obtain federal matching funds
  under Medicaid to pay for a safe home-like or community-based
  residential setting for a child in the conservatorship of the
  Department of Family and Protective Services:
                     (A)  who is identified or diagnosed as having a
  serious behavioral or mental health condition that requires
  intensive treatment;
                     (B)  who is identified as a victim of serious
  abuse or serious neglect;
                     (C)  for whom a traditional substitute care
  placement contracted for or purchased by the department is not
  available or would further denigrate the child's behavioral or
  mental health condition; or
                     (D)  for whom the department determines a safe
  home-like or community-based residential placement could stabilize
  the child's behavioral or mental health condition in order to
  return the child to a traditional substitute care placement.
         (c)  The commission shall report the commission's findings
  to the standing committees of the senate and house of
  representatives having jurisdiction over the Department of Family
  and Protective Services. (Gov. Code, Sec. 533.00521.)
         Sec. 540.0805.  PLACEMENT CHANGE NOTICE AND CARE
  COORDINATION. A STAR Health program managed care contract between
  a Medicaid managed care organization and the commission must
  require the organization to ensure continuity of care for a child
  whose placement has changed by:
               (1)  notifying each specialist treating the child of
  the placement change; and
               (2)  coordinating the transition of care from the
  child's previous treating primary care physician and specialists to
  the child's new treating primary care physician and specialists, if
  any. (Gov. Code, Sec. 533.0056.)
         Sec. 540.0806.  MEDICAID BENEFITS FOR CERTAIN CHILDREN
  FORMERLY IN FOSTER CARE.  (a)  This section applies only with
  respect to a child who:
               (1)  resides in this state; and
               (2)  is eligible for assistance or services under:
                     (A)  Subchapter D, Chapter 162, Family Code; or
                     (B)  Subchapter K, Chapter 264, Family Code.
         (b)  Except as provided by Subsection (c), the commission
  shall ensure that each child to whom this section applies remains or
  is enrolled in the STAR Health program until the child is enrolled
  in another Medicaid managed care program.
         (c)  A child to whom this section applies who received
  Supplemental Security Income (SSI) (42 U.S.C. Section 1381 et seq.)
  or was receiving Supplemental Security Income before becoming
  eligible for assistance or services under Subchapter D, Chapter
  162, Family Code, or Subchapter K, Chapter 264, Family Code, may
  receive Medicaid benefits in accordance with the program
  established under this subsection. To the extent allowed by federal
  law, the commission, in consultation with the Department of Family
  and Protective Services, shall develop and implement a program that
  allows the adoptive parent or permanent managing conservator of a
  child described by this subsection to elect on behalf of the child
  to receive or continue receiving Medicaid benefits under the:
               (1)  STAR Health program; or
               (2)  STAR Kids managed care program.
         (d)  The commission shall protect the continuity of care for
  each child to whom this section applies and ensure coordination
  between the STAR Health program and any other Medicaid managed care
  program for each child who is transitioning between Medicaid
  managed care programs.
         (e)  The executive commissioner shall adopt rules necessary
  to implement this section.  (Gov. Code, Sec. 533.00531.)
  SUBCHAPTER R. DELIVERY OF SERVICES: STAR KIDS MANAGED CARE PROGRAM
         Sec. 540.0851.  STAR KIDS MANAGED CARE PROGRAM. (a) In this
  section, "health home" means a primary care provider practice or
  specialty care provider practice that incorporates several
  features, including comprehensive care coordination,
  family-centered care, and data management, that are focused on
  improving outcome-based quality of care and increasing patient and
  provider satisfaction under Medicaid.
         (b)  Subject to Sections 540.0701 and 540.0753, the
  commission shall establish a mandatory STAR Kids capitated managed
  care program tailored to provide Medicaid benefits to children with
  disabilities. The program must:
               (1)  provide Medicaid benefits customized to meet the
  health care needs of program recipients through a defined system of
  care;
               (2)  better coordinate recipient care under the
  program;
               (3)  improve recipient:
                     (A)  access to health care services; and
                     (B)  health outcomes;
               (4)  achieve cost containment and cost efficiency;
               (5)  reduce:
                     (A)  the administrative complexity of delivering
  Medicaid benefits; and
                     (B)  the incidence of unnecessary
  institutionalizations and potentially preventable events by
  ensuring the availability of appropriate services and care
  management;
               (6)  require a health home; and
               (7)  for recipients who receive long-term services and
  supports outside of the Medicaid managed care organization,
  coordinate and collaborate with long-term care service providers
  and long-term care management providers. (Gov. Code, Secs.
  533.00253(a)(2), (b).)
         Sec. 540.0852.  CARE MANAGEMENT AND CARE NEEDS ASSESSMENT.  
  (a)  The commission may require that care management services made
  available as provided by Section 540.0851(b)(5)(B):
               (1)  incorporate best practices as the commission
  determines;
               (2)  integrate with a nurse advice line to ensure
  appropriate redirection rates;
               (3)  use an identification and stratification
  methodology that identifies recipients who have the greatest need
  for services;
               (4)  include a care needs assessment for a recipient;
               (5)  are delivered through multidisciplinary care
  teams located in different geographic areas of this state that use
  in-person contact with recipients and their caregivers;
               (6)  identify immediate interventions for
  transitioning care;
               (7)  include monitoring and reporting outcomes that, at
  a minimum, include:
                     (A)  recipient quality of life;
                     (B)  recipient satisfaction; and
                     (C)  other financial and clinical metrics the
  commission determines appropriate; and
               (8)  use innovations in providing services.
         (b)  To improve the care needs assessment tool used for a
  care needs assessment provided as a component of care management
  services and to improve the initial assessment and reassessment
  processes, the commission, in consultation and collaboration with
  the STAR Kids Managed Care Advisory Committee, shall consider
  changes that will:
               (1)  reduce the amount of time needed to complete the
  initial care needs assessment and a reassessment; and
               (2)  improve training and consistency in the completion
  of the care needs assessment using the tool and in the initial
  assessment and reassessment processes across different Medicaid
  managed care organizations and different service coordinators
  within the same Medicaid managed care organization.
         (c)  To the extent feasible and allowed by federal law, the
  commission shall streamline the STAR Kids managed care program
  annual care needs reassessment process for a child who has not had a
  significant change in function that may affect medical necessity.
  (Gov. Code, Secs. 533.00253(a)(1), (c), (c-1), (c-2).)
         Sec. 540.0853.  BENEFITS FOR CHILDREN IN MEDICALLY DEPENDENT
  CHILDREN (MDCP) WAIVER PROGRAM. The commission shall:
               (1)  provide Medicaid benefits through the STAR Kids
  managed care program to children receiving benefits under the
  medically dependent children (MDCP) waiver program; and
               (2)  ensure that the STAR Kids managed care program
  provides all of the benefits provided under the medically dependent
  children (MDCP) waiver program to the extent necessary to implement
  this section. (Gov. Code, Sec. 533.00253(d).)
         Sec. 540.0854.  BENEFITS TRANSITION FROM STAR KIDS TO
  STAR+PLUS MEDICAID MANAGED CARE PROGRAM. The commission shall
  ensure that there is a plan for transitioning the provision of
  Medicaid benefits to recipients 21 years of age or older from the
  STAR Kids managed care program to the STAR+PLUS Medicaid managed
  care program in a manner that protects continuity of care. The plan
  must ensure that coordination between the programs begins when a
  recipient reaches 18 years of age. (Gov. Code, Sec. 533.00253(e).)
         Sec. 540.0855.  UTILIZATION REVIEW OF PRIOR AUTHORIZATIONS.  
  At least once every two years, the commission shall conduct a
  utilization review on a sample of cases for children enrolled in the
  STAR Kids managed care program to ensure that all imposed clinical
  prior authorizations are based on publicly available clinical
  criteria and are not being used to negatively impact a recipient's access to care. (Gov. Code, Sec. 533.00253(n).)
 
  CHAPTER 540A. MEDICAID MANAGED TRANSPORTATION SERVICES
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 540A.0001.  DEFINITIONS
  SUBCHAPTER B. MEDICAL TRANSPORTATION PROGRAM SERVICES THROUGH
  MANAGED TRANSPORTATION DELIVERY MODEL
  Sec. 540A.0051.  DELIVERY OF MEDICAL TRANSPORTATION
                    PROGRAM SERVICES THROUGH MANAGED
                    TRANSPORTATION ORGANIZATION
  Sec. 540A.0052.  MINIMUM QUALITY AND EFFICIENCY
                    MEASURES
  Sec. 540A.0053.  MANAGED TRANSPORTATION ORGANIZATION:
                    CONTRACT WITH MEDICAL TRANSPORTATION
                    PROVIDER
  Sec. 540A.0054.  MANAGED TRANSPORTATION ORGANIZATION:
                    SUBCONTRACT WITH TRANSPORTATION
                    NETWORK COMPANY
  Sec. 540A.0055.  MANAGED TRANSPORTATION ORGANIZATION:
                    VEHICLE FLEETS
  Sec. 540A.0056.  PERIODIC SCREENING OF TRANSPORTATION
                    NETWORK COMPANY OR MOTOR VEHICLE
                    OPERATOR AUTHORIZED
  Sec. 540A.0057.  ENROLLMENT AS MEDICAID PROVIDER BY
                    CERTAIN MOTOR VEHICLE OPERATORS NOT
                    REQUIRED
  Sec. 540A.0058.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
                    VEHICLE OPERATORS
  Sec. 540A.0059.  MOTOR VEHICLE OPERATOR: VEHICLE
                    ACCESSIBILITY
  SUBCHAPTER C. NONEMERGENCY TRANSPORTATION SERVICES THROUGH
  MEDICAID MANAGED CARE ORGANIZATION
  Sec. 540A.0101.  DELIVERY OF NONEMERGENCY
                    TRANSPORTATION SERVICES THROUGH
                    MEDICAID MANAGED CARE ORGANIZATION
  Sec. 540A.0102.  RULES FOR NONEMERGENCY TRANSPORTATION
                    SERVICES
  Sec. 540A.0103.  MEDICAID MANAGED CARE ORGANIZATION:
                    SUBCONTRACT WITH TRANSPORTATION
                    NETWORK COMPANY
  Sec. 540A.0104.  PERIODIC SCREENING OF TRANSPORTATION
                    NETWORK COMPANY OR MOTOR VEHICLE
                    OPERATOR AUTHORIZED
  Sec. 540A.0105.  ENROLLMENT AS MEDICAID PROVIDER BY
                    CERTAIN MOTOR VEHICLE OPERATORS NOT
                    REQUIRED
  Sec. 540A.0106.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
                    VEHICLE OPERATORS
  Sec. 540A.0107.  MOTOR VEHICLE OPERATOR: VEHICLE
                    ACCESSIBILITY
  SUBCHAPTER D.  NONMEDICAL TRANSPORTATION SERVICES THROUGH MEDICAID
  MANAGED CARE ORGANIZATION
  Sec. 540A.0151.  DELIVERY OF NONMEDICAL TRANSPORTATION
                    SERVICES THROUGH MEDICAID MANAGED
                    CARE ORGANIZATION
  Sec. 540A.0152.  RULES FOR NONMEDICAL TRANSPORTATION
                    SERVICES
  Sec. 540A.0153.  PERIODIC SCREENING OF TRANSPORTATION
                    VENDOR OR MOTOR VEHICLE OPERATOR
                    AUTHORIZED
  Sec. 540A.0154.  ENROLLMENT AS MEDICAID PROVIDER BY, OR
                    CREDENTIALING OF, MOTOR VEHICLE
                    OPERATOR NOT REQUIRED
  Sec. 540A.0155.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
                    VEHICLE OPERATORS
  Sec. 540A.0156.  MOTOR VEHICLE OPERATOR: VEHICLE
                    ACCESSIBILITY
  CHAPTER 540A. MEDICAID MANAGED TRANSPORTATION SERVICES
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 540A.0001.  DEFINITIONS.  In this chapter:
               (1)  Notwithstanding Section 521.0001(2), "commission" 
  means the Health and Human Services Commission or an agency
  operating part of the Medicaid managed care program, as
  appropriate.
               (2)  "Managed care plan" means a plan under which a
  person undertakes to provide, arrange for, pay for, or reimburse
  any part of the cost of any health care service. A part of the plan
  must consist of arranging for or providing health care services as
  distinguished from indemnification against the cost of those
  services on a prepaid basis through insurance or otherwise. The
  term includes a primary care case management provider network. The
  term does not include a plan that indemnifies a person for the cost
  of health care services through insurance.
               (3)  "Managed transportation organization" means:
                     (A)  a rural or urban transit district created
  under Chapter 458, Transportation Code;
                     (B)  a public transportation provider as defined
  by Section 461.002, Transportation Code;
                     (C)  a regional contracted broker as defined by
  Section 526.0351;
                     (D)  a local private transportation provider the
  commission approves to provide Medicaid nonemergency medical
  transportation services; or
                     (E)  any other entity the commission determines
  meets the requirements of Subchapter B.
               (4)  "Medical transportation program" has the meaning
  assigned by Section 526.0351.
               (5)  "Nonemergency transportation service" has the
  meaning assigned by Section 526.0351.
               (6)  "Nonmedical transportation service" means:
                     (A)  curb-to-curb transportation to or from a
  medically necessary, nonemergency covered health care service in a
  standard passenger vehicle that is scheduled not more than 48 hours
  before the transportation occurs, that is provided to a recipient
  enrolled in a Medicaid managed care plan offered by a Medicaid
  managed care organization, and that the organization determines
  meets the level of care that is medically appropriate for the
  recipient, including transportation related to:
                           (i)  discharging a recipient from a health
  care facility;
                           (ii)  receiving urgent care; and
                           (iii)  obtaining pharmacy services and
  prescription drugs; and
                     (B)  any other transportation to or from a
  medically necessary, nonemergency covered health care service the
  commission considers appropriate to be provided by a transportation
  vendor, as determined by commission rule or policy.
               (7)  "Recipient" means a Medicaid recipient.
               (8)  "Transportation network company" has the meaning
  assigned by Section 2402.001, Occupations Code.
               (9)  "Transportation vendor" means an entity,
  including a transportation network company, that contracts with a
  Medicaid managed care organization to provide nonmedical
  transportation services. (Gov. Code, Secs. 533.001(1), (5), (6),
  533.00257(a)(1), (2), (2-a), 533.002571(a), 533.00258(a),
  533.002581(a); New.)
  SUBCHAPTER B. MEDICAL TRANSPORTATION PROGRAM SERVICES THROUGH
  MANAGED TRANSPORTATION DELIVERY MODEL
         Sec. 540A.0051.  DELIVERY OF MEDICAL TRANSPORTATION PROGRAM
  SERVICES THROUGH MANAGED TRANSPORTATION ORGANIZATION. (a) The
  commission may provide medical transportation program services on a
  regional basis through a managed transportation delivery model
  using managed transportation organizations and providers, as
  appropriate, that:
               (1)  operate under a capitated rate system;
               (2)  assume financial responsibility under a full-risk
  model;
               (3)  operate a call center;
               (4)  use fixed routes when available and appropriate;
  and
               (5)  agree to provide data to the commission if the
  commission determines that the data is required to receive federal
  matching funds.
         (b)  The commission shall procure managed transportation
  organizations under the medical transportation program through a
  competitive bidding process for each managed transportation region
  as determined by the commission.
         (c)  The commission may not delay providing medical
  transportation program services through a managed transportation
  delivery model in:
               (1)  a county with a population of 750,000 or more:
                     (A)  in which all or part of a municipality with a
  population of one million or more is located; and
                     (B)  that is located adjacent to a county with a
  population of two million or more; or
               (2)  a county with a population of at least 55,000 but
  not more than 65,000 that is located adjacent to a county with a
  population of at least 500,000 but not more than 1.5 million. (Gov.
  Code, Secs. 533.00257(b), (c), (j).)
         Sec. 540A.0052.  MINIMUM QUALITY AND EFFICIENCY MEASURES.  
  Except as provided by Sections 540A.0054, 540A.0057, and 540A.0058,
  the commission shall require that managed transportation
  organizations and providers participating in the medical
  transportation program meet minimum quality and efficiency
  measures the commission determines.  (Gov. Code, Sec.
  533.00257(g).)
         Sec. 540A.0053.  MANAGED TRANSPORTATION ORGANIZATION:
  CONTRACT WITH MEDICAL TRANSPORTATION PROVIDER.  Except as provided
  by Sections 540A.0054, 540A.0057, and 540A.0058, a managed
  transportation organization that participates in the medical
  transportation program must attempt to contract with medical
  transportation providers that:
               (1)  are significant traditional providers, as the
  executive commissioner defines by rule;
               (2)  meet the minimum quality and efficiency measures
  required under Section 540A.0052 and other requirements that the
  managed transportation organization may impose; and
               (3)  agree to accept the managed transportation
  organization's prevailing contract rate.  (Gov. Code, Sec.
  533.00257(d).)
         Sec. 540A.0054.  MANAGED TRANSPORTATION ORGANIZATION:
  SUBCONTRACT WITH TRANSPORTATION NETWORK COMPANY.  A managed
  transportation organization may subcontract with a transportation
  network company to provide services under this subchapter. A rule
  or other requirement the executive commissioner adopts under this
  subchapter or Subchapter H, Chapter 526, does not apply to the
  subcontracted transportation network company or a motor vehicle
  operator who is part of the company's network.  (Gov. Code, Sec.
  533.00257(k) (part).)
         Sec. 540A.0055.  MANAGED TRANSPORTATION ORGANIZATION:
  VEHICLE FLEETS.  (a)  To the extent allowed under federal law, a
  managed transportation organization may own, operate, and maintain
  a fleet of vehicles or contract with an entity that owns, operates,
  and maintains a fleet of vehicles. The commission shall seek an
  appropriate federal waiver or other authorization to implement this
  subsection as necessary.
         (b)  The commission shall consider a managed transportation
  organization's ownership, operation, and maintenance of a fleet of
  vehicles to be a related-party transaction for purposes of applying
  experience rebates, administrative costs, and other administrative
  controls the commission determines.  (Gov. Code, Secs.
  533.00257(e), (f).)
         Sec. 540A.0056.  PERIODIC SCREENING OF TRANSPORTATION
  NETWORK COMPANY OR MOTOR VEHICLE OPERATOR AUTHORIZED.  The
  commission or a managed transportation organization that
  subcontracts with a transportation network company under Section
  540A.0054 may require the transportation network company or a motor
  vehicle operator who provides services under this subchapter to be
  periodically screened against the list of excluded individuals and
  entities the Office of Inspector General of the United States
  Department of Health and Human Services maintains.  (Gov. Code,
  Sec. 533.00257(l).)
         Sec. 540A.0057.  ENROLLMENT AS MEDICAID PROVIDER BY CERTAIN
  MOTOR VEHICLE OPERATORS NOT REQUIRED.  The commission or a managed
  transportation organization that subcontracts with a
  transportation network company under Section 540A.0054 may not
  require a motor vehicle operator who is part of the subcontracted
  transportation network company's network to enroll as a Medicaid
  provider to provide services under this subchapter.  (Gov. Code,
  Sec. 533.00257(k) (part).)
         Sec. 540A.0058.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
  VEHICLE OPERATORS.  Notwithstanding any other law, a motor vehicle
  operator who is part of the network of a transportation network
  company that subcontracts with a managed transportation
  organization under Section 540A.0054 and who satisfies the driver
  requirements in Section 2402.107, Occupations Code, is qualified to
  provide services under this subchapter.  The commission and the
  managed transportation organization may not impose any additional
  requirements on a motor vehicle operator who satisfies the driver
  requirements in Section 2402.107, Occupations Code, to provide
  services under this subchapter.  (Gov. Code, Sec. 533.00257(m).)
         Sec. 540A.0059.  MOTOR VEHICLE OPERATOR: VEHICLE
  ACCESSIBILITY.  For purposes of this subchapter and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides a service under this subchapter may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting a passenger using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code. (Gov. Code,
  Sec. 533.00257(n).)
  SUBCHAPTER C. NONEMERGENCY TRANSPORTATION SERVICES THROUGH
  MEDICAID MANAGED CARE ORGANIZATION
         Sec. 540A.0101.  DELIVERY OF NONEMERGENCY TRANSPORTATION
  SERVICES THROUGH MEDICAID MANAGED CARE ORGANIZATION.  (a)  The
  commission shall require each Medicaid managed care organization to
  arrange and provide nonemergency transportation services to a
  recipient enrolled in a Medicaid managed care plan offered by the
  organization using the most cost-effective and cost-efficient
  method of delivery, including by delivering nonmedical
  transportation services through a transportation network company
  or other transportation vendor as provided by Section 540A.0151, if
  available and medically appropriate. The commission shall
  supervise the provision of the services.
         (b)  The commission may temporarily waive the applicability
  of Subsection (a) to a Medicaid managed care organization as
  necessary based on the results of a review conducted under Sections
  540.0207 and 540.0209 and until enrollment of recipients in a
  Medicaid managed care plan offered by the organization is permitted
  under that section.  (Gov. Code, Secs. 533.002571(b), (h).)
         Sec. 540A.0102.  RULES FOR NONEMERGENCY TRANSPORTATION
  SERVICES.  Subject to Sections 540A.0103 and 540A.0105, the
  executive commissioner shall adopt rules as necessary to ensure the
  safe and efficient provision of nonemergency transportation
  services by a Medicaid managed care organization under this
  subchapter.  (Gov. Code, Sec. 533.002571(c).)
         Sec. 540A.0103.  MEDICAID MANAGED CARE ORGANIZATION:
  SUBCONTRACT WITH TRANSPORTATION NETWORK COMPANY.  A Medicaid
  managed care organization may subcontract with a transportation
  network company to provide nonemergency transportation services
  under this subchapter.  A rule or other requirement the executive
  commissioner adopts under Section 540A.0102 or Subchapter H,
  Chapter 526, does not apply to the subcontracted transportation
  network company or a motor vehicle operator who is part of the
  company's network.  (Gov. Code, Sec. 533.002571(d) (part).)
         Sec. 540A.0104.  PERIODIC SCREENING OF TRANSPORTATION
  NETWORK COMPANY OR MOTOR VEHICLE OPERATOR AUTHORIZED.  The
  commission or a Medicaid managed care organization that
  subcontracts with a transportation network company under Section
  540A.0103 may require the transportation network company or a motor
  vehicle operator who provides services under this subchapter to be
  periodically screened against the list of excluded individuals and
  entities the Office of Inspector General of the United States
  Department of Health and Human Services maintains.  (Gov. Code,
  Sec. 533.002571(e).)
         Sec. 540A.0105.  ENROLLMENT AS MEDICAID PROVIDER BY CERTAIN
  MOTOR VEHICLE OPERATORS NOT REQUIRED.  The commission or a Medicaid
  managed care organization that subcontracts with a transportation
  network company under Section 540A.0103 may not require a motor
  vehicle operator who is part of the subcontracted transportation
  network company's network to enroll as a Medicaid provider to
  provide services under this subchapter. (Gov. Code, Sec.
  533.002571(d) (part).)
         Sec. 540A.0106.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
  VEHICLE OPERATORS.  Notwithstanding any other law, a motor vehicle
  operator who is part of the network of a transportation network
  company that subcontracts with a Medicaid managed care organization
  under Section 540A.0103 and who satisfies the driver requirements
  in Section 2402.107, Occupations Code, is qualified to provide
  services under this subchapter. The commission and the Medicaid
  managed care organization may not impose any additional
  requirements on a motor vehicle operator who satisfies the driver
  requirements in Section 2402.107, Occupations Code, to provide
  services under this subchapter.  (Gov. Code, Sec. 533.002571(f).)
         Sec. 540A.0107.  MOTOR VEHICLE OPERATOR: VEHICLE
  ACCESSIBILITY. For purposes of this subchapter and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides a service under this subchapter may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting a passenger using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code. (Gov. Code,
  Sec. 533.002571(g).)
  SUBCHAPTER D.  NONMEDICAL TRANSPORTATION SERVICES THROUGH MEDICAID
  MANAGED CARE ORGANIZATION
         Sec. 540A.0151.  DELIVERY OF NONMEDICAL TRANSPORTATION
  SERVICES THROUGH MEDICAID MANAGED CARE ORGANIZATION. (a)  The
  commission shall require each Medicaid managed care organization to
  arrange for the provision of nonmedical transportation services to
  a recipient enrolled in a Medicaid managed care plan offered by the
  organization.
         (b)  A Medicaid managed care organization may contract with a
  transportation vendor or other third party to arrange for the
  provision of nonmedical transportation services. If a Medicaid
  managed care organization contracts with a third party that is not a
  transportation vendor to arrange for the provision of nonmedical
  transportation services, the third party shall contract with a
  transportation vendor to deliver the nonmedical transportation
  services.
         (c)  A Medicaid managed care organization that contracts
  with a transportation vendor or other third party to arrange for the
  provision of nonmedical transportation services shall ensure the
  effective sharing and integration of service coordination, service
  authorization, and utilization management data between the managed
  care organization and the transportation vendor or third party.
         (d)  The commission may waive the applicability of
  Subsection (a) to a Medicaid managed care organization for not more
  than three months as necessary based on the results of a review
  conducted under Sections 540.0207 and 540.0209 and until enrollment
  of recipients in a Medicaid managed care plan offered by the
  organization is permitted under that section. (Gov. Code, Secs.
  533.002581(c), (d), (e), (h).)
         Sec. 540A.0152.  RULES FOR NONMEDICAL TRANSPORTATION
  SERVICES. (a)  The executive commissioner shall adopt rules
  regarding the manner in which nonmedical transportation services
  may be arranged and provided.
         (b)  The rules must require a Medicaid managed care
  organization to create a process to:
               (1)  verify that a passenger is eligible to receive
  nonmedical transportation services;
               (2)  ensure that nonmedical transportation services
  are provided only to and from covered health care services in areas
  in which a transportation network company operates; and
               (3)  ensure the timely delivery of nonmedical
  transportation services to a recipient, including by setting
  reasonable service response goals.
         (c)  The rules must require a transportation vendor to,
  before permitting a motor vehicle operator to provide nonmedical
  transportation services:
               (1)  confirm that the operator:
                     (A)  is at least 18 years of age;
                     (B)  maintains a valid driver's license issued by
  this state, another state, or the District of Columbia; and
                     (C)  possesses proof of registration and
  automobile financial responsibility for each motor vehicle to be
  used to provide nonmedical transportation services;
               (2)  conduct, or cause to be conducted, a local, state,
  and national criminal background check for the operator that
  includes the use of:
                     (A)  a commercial multistate and
  multijurisdiction criminal records locator or other similar
  commercial nationwide database; and
                     (B)  the national sex offender public website the
  United States Department of Justice or a successor agency
  maintains;
               (3)  confirm that any vehicle to be used to provide
  nonmedical transportation services:
                     (A)  meets the applicable requirements of Chapter
  548, Transportation Code; and
                     (B)  except as provided by Section 540A.0156, has
  at least four doors; and
               (4)  obtain and review the operator's driving record.
         (d)  The rules may not permit a motor vehicle operator to
  provide nonmedical transportation services if the operator:
               (1)  has been convicted in the three-year period
  preceding the issue date of the driving record obtained under
  Subsection (c)(4) of:
                     (A)  more than three offenses the Department of
  Public Safety classifies as moving violations; or
                     (B)  one or more of the following offenses:
                           (i)  fleeing or attempting to elude a police
  officer under Section 545.421, Transportation Code;
                           (ii)  reckless driving under Section
  545.401, Transportation Code;
                           (iii)  driving without a valid driver's
  license under Section 521.025, Transportation Code; or
                           (iv)  driving with an invalid driver's
  license under Section 521.457, Transportation Code;
               (2)  has been convicted in the preceding seven-year
  period of any of the following:
                     (A)  driving while intoxicated under Section
  49.04 or 49.045, Penal Code;
                     (B)  use of a motor vehicle to commit a felony;
                     (C)  a felony crime involving property damage;
                     (D)  fraud;
                     (E)  theft;
                     (F)  an act of violence; or
                     (G)  an act of terrorism; or
               (3)  is found to be registered in the national sex
  offender public website the United States Department of Justice or
  a successor agency maintains. (Gov. Code, Secs. 533.00258(b), (c),
  (e), (f).)
         Sec. 540A.0153.  PERIODIC SCREENING OF TRANSPORTATION
  VENDOR OR MOTOR VEHICLE OPERATOR AUTHORIZED. The commission or a
  Medicaid managed care organization that contracts with a
  transportation vendor may require the transportation vendor or a
  motor vehicle operator who provides services under this subchapter
  to be periodically screened against the list of excluded
  individuals and entities the Office of Inspector General of the
  United States Department of Health and Human Services maintains.
  (Gov. Code, Sec. 533.00258(h).)
         Sec. 540A.0154.  ENROLLMENT AS MEDICAID PROVIDER BY, OR
  CREDENTIALING OF, MOTOR VEHICLE OPERATOR NOT REQUIRED. (a) The
  commission or a Medicaid managed care organization may not require
  a motor vehicle operator to enroll as a Medicaid provider to provide
  nonmedical transportation services.
         (b)  The commission may not require a Medicaid managed care
  organization to credential a motor vehicle operator to provide
  nonmedical transportation services, and the organization may not
  require the credentialing of a motor vehicle operator to provide
  those services. (Gov. Code, Secs. 533.00258(g), 533.002581(f).)
         Sec. 540A.0155.  DRIVER REQUIREMENTS FOR CERTAIN MOTOR
  VEHICLE OPERATORS. Notwithstanding any other law, a motor vehicle
  operator who is part of a transportation network company's network
  and who satisfies the driver requirements in Section 2402.107,
  Occupations Code, is qualified to provide nonmedical
  transportation services. The commission and a Medicaid managed care
  organization may not impose any additional requirements on a motor
  vehicle operator who satisfies the driver requirements in Section
  2402.107, Occupations Code, to provide nonmedical transportation
  services. (Gov. Code, Sec. 533.00258(i).)
         Sec. 540A.0156.  MOTOR VEHICLE OPERATOR: VEHICLE
  ACCESSIBILITY. For purposes of this subchapter and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides a service under this subchapter may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting a passenger using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code. (Gov. Code, Secs. 533.00258(j), 533.002581(g).)
 
  CHAPTER 542. SYSTEM REDESIGN FOR DELIVERY OF MEDICAID ACUTE CARE
  SERVICES AND LONG-TERM SERVICES AND SUPPORTS TO INDIVIDUALS WITH AN
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 542.0001.  DEFINITIONS
  Sec. 542.0002.  CONFLICT WITH OTHER LAW
  Sec. 542.0003.  DELAYED IMPLEMENTATION AUTHORIZED
  SUBCHAPTER B. ACUTE CARE SERVICES AND LONG-TERM SERVICES AND
  SUPPORTS SYSTEM REDESIGN
  Sec. 542.0051.  REDESIGN OF ACUTE CARE SERVICES AND
                   LONG-TERM SERVICES AND SUPPORTS
                   SYSTEM FOR INDIVIDUALS WITH AN
                   INTELLECTUAL OR DEVELOPMENTAL
                   DISABILITY
  Sec. 542.0052.  INTELLECTUAL AND DEVELOPMENTAL
                   DISABILITY SYSTEM REDESIGN ADVISORY
                   COMMITTEE
  Sec. 542.0053.  IMPLEMENTATION OF SYSTEM REDESIGN
  Sec. 542.0054.  ANNUAL REPORT ON IMPLEMENTATION
  SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING SERVICE
  DELIVERY MODELS
  Sec. 542.0101.  DEFINITIONS
  Sec. 542.0102.  PILOT PROGRAM TO TEST PERSON-CENTERED
                   MANAGED CARE STRATEGIES AND
                   IMPROVEMENTS BASED ON CAPITATION
  Sec. 542.0103.  ALTERNATIVE PAYMENT RATE OR METHODOLOGY
  Sec. 542.0104.  PILOT PROGRAM WORK GROUP
  Sec. 542.0105.  STAKEHOLDER INPUT
  Sec. 542.0106.  MEASURABLE GOALS
  Sec. 542.0107.  MANAGED CARE ORGANIZATION SELECTION
  Sec. 542.0108.  MANAGED CARE ORGANIZATION PARTICIPATION
                   REQUIREMENTS
  Sec. 542.0109.  REQUIRED BENEFITS
  Sec. 542.0110.  PROVIDER PARTICIPATION
  Sec. 542.0111.  CARE COORDINATION
  Sec. 542.0112.  PERSON-CENTERED PLANNING
  Sec. 542.0113.  USE OF INNOVATIVE TECHNOLOGY
  Sec. 542.0114.  INFORMATIONAL MATERIALS
  Sec. 542.0115.  IMPLEMENTATION, LOCATION, AND DURATION
  Sec. 542.0116.  RECIPIENT ENROLLMENT, PARTICIPATION,
                   AND ELIGIBILITY
  Sec. 542.0117.  PILOT PROGRAM INFORMATION COLLECTION
                   AND ANALYSIS
  Sec. 542.0118.  PILOT PROGRAM CONCLUSION; PUBLICATION
                   OF CONTINUATION
  Sec. 542.0119.  EVALUATIONS AND REPORTS
  Sec. 542.0120.  TRANSITION BETWEEN PROGRAMS; CONTINUITY
                   OF CARE
  Sec. 542.0121.  SERVICE TRANSITION REQUIREMENTS
  SUBCHAPTER D. STAGE ONE: PROVISION OF ACUTE CARE AND CERTAIN OTHER
  SERVICES
  Sec. 542.0151.  DELIVERY OF ACUTE CARE SERVICES TO
                   INDIVIDUALS WITH AN INTELLECTUAL OR
                   DEVELOPMENTAL DISABILITY
  Sec. 542.0152.  DELIVERY OF CERTAIN OTHER SERVICES
                   UNDER STAR+PLUS MEDICAID MANAGED CARE
                   PROGRAM AND BY WAIVER PROGRAM
                   PROVIDERS
  SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS
  AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED
  MANAGED CARE SYSTEM
  Sec. 542.0201.  TRANSITION OF ICF-IID PROGRAM
                   RECIPIENTS AND CERTAIN OTHER MEDICAID
                   WAIVER PROGRAM RECIPIENTS TO MANAGED
                   CARE PROGRAM
  Sec. 542.0202.  RECIPIENT CHOICE OF DELIVERY MODEL
  Sec. 542.0203.  REQUIRED CONTRACT PROVISIONS
  Sec. 542.0204.  RESPONSIBILITIES OF COMMISSION UNDER
                   SUBCHAPTER
  CHAPTER 542. SYSTEM REDESIGN FOR DELIVERY OF MEDICAID ACUTE CARE
  SERVICES AND LONG-TERM SERVICES AND SUPPORTS TO INDIVIDUALS WITH AN
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 542.0001.  DEFINITIONS. In this chapter:
               (1)  "Advisory committee" means the intellectual and
  developmental disability system redesign advisory committee
  established under Section 542.0052.
               (2)  "Basic attendant service" means a service provided
  to an individual to assist the individual with an activity of daily
  living, including an instrumental activity of daily living, because
  of a physical, cognitive, or behavioral limitation related to the
  individual's disability or chronic health condition.
               (3)  "Comprehensive long-term services and supports
  provider" means a provider of long-term services and supports under
  this chapter that ensures the coordinated, seamless delivery of the
  full range of services in a recipient's program plan. The term
  includes:
                     (A)  an ICF-IID program provider; and
                     (B)  a Medicaid waiver program provider.
               (4)  "Consumer direction model" has the meaning
  assigned by Section 546.0101.
               (5)  "Functional need" means the measurement of an
  individual's services and supports needs, including the
  individual's intellectual, psychiatric, medical, and physical
  support needs.
               (6)  "Habilitation service" includes a service
  provided to an individual to assist the individual with acquiring,
  retaining, or improving:
                     (A)  a skill related to the activities of daily
  living; and
                     (B)  the social and adaptive skills necessary for
  the individual to live and fully participate in the community.
               (7)  "ICF-IID" means the Medicaid program serving
  individuals with an intellectual or developmental disability who
  receive care in intermediate care facilities other than a state
  supported living center.
               (8)  "ICF-IID program" means a Medicaid program serving
  individuals with an intellectual or developmental disability who
  reside in and receive care from:
                     (A)  an intermediate care facility licensed under
  Chapter 252, Health and Safety Code; or
                     (B)  a community-based intermediate care facility
  operated by a local intellectual and developmental disability
  authority.
               (9)  "Local intellectual and developmental disability
  authority" has the meaning assigned by Section 531.002, Health and
  Safety Code.
               (10)  "Managed care organization" has the meaning
  assigned by Section 543A.0001.
               (11)  "Medicaid waiver program" means only the
  following programs that are authorized under Section 1915(c) of the
  Social Security Act (42 U.S.C. Section 1396n(c)) for the provision
  of services to individuals with an intellectual or developmental
  disability:
                     (A)  the community living assistance and support
  services (CLASS) waiver program;
                     (B)  the home and community-based services (HCS)
  waiver program;
                     (C)  the deaf-blind with multiple disabilities
  (DBMD) waiver program; and
                     (D)  the Texas home living (TxHmL) waiver program.
               (12)  "Potentially preventable event" has the meaning
  assigned by Section 543A.0001.
               (13)  "Residential service" means a service provided to
  an individual with an intellectual or developmental disability
  through a community-based ICF-IID, three- or four-person home or
  host home setting under the home and community-based services (HCS)
  waiver program, or a group home under the deaf-blind with multiple
  disabilities (DBMD) waiver program.
               (14)  "State supported living center" has the meaning
  assigned by Section 531.002, Health and Safety Code. (Gov. Code,
  Sec. 534.001 (part).)
         Sec. 542.0002.  CONFLICT WITH OTHER LAW. To the extent of a
  conflict between a provision of this chapter and another state law,
  the provision of this chapter controls. (Gov. Code, Sec. 534.002.)
         Sec. 542.0003.  DELAYED IMPLEMENTATION AUTHORIZED.
  Notwithstanding any other law, the commission may delay
  implementing a provision of this chapter without additional
  investigation, adjustment, or legislative action if the commission
  determines implementing the provision would adversely affect the
  system of services and supports to persons and programs to which
  this chapter applies. (Gov. Code, Sec. 534.251.)
  SUBCHAPTER B. ACUTE CARE SERVICES AND LONG-TERM SERVICES AND
  SUPPORTS SYSTEM REDESIGN
         Sec. 542.0051.  REDESIGN OF ACUTE CARE SERVICES AND
  LONG-TERM SERVICES AND SUPPORTS SYSTEM FOR INDIVIDUALS WITH AN
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY. The commission shall
  design and implement an acute care services and long-term services
  and supports system for individuals with an intellectual or
  developmental disability that supports the following goals:
               (1)  provide Medicaid services to more individuals in a
  cost-efficient manner by providing the type and amount of services
  most appropriate to an individual's needs and preferences in the
  most integrated and least restrictive setting;
               (2)  improve access to services and supports by
  ensuring that an individual receives information about all
  available programs and services, including employment and least
  restrictive housing assistance, and the manner of applying for the
  programs and services;
               (3)  improve the assessment of an individual's needs
  and available supports, including the assessment of an individual's
  functional needs;
               (4)  promote person-centered planning, self-direction,
  self-determination, community inclusion, and customized,
  integrated, competitive employment;
               (5)  promote individualized budgeting based on an
  assessment of an individual's needs and person-centered planning;
               (6)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (7)  improve acute care and long-term services and
  supports outcomes, including reducing unnecessary
  institutionalization and potentially preventable events;
               (8)  promote high-quality care;
               (9)  provide fair hearing and appeals processes in
  accordance with federal law;
               (10)  ensure the availability of a local safety net
  provider and local safety net services;
               (11)  promote independent service coordination and
  independent ombudsmen services; and
               (12)  ensure that individuals with the most significant
  needs are appropriately served in the community and that processes
  are in place to prevent the inappropriate institutionalization of
  an individual. (Gov. Code, Sec. 534.051.)
         Sec. 542.0052.  INTELLECTUAL AND DEVELOPMENTAL DISABILITY
  SYSTEM REDESIGN ADVISORY COMMITTEE. (a) The intellectual and
  developmental disability system redesign advisory committee shall
  advise the commission on implementing the acute care services and
  long-term services and supports system redesign under this chapter.
         (b)  The executive commissioner shall appoint stakeholders
  from the intellectual and developmental disabilities community to
  serve as advisory committee members, including:
               (1)  individuals with an intellectual or developmental
  disability who receive services under a Medicaid waiver program;
               (2)  individuals with an intellectual or developmental
  disability who receive services under an ICF-IID program;
               (3)  representatives who are advocates for individuals
  described by Subdivisions (1) and (2), including at least three
  representatives from intellectual and developmental disability
  advocacy organizations;
               (4)  representatives of Medicaid managed care and
  nonmanaged care health care providers, including:
                     (A)  physicians who are primary care providers;
                     (B)  physicians who are specialty care providers;
                     (C)  nonphysician mental health professionals;
  and
                     (D)  long-term services and supports providers,
  including direct service workers;
               (5)  representatives of entities with responsibilities
  for delivering Medicaid long-term services and supports or for
  other Medicaid service delivery, including:
                     (A)  representatives of aging and disability
  resource centers established under the Aging and Disability
  Resource Center initiative funded in part by the Administration on
  Aging and the Centers for Medicare and Medicaid Services;
                     (B)  representatives of community mental health
  and intellectual disability centers;
                     (C)  representatives of and service coordinators
  or case managers from private and public home and community-based
  services providers that serve individuals with an intellectual or
  developmental disability; and
                     (D)  representatives of private and public
  ICF-IID providers; and
               (6)  representatives of managed care organizations
  that contract with this state to provide services to individuals
  with an intellectual or developmental disability.
         (c)  To the greatest extent possible, the executive
  commissioner shall appoint members to the advisory committee who
  reflect the geographic diversity of this state and include members
  who represent rural Medicaid recipients.
         (d)  The executive commissioner shall appoint the presiding
  officer of the advisory committee.
         (e)  The advisory committee must meet at least quarterly or
  more frequently if the presiding officer determines that more
  frequent meetings are necessary to address planning and development
  needs related to implementation of the acute care services and
  long-term services and supports system.  The advisory committee may
  establish work groups that meet at other times to study and make
  recommendations on issues the advisory committee considers
  appropriate.
         (f)  An advisory committee member serves without
  compensation. An advisory committee member who is a Medicaid
  recipient or the relative of a Medicaid recipient is entitled to a
  per diem allowance and reimbursement at rates established in the
  General Appropriations Act.
         (g)  Chapter 551 applies to the advisory committee.
         (h)  On the second anniversary of the date the commission
  completes implementation of the transition required under Section
  542.0201:
               (1)  the advisory committee is abolished; and
               (2)  this section expires. (Gov. Code, Sec. 534.053.)
         Sec. 542.0053.  IMPLEMENTATION OF SYSTEM REDESIGN. The
  commission shall, in collaboration with the advisory committee,
  implement the acute care services and long-term services and
  supports system for individuals with an intellectual or
  developmental disability in the manner and in the stages described
  by this chapter. (Gov. Code, Sec. 534.052.)
         Sec. 542.0054.  ANNUAL REPORT ON IMPLEMENTATION. (a) Not
  later than September 30 of each year, the commission, in
  collaboration with the advisory committee, shall prepare and submit
  to the legislature a report that includes:
               (1)  an assessment of the implementation of the system
  required by this chapter, including appropriate information
  regarding the provision of acute care services and long-term
  services and supports to individuals with an intellectual or
  developmental disability under Medicaid;
               (2)  recommendations regarding implementation of and
  improvements to the system redesign, including recommendations
  regarding appropriate statutory changes to facilitate the
  implementation; and
               (3)  an assessment of the effect of the system on:
                     (A)  access to long-term services and supports;
                     (B)  the quality of acute care services and
  long-term services and supports;
                     (C)  meaningful outcomes for Medicaid recipients
  using person-centered planning, individualized budgeting, and
  self-determination, including an individual's inclusion in the
  community;
                     (D)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (E)  the efficiency and use of funding;
                     (F)  the placement of individuals in housing that
  is the least restrictive setting appropriate to an individual's
  needs;
                     (G)  employment assistance and customized,
  integrated, competitive employment options; and
                     (H)  the number and types of fair hearing and
  appeals processes in accordance with federal law.
         (b)  This section expires on the second anniversary of the
  date the commission completes implementation of the transition
  required under Section 542.0201. (Gov. Code, Sec. 534.054.)
  SUBCHAPTER C. STAGE ONE: PILOT PROGRAM FOR IMPROVING SERVICE
  DELIVERY MODELS
         Sec. 542.0101.  DEFINITIONS. In this subchapter:
               (1)  "Capitation" means a method of compensating a
  provider on a monthly basis for providing or coordinating the
  provision of a defined set of services and supports that is based on
  a predetermined payment per services recipient.
               (2)  "Pilot program" means the pilot program
  established under this subchapter.
               (3)  "Pilot program participant" means an individual
  who is enrolled in and receives services through the pilot program.
               (4)  "Pilot program work group" means the pilot program
  work group established under Section 542.0104. (Gov. Code, Sec.
  534.101; New.)
         Sec. 542.0102.  PILOT PROGRAM TO TEST PERSON-CENTERED
  MANAGED CARE STRATEGIES AND IMPROVEMENTS BASED ON CAPITATION. (a)
  The commission, in collaboration with the advisory committee and
  pilot program work group, shall develop and implement a pilot
  program to test the delivery of long-term services and supports to
  pilot program participants through the STAR+PLUS Medicaid managed
  care program.
         (b)   A managed care organization participating in the pilot
  program shall provide Medicaid long-term services and supports to
  individuals with an intellectual or developmental disability and
  individuals with similar functional needs to test the
  organization's managed care strategy based on capitation.
         (c)  The pilot program must be designed to:
               (1)  increase access to long-term services and
  supports;
               (2)  improve the quality of acute care services and
  long-term services and supports;
               (3)  promote:
                     (A)  informed choice and meaningful outcomes by
  using person-centered planning, flexible consumer-directed
  services, individualized budgeting, and self-determination; and
                     (B)  community inclusion and engagement;
               (4)  promote integrated service coordination of acute
  care services and long-term services and supports;
               (5)  promote efficiency and best funding use based on a
  pilot program participant's needs and preferences;
               (6)  promote, through housing supports and navigation
  services, stability in housing that is the most integrated and
  least restrictive based on a pilot program participant's needs and
  preferences;
               (7)  promote employment assistance and customized,
  integrated, competitive employment;
               (8)  provide fair hearing and appeals processes in
  accordance with federal and state law;
               (9)  promote the use of innovative technologies and
  benefits, including telemedicine, telemonitoring, the testing of
  remote monitoring, transportation services, and other innovations
  that support community integration;
               (10)  ensure a provider network that is adequate and
  includes comprehensive long-term services and supports providers
  and ensure that pilot program participants have a choice among
  those providers;
               (11)  ensure the timely initiation and consistent
  provision of long-term services and supports in accordance with a
  pilot program participant's person-centered plan;
               (12)  ensure that pilot program participants with
  complex behavioral, medical, and physical needs are assessed and
  receive appropriate services in the most integrated and least
  restrictive setting based on the participants' needs and
  preferences;
               (13)  increase access to, expand flexibility of, and
  promote the use of the consumer direction model;
               (14)  promote independence, self-determination, the
  use of the consumer direction model, and decision making by pilot
  program participants by using alternatives to guardianship,
  including a supported decision-making agreement as defined by
  Section 1357.002, Estates Code; and
               (15)  promote sufficient flexibility to achieve,
  through the pilot program, the goals listed in:
                     (A)  this subsection;
                     (B)  Subsection (b); and
                     (C)  Sections 542.0103, 542.0110(a), 542.0113,
  and 542.0116(c). (Gov. Code, Secs. 534.102, 534.104(a), (h).)
         Sec. 542.0103.  ALTERNATIVE PAYMENT RATE OR METHODOLOGY.
  (a) The pilot program must be designed to test the use of
  innovative payment rates and methodologies for the provision of
  long-term services and supports to achieve the goals of the pilot
  program. The payment methodologies must include:
               (1)  the payment of a bundled amount without downside
  risk to a comprehensive long-term services and supports provider
  for some or all services delivered as part of a comprehensive array
  of long-term services and supports;
               (2)  enhanced incentive payments to comprehensive
  long-term services and supports providers based on the completion
  of predetermined outcomes or quality metrics; and
               (3)  any other payment model the commission approves.
         (b)  An alternative payment rate or methodology may be used
  for a managed care organization and comprehensive long-term
  services and supports provider only if the organization and
  provider agree in advance and in writing to use the rate or
  methodology.
         (c)  In developing an alternative payment rate or
  methodology, the commission, managed care organizations, and
  comprehensive long-term services and supports providers shall
  consider:
               (1)  the historical costs of long-term services and
  supports, including Medicaid fee-for-service rates;
               (2)  reasonable cost estimates for new services under
  the pilot program; and
               (3)  whether an alternative payment rate or methodology
  is sufficient to promote quality outcomes and ensure a provider's
  continued participation in the pilot program.
         (d)  An alternative payment rate or methodology may not
  reduce the minimum payment a provider receives for delivering
  long-term services and supports under the pilot program to an
  amount that is less than the fee-for-service reimbursement rate the
  provider received for delivering those services before
  participating in the pilot program. (Gov. Code, Secs. 534.104(c),
  (d), (e), (f).)
         Sec. 542.0104.  PILOT PROGRAM WORK GROUP. (a) The executive
  commissioner, in consultation with the advisory committee, shall
  establish a pilot program work group to assist in developing and
  provide advice on the operation of the pilot program.
         (b)  The pilot program work group is composed of:
               (1)  representatives of the advisory committee;
               (2)  stakeholders representing individuals with an
  intellectual or developmental disability;
               (3)  stakeholders representing individuals with
  similar functional needs as the individuals described by
  Subdivision (2); and
               (4)  representatives of managed care organizations
  that contract with the commission to provide services under the
  STAR+PLUS Medicaid managed care program.
         (c)  Chapter 2110 applies to the pilot program work group.
  (Gov. Code, Sec. 534.1015.)
         Sec. 542.0105.  STAKEHOLDER INPUT. As part of developing
  and implementing the pilot program, the commission, in
  collaboration with the advisory committee and pilot program work
  group, shall develop a process to receive and evaluate:
               (1)  input from:
                     (A)  statewide stakeholders; and
                     (B)  stakeholders from a STAR+PLUS Medicaid
  managed care service area in which the pilot program will be
  implemented; and
               (2)  other evaluations and data. (Gov. Code, Sec.
  534.103.)
         Sec. 542.0106.  MEASURABLE GOALS. (a) The commission, in
  collaboration with the advisory committee and pilot program work
  group, shall:
               (1)  identify, using national core indicators, the
  National Quality Forum long-term services and supports measures,
  and other appropriate Consumer Assessment of Healthcare Providers
  and Systems measures, measurable goals the pilot program is to
  achieve;
               (2)  develop specific strategies and performance
  measures for achieving the identified goals; and
               (3)  ensure that mechanisms to report, track, and
  assess specific strategies and performance measures for achieving
  the identified goals are established before implementing the pilot
  program.
         (b)  A strategy proposed under Subsection (a)(2) may be
  evidence-based if an evidence-based strategy is available for
  meeting the identified goals. (Gov. Code, Sec. 534.105.)
         Sec. 542.0107.  MANAGED CARE ORGANIZATION SELECTION. The
  commission shall:
               (1)  in collaboration with the advisory committee and
  pilot program work group, develop criteria regarding the selection
  of a managed care organization to participate in the pilot program;
  and
               (2)  select and contract with not more than two managed
  care organizations that contract with the commission to provide
  services under the STAR+PLUS Medicaid managed care program to
  participate in the pilot program. (Gov. Code, Sec. 534.1035.)
         Sec. 542.0108.  MANAGED CARE ORGANIZATION PARTICIPATION
  REQUIREMENTS. The commission shall require that a managed care
  organization participating in the pilot program:
               (1)  ensures that pilot program participants have a
  choice among acute care and comprehensive long-term services and
  supports providers and service delivery options, including the
  consumer direction model;
               (2)  demonstrates to the commission's satisfaction that
  the organization's network of acute care, long-term services and
  supports, and comprehensive long-term services and supports
  providers have experience and expertise in providing services for
  individuals with an intellectual or developmental disability and
  individuals with similar functional needs;
               (3)  has a process for preventing the inappropriate
  institutionalization of pilot program participants; and
               (4)  ensures the timely initiation and consistent
  provision of services in accordance with a pilot program
  participant's person-centered plan. (Gov. Code, Sec. 534.107(a).)
         Sec. 542.0109.  REQUIRED BENEFITS. (a) The commission
  shall ensure that a managed care organization participating in the
  pilot program provides:
               (1)  all Medicaid state plan acute care benefits
  available under the STAR+PLUS Medicaid managed care program;
               (2)  long-term services and supports under the Medicaid
  state plan, including:
                     (A)  Community First Choice services;
                     (B)  personal assistance services;
                     (C)  day activity health services; and
                     (D)  habilitation services;
               (3)  long-term services and supports under the
  STAR+PLUS home and community-based services (HCBS) waiver program,
  including:
                     (A)  assisted living services;
                     (B)  personal assistance services;
                     (C)  employment assistance;
                     (D)  supported employment;
                     (E)  adult foster care;
                     (F)  dental care;
                     (G)  nursing care;
                     (H)  respite care;
                     (I)  home-delivered meals;
                     (J)  cognitive rehabilitative therapy;
                     (K)  physical therapy;
                     (L)  occupational therapy;
                     (M)  speech-language pathology;
                     (N)  medical supplies;
                     (O)  minor home modifications; and
                     (P)  adaptive aids;
               (4)  the following long-term services and supports
  under a Medicaid waiver program:
                     (A)  enhanced behavioral health services;
                     (B)  behavioral supports;
                     (C)  day habilitation; and
                     (D)  community support transportation;
               (5)  the following additional long-term services and
  supports:
                     (A)  housing supports;
                     (B)  behavioral health crisis intervention
  services; and
                     (C)  high medical needs services;
               (6)  other nonresidential long-term services and
  supports that the commission, in collaboration with the advisory
  committee and pilot program work group, determines are appropriate
  and consistent with requirements governing the Medicaid waiver
  programs, person-centered approaches, home and community-based
  setting requirements, and achievement of the most integrated and
  least restrictive setting based on an individual's needs and
  preferences; and
               (7)  dental services benefits in accordance with
  Subsection (b).
         (b)  In developing the pilot program, the commission shall:
               (1)  evaluate dental services benefits provided
  through Medicaid waiver programs and dental services benefits
  provided as a value-added service under the Medicaid managed care
  delivery model;
               (2)  determine which dental services benefits are the
  most cost-effective in reducing emergency room and inpatient
  hospital admissions resulting from poor oral health; and
               (3)  based on the determination made under Subdivision
  (2), provide the most cost-effective dental services benefits to
  pilot program participants.
         (c)  Before implementing the pilot program, the commission,
  in collaboration with the advisory committee and pilot program work
  group, shall:
               (1)  for pilot program purposes only, develop
  recommendations to modify adult foster care and supported
  employment and employment assistance benefits to increase access to
  and availability of those services; and
               (2)  as necessary, define services listed under
  Subsections (a)(4) and (5) and any other services the commission
  determines to be appropriate under Subsection (a)(6).  (Gov. Code,
  Secs. 534.1045(a), (a-1), (f).)
         Sec. 542.0110.  PROVIDER PARTICIPATION.  (a)  The pilot
  program must allow a comprehensive long-term services and supports
  provider for individuals with an intellectual or developmental
  disability or similar functional needs that contracts with the
  commission to provide Medicaid services before the date the pilot
  program is implemented to voluntarily participate in the pilot
  program. A provider's choice not to participate in the pilot
  program does not affect the provider's status as a significant
  traditional provider.
         (b)  For the duration of the pilot program, the commission
  shall ensure that comprehensive long-term services and supports
  providers are:
               (1)  considered significant traditional providers; and
               (2)  included in the provider network of a managed care
  organization participating in the pilot program.
         (c)  A comprehensive long-term services and supports
  provider may deliver services listed under the following provisions
  only if the provider also delivers the services under a Medicaid
  waiver program:
               (1)  Sections 542.0109(a)(2)(A) and (D);
               (2)  Sections 542.0109(a)(3)(B), (C), (D), (G), (H),
  (J), (K), (L), and (M); and
               (3)  Section 542.0109(a)(4).
         (d)  A comprehensive long-term services and supports
  provider may deliver services listed under Sections 542.0109(a)(5)
  and (6) only if the managed care organization in the network of
  which the provider participates agrees, in a contract with the
  provider, to the provision of those services.
         (e)  Day habilitation services listed under Section
  542.0109(a)(4)(C) may be delivered by a provider who contracts or
  subcontracts with the commission to provide day habilitation
  services under the home and community-based services (HCS) waiver
  program or the ICF-IID program.  (Gov. Code, Secs. 534.104(g),
  534.1045(b), (c), (d), 534.107(b).)
         Sec. 542.0111.  CARE COORDINATION.  (a)  A comprehensive
  long-term services and supports provider participating in the pilot
  program shall work in coordination with the care coordinators of a
  managed care organization participating in the pilot program to
  ensure the seamless daily delivery of acute care and long-term
  services and supports in accordance with a pilot program
  participant's plan of care.
         (b)  A managed care organization may reimburse a
  comprehensive long-term services and supports provider for
  coordinating with care coordinators under this section.  (Gov.
  Code, Sec. 534.1045(e).)
         Sec. 542.0112.  PERSON-CENTERED PLANNING. The commission,
  in collaboration with the advisory committee and pilot program work
  group, shall ensure that each pilot program participant or the
  participant's legally authorized representative has access to a
  comprehensive, facilitated, person-centered plan that identifies
  outcomes for the participant and drives the development of the
  individualized budget. The consumer direction model must be an
  available option for a participant to achieve self-determination,
  choice, and control.  (Gov. Code, Sec. 534.109.)
         Sec. 542.0113.  USE OF INNOVATIVE TECHNOLOGY.  A pilot
  program participant is not required to use an innovative technology
  described by Section 542.0102(c)(9). If a participant chooses to
  use an innovative technology described by that subdivision, the
  commission shall ensure that:
               (1)  services associated with the technology are
  delivered in a manner that:
                     (A)  ensures the participant's privacy, health,
  and well-being;
                     (B)  provides access to housing in the most
  integrated and least restrictive environment;
                     (C)  assesses individual needs and preferences to
  promote autonomy, self-determination, the use of the consumer
  direction model, and privacy;
                     (D)  increases personal independence;
                     (E)  specifies the extent to which the innovative
  technology will be used, including:
                           (i)  the times of day during which the
  technology will be used;
                           (ii)  the place in which the technology is
  authorized to be used;
                           (iii)  the types of telemonitoring or remote
  monitoring that will be used; and
                           (iv)  the purposes for which the technology
  will be used; and
                     (F)  is consistent with and agreed on during the
  person-centered planning process;
               (2)  staff overseeing the use of the innovative
  technology:
                     (A)  review the person-centered and
  implementation plans for each participant before overseeing the use
  of the innovative technology; and
                     (B)  demonstrate competency regarding the support
  needs of each participant using the innovative technology;
               (3)  a participant using the innovative technology is
  able to request the removal of equipment associated with the
  technology and, on receipt of a request for the removal, the
  equipment is immediately removed; and
               (4)  a participant is not required to use telemedicine
  at any point during the pilot program and, if the participant
  refuses to use telemedicine, the managed care organization
  providing pilot program health care services to the participant
  arranges for services that do not include telemedicine.  (Gov.
  Code, Sec. 534.104(b).)
         Sec. 542.0114.  INFORMATIONAL MATERIALS. (a) To ensure
  that prospective pilot program participants are able to make an
  informed decision on whether to participate in the pilot program,
  the commission, in collaboration with the advisory committee and
  pilot program work group, shall develop and distribute
  informational materials that describe the pilot program's benefits
  and impact on current services and other related information.
         (b)  The commission shall establish a timeline and process
  for developing and distributing the informational materials and
  ensure that:
               (1)  the materials are developed and distributed to
  individuals eligible to participate in the pilot program with
  sufficient time to educate the individuals, their families, and
  other persons actively involved in their lives regarding the pilot
  program;
               (2)  individuals eligible to participate in the pilot
  program, including individuals enrolled in the STAR+PLUS Medicaid
  managed care program, their families, and other persons actively
  involved in their lives receive the materials and oral information
  on the pilot program;
               (3)  the materials contain clear, simple language
  presented in a manner that is easy to understand; and
               (4)  at a minimum, the materials explain that:
                     (A)  on the pilot program's conclusion, each pilot
  program participant will be asked to provide feedback on the
  participant's experience, including feedback on whether the pilot
  program was able to meet the participant's unique support needs;
                     (B)  participation in the pilot program does not
  remove an individual from any Medicaid waiver program interest
  list;
                     (C)  a pilot program participant who, during the
  pilot program's operation, is offered enrollment in a Medicaid
  waiver program may accept the enrollment, transition, or diversion
  offer; and
                     (D)  a pilot program participant has a choice
  among acute care and comprehensive long-term services and supports
  providers and service delivery options, including the consumer
  direction model and comprehensive services model. (Gov. Code, Sec.
  534.1065(b).)
         Sec. 542.0115.  IMPLEMENTATION, LOCATION, AND DURATION. The
  commission shall:
               (1)  implement the pilot program on September 1, 2023;
               (2)  conduct the pilot program in a STAR+PLUS Medicaid
  managed care service area the commission selects; and
               (3)  operate the pilot program for at least 24 months.
  (Gov. Code, Sec. 534.106.)
         Sec. 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. (Gov. Code, Secs.
  534.104(k), 534.1065(a), (c).)
         Sec. 542.0117.  PILOT PROGRAM INFORMATION COLLECTION AND
  ANALYSIS. (a) The commission, in collaboration with the advisory
  committee and pilot program work group, shall determine the
  information to collect from a managed care organization
  participating in the pilot program for use in conducting the
  evaluation and preparing the report under Section 542.0119.
         (b)  For the duration of the pilot program, a managed care
  organization participating in the pilot program shall submit to the
  commission and the advisory committee quarterly reports on the
  services provided to each pilot program participant. The reports
  must include information on:
               (1)  the level of each requested service and the
  authorization and utilization rates for those services;
               (2)  timelines of:
                     (A)  the authorization of each requested service;
                     (B)  the initiation of each requested service;
                     (C)  the delivery of each requested service; and
                     (D)  each unplanned break in the delivery of
  requested services and the duration of the break;
               (3)  the number of pilot program participants using
  employment assistance and supported employment services;
               (4)  the number of service denials and fair hearings
  and the dispositions of the fair hearings;
               (5)  the number of complaints and inquiries the managed
  care organization received and the outcome of each complaint; and
               (6)  the number of pilot program participants who
  choose the consumer direction model and the reasons other
  participants did not choose the consumer direction model.
         (c)  The commission shall ensure that the mechanisms to
  report and track the information and data required by Subsections
  (a) and (b) are established before implementing the pilot program.
         (d)  For purposes of making a recommendation about a system
  of programs and services for implementation through future state
  legislation or rules, the commission, in collaboration with the
  advisory committee and pilot program work group, shall analyze:
               (1)  information provided by managed care
  organizations participating in the pilot program; and
               (2)  any information the commission collects during the
  operation of the pilot program.
         (e)  The analysis under Subsection (d) must include an
  assessment of the effect of the managed care strategies implemented
  in the pilot program on the goals described by Sections 542.0102(b)
  and (c), 542.0103, 542.0110(a), 542.0113, and 542.0116(c). (Gov.
  Code, Secs. 534.104(i), (j), 534.108.)
         Sec. 542.0118.  PILOT PROGRAM CONCLUSION; PUBLICATION OF
  CONTINUATION. On September 1, 2025, the pilot program is concluded
  unless the commission continues the pilot program under Section
  542.0120. If the commission continues the pilot program, the
  commission shall publish notice of that continuation in the Texas
  Register not later than September 1, 2025. (Gov. Code, Sec.
  534.111.)
         Sec. 542.0119.  EVALUATIONS AND REPORTS. (a) The
  commission, in collaboration with the advisory committee and pilot
  program work group, shall review and evaluate the progress and
  outcomes of the pilot program and submit, as part of the annual
  report required under Section 542.0054, a report on the pilot
  program's status that includes recommendations for improving the
  pilot program.
         (b)  Not later than September 1, 2026, the commission, in
  collaboration with the advisory committee and pilot program work
  group, shall prepare and submit to the legislature a written report
  that evaluates the pilot program based on a comprehensive analysis.
  The analysis must:
               (1)  assess the effect of the pilot program on:
                     (A)  access to and quality of long-term services
  and supports;
                     (B)  informed choice and meaningful outcomes
  using person-centered planning, flexible consumer-directed
  services, individualized budgeting, and self-determination,
  including a pilot program participant's inclusion in the community;
                     (C)  the integration of service coordination of
  acute care services and long-term services and supports;
                     (D)  employment assistance and customized,
  integrated, competitive employment options;
                     (E)  the number, types, and dispositions of fair
  hearings and appeals in accordance with federal and state law;
                     (F)  increasing the use and flexibility of the
  consumer direction model;
                     (G)  increasing the use of alternatives to
  guardianship, including supported decision-making agreements as
  defined by Section 1357.002, Estates Code;
                     (H)  achieving the best and most cost-effective
  funding use based on a pilot program participant's needs and
  preferences; and
                     (I)  attendant recruitment and retention;
               (2)  analyze the experiences and outcomes of the
  following systems changes:
                     (A)  the comprehensive assessment instrument
  described by Section 533A.0335, Health and Safety Code;
                     (B)  the 21st Century Cures Act (Pub. L.
  No. 114-255);
                     (C)  implementation of the federal rule adopted by
  the Centers for Medicare and Medicaid Services and published at 79
  Fed. Reg. 2948 (January 16, 2014) related to the provision of
  long-term services and supports through a home and community-based
  services (HCS) waiver program under Section 1915(c), 1915(i), or
  1915(k) of the Social Security Act (42 U.S.C. Section 1396n(c),
  (i), or (k));
                     (D)  the provision of basic attendant and
  habilitation services under Section 542.0152; and
                     (E)  the benefits of providing STAR+PLUS Medicaid
  managed care services to individuals based on functional needs;
               (3)  include feedback on the pilot program based on the
  personal experiences of:
                     (A)  individuals with an intellectual or
  developmental disability and individuals with similar functional
  needs who were pilot program participants;
                     (B)  families of and other persons actively
  involved in the lives of individuals described by Paragraph (A);
  and
                     (C)  comprehensive long-term services and
  supports providers who delivered services under the pilot program;
               (4)  be incorporated in the annual report required
  under Section 542.0054; and
               (5)  include recommendations on:
                     (A)  a system of programs and services for the
  legislature's consideration;
                     (B)  necessary statutory changes; and
                     (C)  whether to implement the pilot program
  statewide under the STAR+PLUS Medicaid managed care program for
  eligible individuals. (Gov. Code, Sec. 534.112.)
         Sec. 542.0120.  TRANSITION BETWEEN PROGRAMS; CONTINUITY OF
  CARE. (a) During the evaluation of the pilot program required
  under Section 542.0119, the commission may continue the pilot
  program to ensure continuity of care for pilot program
  participants. If, following the evaluation, the commission does
  not continue the pilot program, the commission shall ensure that
  there is a comprehensive plan for transitioning the provision of
  Medicaid benefits for pilot program participants to the benefits
  provided before participation in the pilot program.
         (b)  A transition plan under Subsection (a) shall be
  developed in collaboration with the advisory committee and pilot
  program work group and with stakeholder input as described by
  Section 542.0105. (Gov. Code, Sec. 534.110.)
         Sec. 542.0121.  SERVICE TRANSITION REQUIREMENTS. (a) For
  purposes of implementing the pilot program and transitioning the
  provision of services provided to recipients under certain Medicaid
  waiver programs to a Medicaid managed care delivery model following
  completion of the pilot program, the commission shall:
               (1)  implement and maintain a certification process for
  and maintain regulatory oversight over providers under the Texas
  home living (TxHmL) and home and community-based services (HCS)
  waiver programs; and
               (2)  require managed care organizations to include in
  the organizations' provider networks providers who are certified in
  accordance with the certification process described by Subdivision
  (1).
         (b)  For purposes of implementing the pilot program and
  transitioning the provision of services described by Section
  542.0201 to the STAR+PLUS Medicaid managed care program, a
  comprehensive long-term services and supports provider:
               (1)  must report to the managed care organization in
  the network of which the provider participates each encounter of
  any directly contracted service;
               (2)  must provide to the managed care organization
  quarterly reports on:
                     (A)  coordinated services and time frames for the
  delivery of those services; and
                     (B)  the goals and objectives outlined in an
  individual's person-centered plan and progress made toward meeting
  those goals and objectives; and
               (3)  may not be held accountable for the provision of
  services specified in an individual's service plan that are not
  authorized or are subsequently denied by the managed care
  organization.
         (c)  On transitioning services under a Medicaid waiver
  program to a Medicaid managed care delivery model, the commission
  shall ensure that individuals do not lose benefits the individuals
  receive under the Medicaid waiver program. (Gov. Code, Sec.
  534.252.)
  SUBCHAPTER D. STAGE ONE: PROVISION OF ACUTE CARE AND CERTAIN OTHER
  SERVICES
         Sec. 542.0151.  DELIVERY OF ACUTE CARE SERVICES TO
  INDIVIDUALS WITH AN INTELLECTUAL OR DEVELOPMENTAL DISABILITY. (a)
  Subject to Sections 540.0701 and 540.0753, the commission shall:
               (1)  provide acute care Medicaid benefits to
  individuals with an intellectual or developmental disability
  through the STAR+PLUS Medicaid managed care program or the most
  appropriate integrated capitated managed care program delivery
  model; and
               (2)  monitor the provision of those benefits.
         (b)  The commission, in collaboration with the advisory
  committee, shall analyze the outcomes of providing acute care
  Medicaid benefits to individuals with an intellectual or
  developmental disability under a model described by Subsection (a).
  The analysis must:
               (1)  include an assessment of the effects of the
  delivery model on:
                     (A)  access to and quality of acute care services;
  and
                     (B)  the number and types of fair hearing and
  appeals processes in accordance with federal law;
               (2)  be incorporated into the annual report to the
  legislature required under Section 542.0054; and
               (3)  include recommendations for delivery model
  improvements and implementation for the legislature's
  consideration, including recommendations for needed statutory
  changes. (Gov. Code, Sec. 534.151.)
         Sec. 542.0152.  DELIVERY OF CERTAIN OTHER SERVICES UNDER
  STAR+PLUS MEDICAID MANAGED CARE PROGRAM AND BY WAIVER PROGRAM
  PROVIDERS. (a) The commission shall:
               (1)  implement the option for the delivery of basic
  attendant and habilitation services to individuals with an
  intellectual or developmental disability under the STAR+PLUS
  Medicaid managed care program that:
                     (A)  is the most cost-effective; and
                     (B)  maximizes federal funding for the delivery of
  services for that program and other similar programs; and
               (2)  provide voluntary training to individuals
  receiving services under the STAR+PLUS Medicaid managed care
  program or their legally authorized representatives regarding how
  to select, manage, and dismiss a personal attendant providing basic
  attendant and habilitation services under the program.
         (b)  The commission shall require each managed care
  organization that contracts with the commission to provide basic
  attendant and habilitation services under the STAR+PLUS Medicaid
  managed care program in accordance with this section to:
               (1)  include in the organization's provider network for
  the provision of those services:
                     (A)  home and community support services agencies
  licensed under Chapter 142, Health and Safety Code, with which the
  commission has a contract to provide services under the community
  living assistance and support services (CLASS) waiver program; and
                     (B)  persons exempted from licensing under
  Section 142.003(a)(19), Health and Safety Code, with which the
  commission has a contract to provide services under:
                           (i)  the home and community-based services
  (HCS) waiver program; or
                           (ii)  the Texas home living (TxHmL) waiver
  program;
               (2)  review and consider any assessment conducted by a
  local intellectual and developmental disability authority
  providing intellectual and developmental disability service
  coordination under Subsection (c); and
               (3)  enter into a written agreement with each local
  intellectual and developmental disability authority in the service
  area regarding the processes the organization and the authority
  will use to coordinate the services provided to individuals with an
  intellectual or developmental disability.
         (c)  The commission shall contract with and make contract
  payments to local intellectual and developmental disability
  authorities to:
               (1)  provide intellectual and developmental disability
  service coordination to individuals with an intellectual or
  developmental disability under the STAR+PLUS Medicaid managed care
  program by assisting individuals who are eligible to receive
  services in a community-based setting, including individuals
  transitioning to a community-based setting;
               (2)  provide to the appropriate managed care
  organization, based on the functional need, risk factors, and
  desired outcomes of an individual with an intellectual or
  developmental disability, an assessment of whether the individual
  needs attendant or habilitation services;
               (3)  assist individuals with an intellectual or
  developmental disability with developing the individuals' plans of
  care under the STAR+PLUS Medicaid managed care program, including
  with making any changes resulting from periodic reassessments of
  the plans;
               (4)  provide to the appropriate managed care
  organization and the commission information regarding the
  recommended plans of care with which the authorities provide
  assistance as provided by Subdivision (3), including documentation
  necessary to demonstrate the need for care described by a plan; and
               (5)  annually provide to the appropriate managed care
  organization and the commission a description of outcomes based on
  an individual's plan of care.
         (d)  Local intellectual and developmental disability
  authorities providing service coordination under this section may
  not also provide attendant and habilitation services under this
  section.
         (e)  A local intellectual and developmental disability
  authority with which the commission contracts under Subsection (c)
  may subcontract with an eligible person, including a nonprofit
  entity, to coordinate the delivery of services to individuals with
  an intellectual or developmental disability under this section.
  The executive commissioner by rule shall establish minimum
  qualifications a person must meet to be considered an eligible
  person under this subsection.
         (f)  The commission may contract with providers
  participating in the home and community-based services (HCS) waiver
  program, the Texas home living (TxHmL) waiver program, the
  community living assistance and support services (CLASS) waiver
  program, or the deaf-blind with multiple disabilities (DBMD) waiver
  program for the delivery of basic attendant and habilitation
  services to individuals as described by Subsection (a). The
  commission has regulatory and oversight authority over the
  providers with which the commission contracts for the delivery of
  those services. (Gov. Code, Secs. 534.152(a), (b), (c), (d), (f),
  (g).)
  SUBCHAPTER E. STAGE TWO: TRANSITION OF ICF-IID PROGRAM RECIPIENTS
  AND LONG-TERM CARE MEDICAID WAIVER PROGRAM RECIPIENTS TO INTEGRATED
  MANAGED CARE SYSTEM
         Sec. 542.0201.  TRANSITION OF ICF-IID PROGRAM RECIPIENTS AND
  CERTAIN OTHER MEDICAID WAIVER PROGRAM RECIPIENTS TO MANAGED CARE
  PROGRAM. (a) This section applies to individuals with an
  intellectual or developmental disability who are receiving
  long-term services and supports under:
               (1)  a Medicaid waiver program; or
               (2)  an ICF-IID program.
         (b)  After implementing the pilot program under Subchapter C
  and completing the evaluations required by Section 542.0119, the
  commission, in collaboration with the advisory committee, shall
  develop a plan for transitioning all or a portion of the services
  provided through a Medicaid waiver program or an ICF-IID program to
  a Medicaid managed care model. The plan must include:
               (1)  a process for transitioning the services in the
  following phases:
                     (A)  beginning September 1, 2027, the Texas home
  living (TxHmL) waiver program services;
                     (B)  beginning September 1, 2029, the community
  living assistance and support services (CLASS) waiver program
  services;
                     (C)  beginning September 1, 2031, nonresidential
  services provided under the home and community-based services (HCS)
  waiver program and the deaf-blind with multiple disabilities (DBMD)
  waiver program; and
                     (D)  subject to Subdivision (2), the residential
  services provided under an ICF-IID program, the home and
  community-based services (HCS) waiver program, and the deaf-blind
  with multiple disabilities (DBMD) waiver program; and
               (2)  a process for evaluating and determining the
  feasibility and cost efficiency of transitioning residential
  services described by Subdivision (1)(D) to a Medicaid managed care
  model based on an evaluation of a separate pilot program the
  commission, in collaboration with the advisory committee, conducts
  that operates after the transition process described by Subdivision
  (1).
         (c)  Before implementing the transition plan, the commission
  shall determine whether to:
               (1)  continue operating the Medicaid waiver programs or
  ICF-IID program only for purposes of providing, if applicable:
                     (A)  supplemental long-term services and supports
  not available under the managed care program delivery model the
  commission selects; or
                     (B)  long-term services and supports to Medicaid
  waiver program recipients who choose to continue receiving benefits
  under the waiver programs as provided by Section 542.0202(a); or
               (2)  provide all or a portion of the long-term services
  and supports previously available under the Medicaid waiver
  programs or ICF-IID program through the managed care program
  delivery model the commission selects.
         (d)  In implementing the transition plan, the commission
  shall develop a process to receive and evaluate input from
  interested statewide stakeholders that is in addition to the input
  the advisory committee provides.
         (e)  The commission shall ensure that there is a
  comprehensive plan for transitioning the provision of Medicaid
  benefits under this section that protects the continuity of care
  provided to individuals to whom this section applies and ensures
  that individuals have a choice among acute care and comprehensive
  long-term services and supports providers and service delivery
  options, including the consumer direction model.
         (f)  Before transitioning the provision of Medicaid benefits
  for children under this section, a managed care organization
  providing services under the managed care program delivery model
  the commission selects must demonstrate to the commission's
  satisfaction that the providers in the organization's provider
  network have experience and expertise in providing services to
  children with an intellectual or developmental disability.
         (g)  Before transitioning the provision of Medicaid benefits
  for adults under this section, a managed care organization
  providing services under the managed care program delivery model
  the commission selects must demonstrate to the commission's
  satisfaction that the providers in the organization's provider
  network have experience and expertise in providing services to
  adults with an intellectual or developmental disability. (Gov.
  Code, Secs. 534.202(a), (b), (c), (d), (e), (f).)
         Sec. 542.0202.  RECIPIENT CHOICE OF DELIVERY MODEL. (a) If
  the commission determines under Section 542.0201(c)(2) that all or
  a portion of the long-term services and supports previously
  available under Medicaid waiver programs should be provided through
  a managed care program delivery model, the commission shall, at the
  time of the transition, allow each recipient receiving long-term
  services and supports under a Medicaid waiver program the option
  of:
               (1)  continuing to receive the services and supports
  under the Medicaid waiver program; or
               (2)  receiving the services and supports through the
  managed care program delivery model the commission selects.
         (b)  A recipient who chooses under Subsection (a) to receive
  long-term services and supports through a managed care program
  delivery model may not subsequently choose to receive the services
  and supports under a Medicaid waiver program. (Gov. Code, Secs.
  534.202(g), (h).)
         Sec. 542.0203.  REQUIRED CONTRACT PROVISIONS. In addition
  to the requirements of Subchapter F, Chapter 540, a contract
  between a managed care organization and the commission for the
  organization to provide Medicaid benefits under Section 542.0201
  must contain a requirement that the organization implement a
  process for individuals with an intellectual or developmental
  disability that:
               (1)  ensures that the individuals have a choice among
  acute care and comprehensive long-term services and supports
  providers and service delivery options, including the consumer
  direction model;
               (2)  to the greatest extent possible, protects those
  individuals' continuity of care with respect to access to primary
  care providers, including through the use of single-case agreements
  with out-of-network providers; and
               (3)  provides access to a member services telephone
  line for individuals or their legally authorized representatives to
  obtain information on and assistance with accessing services
  through network providers, including providers of primary and
  specialty services and other long-term services and supports. (Gov.
  Code, Sec. 534.202(i).)
         Sec. 542.0204.  RESPONSIBILITIES OF COMMISSION UNDER
  SUBCHAPTER. In administering this subchapter, the commission shall
  ensure, on making a determination to transition services under
  Section 542.0201:
               (1)  that the commission is responsible for setting the
  minimum reimbursement rate paid to an ICF-IID services or group
  home provider under the integrated managed care system, including
  the staff rate enhancement paid to an ICF-IID services or group home
  provider;
               (2)  that an ICF-IID services or group home provider is
  paid not later than the 10th day after the date the provider submits
  a clean claim in accordance with the criteria the commission uses to
  reimburse an ICF-IID services or group home provider, as
  applicable;
               (3)  the establishment of an electronic portal through
  which an ICF-IID services or group home provider participating in
  the STAR+PLUS Medicaid managed care program delivery model or the
  most appropriate integrated capitated managed care program
  delivery model, as appropriate, may submit long-term services and
  supports claims to any participating managed care organization; and
               (4)  that the consumer direction model is an available
  option for each individual with an intellectual or developmental
  disability who receives Medicaid benefits in accordance with this
  subchapter to achieve self-determination, choice, and control and
  that the individual or the individual's legally authorized
  representative has access to a comprehensive, facilitated,
  person-centered plan that identifies outcomes for the individual. (Gov. Code, Sec. 534.203.)
 
  CHAPTER 543. CLINICAL INITIATIVES TO IMPROVE MEDICAID QUALITY OF
  CARE AND COST-EFFECTIVENESS
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 543.0001.  EFFECT OF CHAPTER ON COMMISSION'S
                   AUTHORITY
  Sec. 543.0002.  RULES
  Sec. 543.0003.  INTERNET WEBSITE
  SUBCHAPTER B. ASSESSMENT OF CLINICAL INITIATIVES
  Sec. 543.0051.  MEDICAID QUALITY IMPROVEMENT PROCESS
  Sec. 543.0052.  SOLICITATION OF SUGGESTIONS FOR
                   CLINICAL INITIATIVES
  Sec. 543.0053.  CLINICAL INITIATIVE EVALUATION PROCESS
  Sec. 543.0054.  ANALYSIS OF CLINICAL INITIATIVES
  Sec. 543.0055.  FINAL REPORT ON CLINICAL INITIATIVE
  Sec. 543.0056.  COMMISSION ACTION ON CLINICAL
                   INITIATIVE
  CHAPTER 543. CLINICAL INITIATIVES TO IMPROVE MEDICAID QUALITY OF
  CARE AND COST-EFFECTIVENESS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 543.0001.  EFFECT OF CHAPTER ON COMMISSION'S AUTHORITY.
  This chapter does not affect the commission's authority, or give
  the commission additional authority, to:
               (1)  affect any individual health care treatment
  decision for a Medicaid recipient;
               (2)  replace or affect:
                     (A)  the process of determining Medicaid
  benefits, including the approval process for receiving benefits for
  durable medical equipment; or
                     (B)  any applicable approval process required for
  reimbursement for services or other equipment under Medicaid;
               (3)  implement a clinical initiative or associated rule
  or program policy that is otherwise prohibited under state or
  federal law; or
               (4)  implement any initiative that would expand
  eligibility for Medicaid benefits.  (Gov. Code, Sec. 538.002.)
         Sec. 543.0002.  RULES. The executive commissioner shall
  adopt rules necessary to implement this chapter.  (Gov. Code, Sec.
  538.003.)
         Sec. 543.0003.  INTERNET WEBSITE. The commission shall
  maintain an Internet website related to the quality improvement
  process required under this chapter. The website must include:
               (1)  an explanation of the process for submission,
  preliminary review, analysis, and approval of a clinical initiative
  under this chapter;
               (2)  an explanation of how members of the public may
  submit comments or research related to an initiative;
               (3)  a copy of each initiative selected for analysis
  under Section 543.0054;
               (4)  the status of each initiative in the approval
  process; and
               (5)  a copy of each final report prepared under this
  chapter. (Gov. Code, Sec. 538.056.)
  SUBCHAPTER B. ASSESSMENT OF CLINICAL INITIATIVES
         Sec. 543.0051.  MEDICAID QUALITY IMPROVEMENT PROCESS. The
  commission shall, in accordance with this chapter, develop and
  implement a quality improvement process by which the commission:
               (1)  receives suggestions for clinical initiatives
  designed to improve:
                     (A)  the quality of care provided under Medicaid;
  and
                     (B)  the cost-effectiveness of Medicaid;
               (2)  conducts a preliminary review under Section
  543.0053(2) of each suggestion received under Section 543.0052 to
  determine whether the suggestion warrants further consideration
  and analysis; and
               (3)  conducts an analysis under Section 543.0054 of
  each suggestion that is selected for analysis in accordance with
  Subdivision (2).  (Gov. Code, Sec. 538.051.)
         Sec. 543.0052.  SOLICITATION OF SUGGESTIONS FOR CLINICAL
  INITIATIVES. (a) Subject to Subsection (b), the commission shall
  solicit and accept written or electronic suggestions for clinical
  initiatives from:
               (1)  a member of the legislature;
               (2)  the executive commissioner;
               (3)  the commissioner of state health services;
               (4)  the commissioner of the Department of Family and
  Protective Services; and
               (5)  the medical care advisory committee appointed
  under Section 32.022, Human Resources Code.
         (b)  The commission may not accept a suggestion for a
  clinical initiative that:
               (1)  is undergoing clinical trials; or
               (2)  expands a health care provider's scope of practice
  beyond the law governing the provider's practice.  (Gov. Code, Sec.
  538.052.)
         Sec. 543.0053.  CLINICAL INITIATIVE EVALUATION PROCESS. The
  commission shall establish and implement an evaluation process for
  the submission, preliminary review, analysis, and approval of a
  clinical initiative. The process must:
               (1)  require that a suggestion for a clinical
  initiative be submitted to the state Medicaid director;
               (2)  allow the commission to conduct, with the
  assistance of an appropriate advisory committee or similar group as
  determined by the commission, a preliminary review of each
  suggested clinical initiative to determine whether the initiative
  warrants further consideration and analysis under Section
  543.0054;
               (3)  require the commission to publish on the Internet
  website maintained in accordance with Section 543.0003 the criteria
  the commission uses in the preliminary review under Subdivision (2)
  to determine whether an initiative warrants analysis under Section
  543.0054;
               (4)  limit the number of suggestions analyzed under
  Section 543.0054;
               (5)  require that a suggestion for a clinical
  initiative selected for analysis under Section 543.0054 be
  published on the Internet website maintained in accordance with
  Section 543.0003 not later than the 30th day after the date the
  state Medicaid director receives the suggestion;
               (6)  provide for a formal public comment period that
  lasts at least 30 days during which the public may submit comments
  and research relating to a suggested clinical initiative;
               (7)  require commission employees to analyze, in
  accordance with Section 543.0054, each suggested clinical
  initiative selected for analysis; and
               (8)  require the development and publication of a final
  report in accordance with Section 543.0055 on each clinical
  initiative selected for analysis under Section 543.0054 not later
  than the 180th day after the date the state Medicaid director
  receives the suggestion.  (Gov. Code, Sec. 538.053.)
         Sec. 543.0054.  ANALYSIS OF CLINICAL INITIATIVES. After
  conducting a preliminary review of a clinical initiative under
  Section 543.0053(2), the commission shall analyze the clinical
  initiative if the commission selects the initiative for analysis.
  The analysis must include a review of:
               (1)  any public comments and submitted research
  relating to the initiative;
               (2)  the available clinical research and historical
  utilization information relating to the initiative;
               (3)  published medical literature relating to the
  initiative;
               (4)  any adoption of the initiative by a medical
  society or other clinical group;
               (5)  whether the initiative has been implemented under:
                     (A)  the Medicare program;
                     (B)  another state medical assistance program; or
                     (C)  a state-operated health care program,
  including the child health plan program;
               (6)  the results of reports, research, pilot programs,
  or clinical studies relating to the initiative conducted by:
                     (A)  institutions of higher education, including
  related medical schools;
                     (B)  governmental entities and agencies; and
                     (C)  private and nonprofit think tanks and
  research groups;
               (7)  the impact the initiative would have on Medicaid
  if the initiative were implemented in this state, including:
                     (A)  an estimate of the number of Medicaid
  recipients that would be impacted by implementing the initiative;
  and
                     (B)  a description of any potential cost savings
  to the state that would result from implementing the initiative;
  and
               (8)  any statutory barriers to implementing the
  initiative. (Gov. Code, Sec. 538.054.)
         Sec. 543.0055.  FINAL REPORT ON CLINICAL INITIATIVE. The
  commission shall prepare a final report based on the analysis of a
  clinical initiative conducted under Section 543.0054. The final
  report must include:
               (1)  a final determination of:
                     (A)  the feasibility of implementing the
  initiative;
                     (B)  the likely impact implementing the
  initiative would have on the quality of care provided under
  Medicaid; and
                     (C)  the anticipated cost savings to the state
  that would result from implementing the initiative;
               (2)  a summary of the public comments, including a
  description of any opposition to the initiative;
               (3)  an identification of any statutory barriers to
  implementing the initiative; and
               (4)  if the initiative is not implemented, an
  explanation of that decision. (Gov. Code, Sec. 538.055.)
         Sec. 543.0056.  COMMISSION ACTION ON CLINICAL INITIATIVE.
  After the commission analyzes a clinical initiative under Section
  543.0054:
               (1)  if the commission determined that the initiative
  is cost-effective and will improve the quality of care under
  Medicaid, the commission may:
                     (A)  implement the initiative if implementing the
  initiative is not otherwise prohibited by law; or
                     (B)  if implementation requires a change in law,
  submit a copy of the final report together with recommendations
  relating to the initiative's implementation to the standing
  committees of the senate and house of representatives with
  jurisdiction over Medicaid; and
               (2)  if the commission determined that the initiative
  is not cost-effective or will not improve quality of care under
  Medicaid, the commission may not implement the initiative. (Gov. Code, Sec. 538.057.)
 
  CHAPTER 543A. QUALITY-BASED OUTCOMES AND PAYMENTS UNDER MEDICAID
  AND CHILD HEALTH PLAN PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 543A.0001.  DEFINITIONS
  Sec. 543A.0002.  DEVELOPMENT OF OUTCOME AND PROCESS
                    MEASURES; CORRELATION WITH INCREASED
                    REIMBURSEMENT RATES
  Sec. 543A.0003.  USE OF QUALITY-BASED OUTCOME MEASURE
                    FOR ENROLLEES OR RECIPIENTS WITH HIV
                    INFECTION
  Sec. 543A.0004.  DEVELOPMENT OF QUALITY-BASED PAYMENT
                    SYSTEMS
  Sec. 543A.0005.  PAYMENT METHODOLOGY CONVERSION
  Sec. 543A.0006.  TRANSPARENCY; CONSIDERATIONS
  Sec. 543A.0007.  PERIODIC EVALUATION
  Sec. 543A.0008.  ANNUAL REPORT
  SUBCHAPTER B. QUALITY-BASED PAYMENTS RELATING TO MANAGED CARE
  ORGANIZATIONS
  Sec. 543A.0051.  QUALITY-BASED PREMIUM PAYMENTS;
                    PERFORMANCE REPORTING
  Sec. 543A.0052.  FINANCIAL INCENTIVES AND CONTRACT
                    AWARD PREFERENCES
  SUBCHAPTER C. QUALITY-BASED HEALTH HOME PAYMENT SYSTEMS
  Sec. 543A.0101.  DEFINITION
  Sec. 543A.0102.  QUALITY-BASED HEALTH HOME PAYMENTS
  Sec. 543A.0103.  HEALTH HOME ELIGIBILITY
  SUBCHAPTER D. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
  Sec. 543A.0151.  COLLECTING CERTAIN INFORMATION;
                    REPORTS TO CERTAIN HOSPITALS
  Sec. 543A.0152.  REIMBURSEMENT ADJUSTMENTS
  SUBCHAPTER E. QUALITY-BASED PAYMENT INITIATIVES
  Sec. 543A.0201.  PAYMENT INITIATIVES; DETERMINATION OF
                    BENEFIT TO STATE
  Sec. 543A.0202.  PAYMENT INITIATIVE ADMINISTRATION
  Sec. 543A.0203.  QUALITY-OF-CARE AND COST-EFFICIENCY
                    BENCHMARKS AND GOALS; EFFICIENCY
                    PERFORMANCE STANDARDS
  Sec. 543A.0204.  PAYMENT RATES UNDER PAYMENT
                    INITIATIVES
  SUBCHAPTER F. QUALITY-BASED LONG-TERM SERVICES AND SUPPORTS
  PAYMENT SYSTEMS
  Sec. 543A.0251.  QUALITY-BASED PAYMENT SYSTEMS FOR
                    LONG-TERM SERVICES AND SUPPORTS
  Sec. 543A.0252.  DATA SET EVALUATION
  Sec. 543A.0253.  COLLECTING CERTAIN INFORMATION;
                    REPORTS TO CERTAIN PROVIDERS
  CHAPTER 543A. QUALITY-BASED OUTCOMES AND PAYMENTS UNDER MEDICAID
  AND CHILD HEALTH PLAN PROGRAM
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 543A.0001.  DEFINITIONS. In this chapter:
               (1)  "Alternative payment system" includes:
                     (A)  a global payment system;
                     (B)  an episode-based bundled payment system; and
                     (C)  a blended payment system.
               (2)  "Blended payment system" means a system for
  compensating a physician or other health care provider that:
                     (A)  includes at least one feature of a global
  payment system and an episode-based bundled payment system; and
                     (B)  may include a system under which a portion of
  the compensation paid to a physician or other health care provider
  is based on a fee-for-service payment arrangement.
               (3)  "Enrollee" means an individual enrolled in the
  child health plan program.
               (4)  "Episode-based bundled payment system" means a
  system for compensating a physician or other health care provider
  for providing or arranging for health care services to an enrollee
  or recipient that is based on a flat payment for all services
  provided in connection with a single episode of medical care.
               (5)  "Exclusive provider benefit plan" means a managed
  care plan subject to 28 T.A.C. Part 1, Chapter 3, Subchapter KK.
               (6)  "Freestanding emergency medical care facility"
  means a facility licensed under Chapter 254, Health and Safety
  Code.
               (7)  "Global payment system" means a system for
  compensating a physician or other health care provider for
  providing or arranging for a defined set of covered health care
  services to an enrollee or recipient for a specified period that is
  based on a predetermined payment per enrollee or recipient for the
  specified period, without regard to the quantity of services
  actually provided.
               (8)  "Health care provider" means a person, facility,
  or institution licensed, certified, registered, or chartered by
  this state to provide health care.  The term includes an employee,
  independent contractor, or agent of a health care provider acting
  in the course and scope of the employment or contractual
  relationship.
               (9)  "HIV" has the meaning assigned by Section 81.101,
  Health and Safety Code.
               (10)  "Hospital" means an institution licensed under
  Chapter 241 or 577, Health and Safety Code, including a general or
  special hospital as defined by Section 241.003 of that code.
               (11)  "Managed care organization" means a person that
  is authorized or otherwise permitted by law to arrange for or
  provide a managed care plan.  The term includes a health maintenance
  organization and an exclusive provider organization.
               (12)  "Managed care plan" means a plan, including an
  exclusive provider benefit plan, under which a person undertakes to
  provide, arrange or pay for, or reimburse any part of the cost of
  health care services.  The plan must include arranging for or
  providing health care services as distinguished from
  indemnification against the cost of those services on a prepaid
  basis through insurance or otherwise. The term does not include a
  plan that indemnifies a person for the cost of health care services
  through insurance.
               (13)  "Physician" means an individual licensed to
  practice medicine in this state under Subtitle B, Title 3,
  Occupations Code.
               (14)  "Potentially preventable admission" means an
  individual's admission to a hospital or long-term care facility
  that may have reasonably been prevented with adequate access to
  ambulatory care or health care coordination.
               (15)  "Potentially preventable ancillary service"
  means a health care service that:
                     (A)  a physician or other health care provider
  provides or orders to supplement or support evaluating or treating
  a patient, including a diagnostic test, laboratory test, therapy
  service, or radiology service; and
                     (B)  might not be reasonably necessary to provide
  quality health care or treatment.
               (16)  "Potentially preventable complication" means a
  harmful event or negative outcome with respect to an individual,
  including an infection or surgical complication, that:
                     (A)  occurs after the individual's admission to a
  hospital or long-term care facility; and
                     (B)  may have resulted from the care, lack of
  care, or treatment provided during the hospital or long-term care
  facility stay rather than from a natural progression of an
  underlying disease.
               (17)  "Potentially preventable emergency room visit"
  means an individual's treatment in a hospital emergency room or
  freestanding emergency medical care facility for a condition that
  might not require emergency medical attention because the condition
  could be treated, or could have been prevented, by a physician or
  other health care provider in a nonemergency setting.
               (18)  "Potentially preventable event" means a:
                     (A)  potentially preventable admission;
                     (B)  potentially preventable ancillary service;
                     (C)  potentially preventable complication;
                     (D)  potentially preventable emergency room
  visit;
                     (E)  potentially preventable readmission; or
                     (F)  combination of those events.
               (19)  "Potentially preventable readmission" means an
  individual's return hospitalization within a period the commission
  specifies that may have resulted from deficiencies in the
  individual's care or treatment provided during a previous hospital
  stay or from deficiencies in post-hospital discharge follow-up. The
  term does not include a hospital readmission necessitated by the
  occurrence of unrelated events after the individual's discharge.
  The term includes an individual's readmission to a hospital for:
                     (A)  the same condition or procedure for which the
  individual was previously admitted;
                     (B)  an infection or other complication resulting
  from care previously provided;
                     (C)  a condition or procedure indicating that a
  surgical intervention performed during a previous admission was
  unsuccessful in achieving the anticipated outcome; or
                     (D)  another condition or procedure of a similar
  nature that the executive commissioner determines.
               (20)  "Quality-based payment system" means a system,
  including an alternative payment system, for compensating a
  physician or other health care provider that:
                     (A)  provides incentives to the physician or other
  health care provider to provide high-quality, cost-effective care;
  and
                     (B)  bases some portion of the payment made to the
  physician or other health care provider on quality-of-care
  outcomes, which may include the extent to which the physician or
  other health care provider reduces potentially preventable events.
               (21)  "Recipient" means a Medicaid recipient.  (Gov.
  Code, Secs. 536.001, 536.003(h); New.)
         Sec. 543A.0002.  DEVELOPMENT OF OUTCOME AND PROCESS
  MEASURES; CORRELATION WITH INCREASED REIMBURSEMENT RATES. (a) The
  commission shall develop quality-based outcome and process
  measures that:
               (1)  promote the provision of efficient, quality health
  care; and
               (2)  can be used in the child health plan program and
  Medicaid to implement quality-based payments for acute care
  services and long-term services and supports across all delivery
  models and payment systems, including fee-for-service and managed
  care payment systems.
         (b)  The commission, in coordination with the Department of
  State Health Services, shall develop and implement a quality-based
  outcome measure for the child health plan program and Medicaid to
  annually measure the percentage of enrollees or recipients with HIV
  infection, regardless of age, whose most recent viral load test
  indicates a viral load of less than 200 copies per milliliter of
  blood.
         (c)  To the extent feasible, the commission shall develop
  outcome and process measures:
               (1)  consistently across all child health plan program
  and Medicaid delivery models and payment systems;
               (2)  in a manner that takes into account appropriate
  patient risk factors, including the burden of chronic illness on a
  patient and the severity of a patient's illness;
               (3)  that will have the greatest effect on improving
  quality of care and the efficient use of services, including acute
  care services and long-term services and supports;
               (4)  that are similar to outcome and process measures
  used in the private sector, as appropriate;
               (5)  that reflect effective coordination of acute care
  services and long-term services and supports;
               (6)  that can be tied to expenditures; and
               (7)  that reduce preventable health care utilization
  and costs.
         (d)  In developing the outcome and process measures, the
  commission must include measures that are based on potentially
  preventable events and advance quality improvement and innovation.
  The outcome measures based on potentially preventable events must:
               (1)  allow for a rate-based determination of health
  care provider performance compared to statewide norms; and
               (2)  be risk-adjusted to account for the severity of
  the illnesses of patients a provider serves.
         (e)  The commission may modify the outcome and process
  measures to:
               (1)  promote continuous system reform, improved
  quality, and reduced costs; and
               (2)  account for managed care organizations added to a
  service area.
         (f)  To the extent feasible, the commission shall align the
  outcome and process measures with measures required or recommended
  under reporting guidelines established by:
               (1)  the Centers for Medicare and Medicaid Services;
               (2)  the Agency for Healthcare Research and Quality; or
               (3)  another federal agency.
         (g)  The executive commissioner by rule may require
  physicians, other health care providers, and managed care
  organizations participating in the child health plan program and
  Medicaid to report information necessary to develop the outcome and
  process measures to the commission in a format the executive
  commissioner specifies.
         (h)  If the commission increases physician and other health
  care provider reimbursement rates under the child health plan
  program or Medicaid as a result of an increase in the amounts
  appropriated for those programs for a state fiscal biennium as
  compared to the preceding state fiscal biennium, the commission
  shall, to the extent permitted under federal law and to the extent
  otherwise possible considering other relevant factors, correlate
  the increased reimbursement rates with the quality-based outcome
  and process measures.  (Gov. Code, Secs. 536.003(a), (a-1), (b),
  (c), (d), (e), (f).)
         Sec. 543A.0003.  USE OF QUALITY-BASED OUTCOME MEASURE FOR
  ENROLLEES OR RECIPIENTS WITH HIV INFECTION.  (a)  The commission
  shall include aggregate, nonidentifying data collected using the
  quality-based outcome measure described by Section 543A.0002(b) in
  the annual report required by Section 543A.0008.  The commission
  may include the data in any other report required by this chapter.
         (b)  The commission shall determine the appropriateness of
  including the quality-based outcome measure described by Section
  543A.0002(b) in the quality-based payments and payment systems
  developed under Sections 543A.0004 and 543A.0051.  (Gov. Code, Sec.
  536.003(g).)
         Sec. 543A.0004.  DEVELOPMENT OF QUALITY-BASED PAYMENT
  SYSTEMS.  (a)  Using the quality-based outcome and process measures
  developed under Section 543A.0002 and after consulting with
  appropriate stakeholders with an interest in the provision of acute
  care and long-term services and supports under the child health
  plan program and Medicaid, the commission shall develop and require
  managed care organizations to develop quality-based payment
  systems for compensating a physician or other health care provider
  participating in the child health plan program or Medicaid that:
               (1)  align payment incentives with high-quality,
  cost-effective health care;
               (2)  reward the use of evidence-based best practices;
               (3)  promote health care coordination;
               (4)  encourage appropriate physician and other health
  care provider collaboration;
               (5)  promote effective health care delivery models; and
               (6)  take into account the specific needs of the
  enrollee and recipient populations.
         (b)  The commission shall develop the quality-based payment
  systems in the manner specified by this chapter.  To the extent
  necessary to maximize the receipt of federal funds or reduce
  administrative burdens, the commission shall coordinate the
  timeline for developing and implementing a payment system with the
  implementation of other initiatives such as:
               (1)  the Medicaid Information Technology Architecture
  (MITA) initiative of the Center for Medicaid and State Operations;
               (2)  the ICD-10 code sets initiative; or
               (3)  the ongoing Enterprise Data Warehouse (EDW)
  planning process.
         (c)  In developing the quality-based payment systems, the
  commission shall examine and consider implementing:
               (1)  an alternative payment system;
               (2)  an existing performance-based payment system used
  under the Medicare program that meets the requirements of this
  chapter, modified as necessary to account for programmatic
  differences, if implementing the system would:
                     (A)  reduce unnecessary administrative burdens;
  and
                     (B)  align quality-based payment incentives for
  physicians and other health care providers with the Medicare
  program; and
               (3)  alternative payment methodologies within a system
  that are used in the Medicare program, modified as necessary to
  account for programmatic differences, and that will achieve cost
  savings and improve quality of care in the child health plan program
  and Medicaid.
         (d)  In developing the quality-based payment systems, the
  commission shall ensure that a system will not reward a physician,
  other health care provider, or managed care organization for
  withholding or delaying medically necessary care.
         (e)  The commission may modify a quality-based payment
  system to account for:
               (1)  programmatic differences between the child health
  plan program and Medicaid; and
               (2)  delivery systems under those programs.  (Gov.
  Code, Sec. 536.004.)
         Sec. 543A.0005.  PAYMENT METHODOLOGY CONVERSION. (a) To the
  extent possible, the commission shall convert hospital
  reimbursement systems under the child health plan program and
  Medicaid to a diagnosis-related groups (DRG) methodology that will
  allow the commission to more accurately classify specific patient
  populations and account for the severity of patient illness and
  mortality risk.
         (b)  Subsection (a) does not authorize the commission to
  direct a managed care organization to compensate a physician or
  other health care provider providing services under the
  organization's managed care plan based on a diagnosis-related
  groups (DRG) methodology.
         (c)  Notwithstanding Subsection (a) and to the extent
  possible, the commission shall convert outpatient hospital
  reimbursement systems under the child health plan program and
  Medicaid to an appropriate prospective payment system that will
  allow the commission to:
               (1)  more accurately classify the full range of
  outpatient service episodes;
               (2)  more accurately account for the intensity of
  services provided; and
               (3)  motivate outpatient service providers to increase
  efficiency and effectiveness. (Gov. Code, Sec. 536.005.)
         Sec. 543A.0006.  TRANSPARENCY; CONSIDERATIONS. (a) The
  commission shall:
               (1)  ensure transparency in developing and
  establishing:
                     (A)  quality-based payment and reimbursement
  systems under Section 543A.0004 and Subchapters B, C, and D,
  including in developing outcome and process measures under Section
  543A.0002; and
                     (B)  quality-based payment initiatives under
  Subchapter E, including developing quality-of-care and
  cost-efficiency benchmarks under Section 543A.0203(a) and
  approving efficiency performance standards under Section
  543A.0203(b); and
               (2)  for developing and establishing the quality-based
  payment and reimbursement systems and initiatives described by
  Subdivision (1), develop guidelines that establish procedures to
  provide notice and information to and receive input from managed
  care organizations, health care providers, including physicians
  and experts in the various medical specialty fields, and other
  stakeholders, as appropriate.
         (b)  In developing and establishing the quality-based
  payment and reimbursement systems and initiatives described by
  Subsection (a)(1), the commission shall consider that there will be
  a diminishing rate of improved performance over time as the
  performance of a physician, other health care provider, or managed
  care organization improves with respect to an outcome or process
  measure, quality-of-care and cost-efficiency benchmark, or
  efficiency performance standard, as applicable.
         (c)  The commission shall develop web-based capability that:
               (1)  provides health care providers and managed care
  organizations with data on their clinical and utilization
  performance, including comparisons to peer organizations and
  providers located in this state and in the provider's respective
  region; and
               (2)  supports the requirements of the electronic health
  information exchange system under Sections 525.0206, 525.0207, and
  525.0208.  (Gov. Code, Sec. 536.006.)
         Sec. 543A.0007.  PERIODIC EVALUATION. At least once each
  two-year period, the commission shall evaluate the outcomes and
  cost-effectiveness of any quality-based payment system or other
  payment initiative implemented under this chapter. (Gov. Code, Sec.
  536.007.)
         Sec. 543A.0008.  ANNUAL REPORT. (a) The commission shall
  submit to the legislature and make available to the public an annual
  report on:
               (1)  the quality-based outcome and process measures
  developed under Section 543A.0002, including measures based on each
  potentially preventable event; and
               (2)  the progress of implementing quality-based
  payment systems and other payment initiatives under this chapter.
         (b)  The commission shall, as appropriate, report outcome
  and process measures under Subsection (a)(1) by:
               (1)  geographic location, which may require reporting
  by county, health care service region, or another appropriately
  defined geographic area;
               (2)  enrollee or recipient population or eligibility
  group served;
               (3)  type of health care provider, such as acute care or
  long-term care provider;
               (4)  number of enrollees and recipients who relocated
  to a community-based setting from a less integrated setting;
               (5)  quality-based payment system; and
               (6)  service delivery model.
         (c)  The report may not identify a specific health care
  provider. (Gov. Code, Sec. 536.008.)
  SUBCHAPTER B. QUALITY-BASED PAYMENTS RELATING TO MANAGED CARE
  ORGANIZATIONS
         Sec. 543A.0051.  QUALITY-BASED PREMIUM PAYMENTS;
  PERFORMANCE REPORTING. (a) Subject to Section 1903(m)(2)(A),
  Social Security Act (42 U.S.C. Section 1396b(m)(2)(A)), and other
  federal law, the commission shall base a percentage of the premiums
  paid to a managed care organization participating in the child
  health plan program or Medicaid on the organization's performance
  with respect to outcome and process measures developed under
  Section 543A.0002 that address potentially preventable events. The
  percentage may increase each year.
         (b)  The commission shall make available information
  relating to a managed care organization's performance with respect
  to outcome and process measures under this subchapter to an
  enrollee or recipient before the enrollee or recipient chooses a
  managed care plan. (Gov. Code, Sec. 536.051.)
         Sec. 543A.0052.  FINANCIAL INCENTIVES AND CONTRACT AWARD
  PREFERENCES. (a) The commission may allow a managed care
  organization participating in the child health plan program or
  Medicaid increased flexibility to implement quality initiatives in
  a managed care plan offered by the organization, including
  flexibility with respect to financial arrangements, to:
               (1)  achieve high-quality, cost-effective health care;
               (2)  increase the use of high-quality, cost-effective
  delivery models;
               (3)  reduce the incidence of unnecessary
  institutionalization and potentially preventable events; and
               (4)  in collaboration with physicians and other health
  care providers, increase the use of alternative payment systems,
  including shared savings models.
         (b)  The commission shall develop quality-of-care and
  cost-efficiency benchmarks, including benchmarks based on a
  managed care organization's performance with respect to:
               (1)  reducing potentially preventable events; and
               (2)  containing the growth rate of health care costs.
         (c)  The commission may include in a contract between a
  managed care organization and the commission financial incentives
  that are based on the organization's successful implementation of
  quality initiatives under Subsection (a) or success in achieving
  quality-of-care and cost-efficiency benchmarks under Subsection
  (b). The commission may implement the financial incentives only if
  implementing the incentives would be cost-effective.
         (d)  In awarding contracts to managed care organizations
  under the child health plan program and Medicaid, the commission
  shall, in addition to considerations under Section 540.0204 of this
  code and Section 62.155, Health and Safety Code, give preference to
  an organization that offers a managed care plan that:
               (1)  successfully implements quality initiatives under
  Subsection (a) as the commission determines based on data or other
  evidence the organization provides; or
               (2)  meets quality-of-care and cost-efficiency
  benchmarks under Subsection (b). (Gov. Code, Sec. 536.052.)
  SUBCHAPTER C. QUALITY-BASED HEALTH HOME PAYMENT SYSTEMS
         Sec. 543A.0101.  DEFINITION. In this subchapter, "health
  home" means a primary care provider practice or, if appropriate, a
  specialty care provider practice, incorporating several features,
  including comprehensive care coordination, family-centered care,
  and data management, that are focused on improving outcome-based
  quality of care and increasing patient and provider satisfaction
  under the child health plan program and Medicaid. (Gov. Code, Sec.
  536.101(1).)
         Sec. 543A.0102.  QUALITY-BASED HEALTH HOME PAYMENTS.  (a)  
  The commission may develop and implement quality-based payment
  systems for health homes designed to improve quality of care and
  reduce the provision of unnecessary medical services. A
  quality-based payment system must:
               (1)  base payments made to an enrollee's or recipient's
  health home on quality and efficiency measures that may include
  measurable wellness and prevention criteria and the use of
  evidence-based best practices, sharing a portion of any realized
  cost savings the health home achieves, and ensuring quality of care
  outcomes, including a reduction in potentially preventable events;
  and
               (2)  allow for the examination of measurable wellness
  and prevention criteria, use of evidence-based best practices, and
  quality-of-care outcomes based on the type of primary or specialty
  care provider practice.
         (b)  The commission may develop a quality-based payment
  system for health homes only if implementing the system would be
  feasible and cost-effective. (Gov. Code, Sec. 536.102.)
         Sec. 543A.0103.  HEALTH HOME ELIGIBILITY. To be eligible to
  receive reimbursement under a quality-based payment system under
  this subchapter, a health home must:
               (1)  directly or indirectly provide enrollees or
  recipients who have a health home with access to health care
  services outside of regular business hours;
               (2)  educate those enrollees and recipients about the
  availability of health care services outside of regular business
  hours; and
               (3)  provide evidence satisfactory to the commission
  that the health home meets the requirement of Subdivision (1).
  (Gov. Code, Sec. 536.103.)
  SUBCHAPTER D. QUALITY-BASED HOSPITAL REIMBURSEMENT SYSTEM
         Sec. 543A.0151.  COLLECTING CERTAIN INFORMATION; REPORTS TO
  CERTAIN HOSPITALS. (a)  The executive commissioner shall adopt
  rules for identifying:
               (1)  potentially preventable admissions and
  readmissions of enrollees and recipients, including preventable
  admissions to long-term care facilities;
               (2)  potentially preventable ancillary services
  provided to or ordered for enrollees and recipients;
               (3)  potentially preventable emergency room visits by
  enrollees and recipients; and
               (4)  potentially preventable complications experienced
  by enrollees and recipients.
         (b)  The commission shall collect data from hospitals on
  present-on-admission indicators for purposes of this section.
         (c)  The commission shall establish a program to provide to
  each hospital in this state that participates in the child health
  plan program or Medicaid a report regarding the hospital's
  performance with respect to each potentially preventable event
  described by Subsection (a). To the extent possible, the report
  should include all potentially preventable events across all child
  health plan program and Medicaid payment systems. A hospital shall
  distribute the information in the report to physicians and other
  health care providers providing services at the hospital.
         (d)  Except as provided by Subsection (e), a report provided
  to a hospital under Subsection (c) is confidential and not subject
  to Chapter 552.
         (e)  The commission may release information in a report
  described by Subsection (c):
               (1)  not earlier than one year after the date the report
  is provided to the hospital; and
               (2)  only after deleting any data that relates to a
  hospital's performance with respect to a particular
  diagnosis-related group or an individual patient.  (Gov. Code, Sec.
  536.151.)
         Sec. 543A.0152.  REIMBURSEMENT ADJUSTMENTS. (a)  The
  commission shall use the data collected under Section 543A.0151 and
  the diagnosis-related groups (DRG) methodology implemented under
  Section 543A.0005, if applicable, to adjust, to the extent
  feasible, child health plan program and Medicaid reimbursements to
  hospitals, including payments made under the disproportionate
  share hospitals and upper payment limit supplemental payment
  programs.  The commission shall base an adjustment for a hospital on
  the hospital's performance with respect to exceeding or failing to
  achieve outcome and process measures developed under Section
  543A.0002 that address the rates of potentially preventable
  readmissions and potentially preventable complications.
         (b)  The commission must provide the report required by
  Section 543A.0151(c) to a hospital at least one year before
  adjusting child health plan program and Medicaid reimbursements to
  the hospital under this section. (Gov. Code, Sec. 536.152.)
  SUBCHAPTER E. QUALITY-BASED PAYMENT INITIATIVES
         Sec. 543A.0201.  PAYMENT INITIATIVES; DETERMINATION OF
  BENEFIT TO STATE. (a) The commission shall establish payment
  initiatives to test the effectiveness of quality-based payment
  systems, alternative payment methodologies, and high-quality,
  cost-effective health care delivery models that provide incentives
  to physicians and other health care providers to develop health
  care interventions for enrollees or recipients that will:
               (1)  improve the quality of health care provided to the
  enrollees or recipients;
               (2)  reduce potentially preventable events;
               (3)  promote prevention and wellness;
               (4)  increase the use of evidence-based best practices;
               (5)  increase appropriate physician and other health
  care provider collaboration;
               (6)  contain costs; and
               (7)  improve integration of acute care services and
  long-term services and supports, including discharge planning from
  acute care services to community-based long-term services and
  supports.
         (b)  The commission shall:
               (1)  establish a process through which a physician,
  other health care provider, or managed care organization may submit
  a proposal for a payment initiative; and
               (2)  determine whether implementing one or more
  proposed payment initiatives is feasible and cost-effective.
         (c)  If the commission determines that implementing one or
  more payment initiatives is feasible and cost-effective for this
  state, the commission shall establish one or more payment
  initiatives as provided by this subchapter. (Gov. Code, Secs.
  536.202, 536.203(a).)
         Sec. 543A.0202.  PAYMENT INITIATIVE ADMINISTRATION. (a)
  The commission shall administer any payment initiative the
  commission establishes under this subchapter. The executive
  commissioner may adopt rules, plans, and procedures and enter into
  contracts and other agreements as the executive commissioner
  considers appropriate and necessary to administer this subchapter.
         (b)  The commission may limit a payment initiative to:
               (1)  one or more regions in this state;
               (2)  one or more organized networks of physicians and
  other health care providers; or
               (3)  specified types of services provided under the
  child health plan program or Medicaid, or specified types of
  enrollees or recipients.
         (c)  An implemented payment initiative must be operated for
  at least one calendar year. (Gov. Code, Secs. 536.203(b), (c),
  (d).)
         Sec. 543A.0203.  QUALITY-OF-CARE AND COST-EFFICIENCY
  BENCHMARKS AND GOALS; EFFICIENCY PERFORMANCE STANDARDS.  (a)  The
  executive commissioner shall develop quality-of-care and
  cost-efficiency benchmarks and measurable goals that a payment
  initiative must meet to ensure high-quality and cost-effective
  health care services and healthy outcomes.
         (b)  In addition to the benchmarks and goals described by
  Subsection (a), the executive commissioner may approve efficiency
  performance standards that may include the sharing of realized cost
  savings with physicians and other health care providers who provide
  health care services that exceed the standards. The standards may
  not create a financial incentive for or involve making a payment to
  a physician or other health care provider that directly or
  indirectly induces limiting medically necessary services. (Gov.
  Code, Sec. 536.204.)
         Sec. 543A.0204.  PAYMENT RATES UNDER PAYMENT INITIATIVES.
  The executive commissioner may contract with appropriate entities,
  including qualified actuaries, to assist in determining
  appropriate payment rates for an implemented payment initiative.
  (Gov. Code, Sec. 536.205.)
  SUBCHAPTER F. QUALITY-BASED LONG-TERM SERVICES AND SUPPORTS
  PAYMENT SYSTEMS
         Sec. 543A.0251.  QUALITY-BASED PAYMENT SYSTEMS FOR
  LONG-TERM SERVICES AND SUPPORTS.  (a)  The commission, after
  consulting with appropriate stakeholders representing nursing
  facility providers with an interest in providing long-term services
  and supports, may develop and implement quality-based payment
  systems for Medicaid long-term services and supports providers
  designed to improve quality of care and reduce the provision of
  unnecessary services. A quality-based payment system must base
  payments made to providers on quality and efficiency measures that
  may include measurable wellness and prevention criteria and the use
  of evidence-based best practices, sharing a portion of any realized
  cost savings the provider achieves, and ensuring quality of care
  outcomes, including a reduction in potentially preventable events.
         (b)  The commission may develop a quality-based payment
  system for Medicaid long-term services and supports providers only
  if implementing the system would be feasible and cost-effective.
  (Gov. Code, Sec. 536.251.)
         Sec. 543A.0252.  DATA SET EVALUATION. To ensure that the
  commission is using the best data to inform developing and
  implementing quality-based payment systems under Section
  543A.0251, the commission shall evaluate the reliability,
  validity, and functionality of post-acute and long-term services
  and supports data sets. The commission's evaluation should assess:
               (1)  to what degree data sets on which the commission
  relies meet a standard:
                     (A)  for integrating care;
                     (B)  for developing coordinated care plans; and
                     (C)  that would allow for the meaningful
  development of risk adjustment techniques;
               (2)  whether the data sets will provide value for
  outcome or performance measures and cost containment; and
               (3)  how classification systems and data sets used for
  Medicaid long-term services and supports providers can be
  standardized and, where possible, simplified. (Gov. Code, Sec.
  536.252.)
         Sec. 543A.0253.  COLLECTING CERTAIN INFORMATION; REPORTS TO
  CERTAIN PROVIDERS. (a) The executive commissioner shall adopt
  rules for identifying the incidence of potentially preventable
  admissions, potentially preventable readmissions, and potentially
  preventable emergency room visits by Medicaid long-term services
  and supports recipients.
         (b)  The commission shall establish a program to provide to
  each Medicaid long-term services and supports provider in this
  state a report regarding the provider's performance with respect to
  potentially preventable admissions, potentially preventable
  readmissions, and potentially preventable emergency room visits.
  To the extent possible, the report should include applicable
  potentially preventable events information across all Medicaid
  payment systems.
         (c)  Except as provided by Subsection (d), a report provided
  to a provider under Subsection (b) is confidential and not subject
  to Chapter 552.
         (d)  The commission may release information in a report
  described by Subsection (b):
               (1)  not earlier than one year after the date the report
  is provided to the provider; and
               (2)  only after deleting any data that relates to a
  provider's performance with respect to a particular resource
  utilization group or an individual recipient. (Gov. Code, Sec. 536.253.)
 
  CHAPTER 544. FRAUD, WASTE, ABUSE, AND OVERCHARGES RELATING TO
  HEALTH AND HUMAN SERVICES
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 544.0001.  DEFINITIONS
  Sec. 544.0002.  REFERENCE TO OFFICE OF INVESTIGATIONS
                   AND ENFORCEMENT
  Sec. 544.0003.  AUTHORITY OF STATE AGENCY OR
                   GOVERNMENTAL ENTITY NOT LIMITED
  SUBCHAPTER B. HEALTH AND HUMAN SERVICES COMMISSION: ADMINISTRATIVE
  PROVISIONS
  Sec. 544.0051.  COORDINATION WITH OFFICE OF ATTORNEY
                   GENERAL; ANNUAL REPORT
  Sec. 544.0052.  RULES REGARDING ENFORCEMENT AND
                   PUNITIVE ACTIONS
  Sec. 544.0053.  PROVISION OF INFORMATION TO PHARMACY
                   SUBJECT TO AUDIT; INFORMAL HEARING ON
                   AUDIT FINDINGS
  Sec. 544.0054.  RECORDS OF ALLEGATIONS OF FRAUD OR
                   ABUSE
  Sec. 544.0055.  RECORD AND CONFIDENTIALITY OF INFORMAL
                   RESOLUTION MEETINGS
  Sec. 544.0056.  EXPUNCTION OF CHILD'S CHEMICAL
                   DEPENDENCY DIAGNOSIS IN CERTAIN
                   RECORDS
  SUBCHAPTER C. OFFICE OF INSPECTOR GENERAL: GENERAL PROVISIONS
  Sec. 544.0101.  APPOINTMENT OF INSPECTOR GENERAL; TERM
  Sec. 544.0102.  COMMISSION POWERS AND DUTIES RELATED TO
                   OFFICE OF INSPECTOR GENERAL
  Sec. 544.0103.  OFFICE OF INSPECTOR GENERAL: GENERAL
                   POWERS AND DUTIES
  Sec. 544.0104.  EMPLOYMENT OF MEDICAL DIRECTOR
  Sec. 544.0105.  EMPLOYMENT OF DENTAL DIRECTOR
  Sec. 544.0106.  CONTRACT FOR REVIEW OF INVESTIGATIVE
                   FINDINGS BY QUALIFIED EXPERT
  Sec. 544.0107.  EMPLOYMENT OF PEACE OFFICERS
  Sec. 544.0108.  INVESTIGATIVE PROCESS REVIEW
  Sec. 544.0109.  PERFORMANCE AUDITS AND COORDINATION OF
                   AUDIT ACTIVITIES
  Sec. 544.0110.  REPORTS ON AUDITS, INSPECTIONS, AND
                   INVESTIGATIONS
  Sec. 544.0111.  COMPLIANCE WITH FEDERAL CODING
                   GUIDELINES
  Sec. 544.0112.  HOSPITAL UTILIZATION REVIEWS AND
                   AUDITS: PROVIDER EDUCATION PROCESS
  Sec. 544.0113.  PROGRAM EXCLUSIONS
  Sec. 544.0114.  REPORT
  SUBCHAPTER D. MEDICAID PROVIDER CRIMINAL HISTORY RECORD
  INFORMATION AND ELIGIBILITY
  Sec. 544.0151.  DEFINITIONS
  Sec. 544.0152.  EXCHANGE OF CRIMINAL HISTORY RECORD
                   INFORMATION BETWEEN PARTICIPATING
                   AGENCIES
  Sec. 544.0153.  PROVIDER ELIGIBILITY FOR MEDICAID
                   PARTICIPATION: CRIMINAL HISTORY
                   RECORD INFORMATION
  Sec. 544.0154.  MONITORING OF CERTAIN FEDERAL DATABASES
  Sec. 544.0155.  PERIOD FOR DETERMINING PROVIDER
                   ELIGIBILITY FOR MEDICAID
  SUBCHAPTER E. PREVENTION AND DETECTION OF FRAUD, WASTE, AND ABUSE
  Sec. 544.0201.  SELECTION AND REVIEW OF MEDICAID CLAIMS
                   TO DETERMINE RESOURCE ALLOCATION
  Sec. 544.0202.  DUTIES RELATED TO FRAUD PREVENTION
  Sec. 544.0203.  FRAUD, WASTE, AND ABUSE DETECTION
                   TRAINING
  Sec. 544.0204.  HEALTH AND HUMAN SERVICES AGENCY
                   MEDICAID FRAUD, WASTE, AND ABUSE
                   DETECTION GOAL
  Sec. 544.0205.  AWARD FOR REPORTING MEDICAID FRAUD,
                   ABUSE, OR OVERCHARGES
  SUBCHAPTER F. INVESTIGATION OF FRAUD, WASTE, ABUSE, AND
  OVERCHARGES
  Sec. 544.0251.  CLAIMS CRITERIA REQUIRING COMMENCEMENT
                   OF INVESTIGATION
  Sec. 544.0252.  CIRCUMSTANCES REQUIRING COMMENCEMENT OF
                   PRELIMINARY INVESTIGATION OF ALLEGED
                   FRAUD OR ABUSE
  Sec. 544.0253.  CONDUCT OF PRELIMINARY INVESTIGATION OF
                   ALLEGED FRAUD OR ABUSE
  Sec. 544.0254.  FINDING OF CERTAIN MEDICAID FRAUD OR
                   ABUSE FOLLOWING PRELIMINARY
                   INVESTIGATION: CRIMINAL REFERRAL OR
                   FULL INVESTIGATION
  Sec. 544.0255.  IMMEDIATE CRIMINAL REFERRAL UNDER
                   CERTAIN CIRCUMSTANCES
  Sec. 544.0256.  CONTINUATION OF PAYMENT HOLD FOLLOWING
                   REFERRAL TO LAW ENFORCEMENT AGENCY
  Sec. 544.0257.  COMPLETION OF FULL INVESTIGATION OF
                   ALLEGED MEDICAID FRAUD OR ABUSE
  Sec. 544.0258.  MEMORANDUM OF UNDERSTANDING FOR
                   ASSISTING ATTORNEY GENERAL
                   INVESTIGATIONS RELATED TO MEDICAID
  Sec. 544.0259.  SUBPOENAS
  SUBCHAPTER G. PAYMENT HOLDS
  Sec. 544.0301.  IMPOSITION OF PAYMENT HOLD
  Sec. 544.0302.  NOTICE
  Sec. 544.0303.  EXPEDITED ADMINISTRATIVE HEARING
  Sec. 544.0304.  INFORMAL RESOLUTION
  Sec. 544.0305.  WEBSITE POSTING
  SUBCHAPTER H. MANAGED CARE ORGANIZATION PREVENTION AND
  INVESTIGATION OF FRAUD AND ABUSE
  Sec. 544.0351.  APPLICABILITY OF SUBCHAPTER
  Sec. 544.0352.  SPECIAL INVESTIGATIVE UNIT OR
                   CONTRACTED ENTITY TO INVESTIGATE
                   FRAUD AND ABUSE
  Sec. 544.0353.  FRAUD AND ABUSE PREVENTION PLAN
  Sec. 544.0354.  ASSISTANCE AND OVERSIGHT BY OFFICE OF
                   INSPECTOR GENERAL
  Sec. 544.0355.  RULES
  SUBCHAPTER I. FINANCIAL ASSISTANCE FRAUD
  Sec. 544.0401.  DEFINITION
  Sec. 544.0402.  FALSE OR MISLEADING INFORMATION RELATED
                   TO FINANCIAL ASSISTANCE ELIGIBILITY
  Sec. 544.0403.  COMMISSION ACTION FOLLOWING
                   DETERMINATION OF VIOLATION
  Sec. 544.0404.  INELIGIBILITY FOR FINANCIAL ASSISTANCE
                   FOLLOWING VIOLATION; RIGHT TO APPEAL
  Sec. 544.0405.  HOUSEHOLD ELIGIBILITY FOR FINANCIAL
                   ASSISTANCE NOT AFFECTED
  Sec. 544.0406.  RULES
  SUBCHAPTER J.  USE OF TECHNOLOGY TO DETECT, INVESTIGATE, AND
  PREVENT FRAUD, ABUSE, AND OVERCHARGES
  Sec. 544.0451.  LEARNING, NEURAL NETWORK, OR OTHER
                   TECHNOLOGY RELATING TO MEDICAID
  Sec. 544.0452.  MEDICAID FRAUD INVESTIGATION TRACKING
                   SYSTEM
  Sec. 544.0453.  MEDICAID FRAUD DETECTION TECHNOLOGY
  Sec. 544.0454.  DATA MATCHING AGAINST FEDERAL FELON
                   LIST
  Sec. 544.0455.  ELECTRONIC DATA MATCHING
  Sec. 544.0456.  METHODS TO REDUCE FRAUD, WASTE, AND
                   ABUSE IN CERTAIN PUBLIC ASSISTANCE
                   PROGRAMS
  SUBCHAPTER K.  RECOVERY AND RECOUPMENT IN CASES OF FRAUD, ABUSE, AND
  OVERCHARGES
  Sec. 544.0501.  RECOVERY MONITORING SYSTEM
  Sec. 544.0502.  PAYMENT RECOVERY EFFORTS BY CERTAIN
                   PERSONS; RETENTION OF RECOVERED
                   AMOUNTS
  Sec. 544.0503.  PROCESS FOR MANAGED CARE ORGANIZATIONS
                   TO RECOUP OVERPAYMENTS RELATED TO
                   ELECTRONIC VISIT VERIFICATION
                   TRANSACTIONS
  Sec. 544.0504.  RECOVERY AUDIT CONTRACTORS
  Sec. 544.0505.  ANNUAL REPORT ON CERTAIN FRAUD AND
                   ABUSE RECOVERIES
  Sec. 544.0506.  NOTICE AND INFORMAL RESOLUTION OF
                   PROPOSED RECOUPMENT OF OVERPAYMENT OR
                   DEBT
  Sec. 544.0507.  APPEAL OF DETERMINATION TO RECOUP
                   OVERPAYMENT OR DEBT
  CHAPTER 544. FRAUD, WASTE, ABUSE, AND OVERCHARGES RELATING TO
  HEALTH AND HUMAN SERVICES
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 544.0001.  DEFINITIONS. In this chapter:
               (1)  "Abuse" means:
                     (A)  a practice a provider engages in that is
  inconsistent with sound fiscal, business, or medical practices and
  that results in:
                           (i)  an unnecessary cost to Medicaid; or
                           (ii)  reimbursement for services that are
  not medically necessary or that fail to meet professionally
  recognized standards for health care; or
                     (B)  a practice a recipient engages in that
  results in an unnecessary cost to Medicaid.
               (2)  "Allegation of fraud" means an allegation of
  Medicaid fraud the commission receives from any source that has not
  been verified by this state, including an allegation based on:
                     (A)  a fraud hotline complaint;
                     (B)  claims data mining;
                     (C)  data analysis processes; or
                     (D)  a pattern identified through provider
  audits, civil false claims cases, or law enforcement
  investigations.
               (3)  "Credible allegation of fraud" means an allegation
  of fraud that has been verified by this state.  An allegation is
  considered credible when the commission has:
                     (A)  verified that the allegation has indicia of
  reliability; and
                     (B)  carefully reviewed all allegations, facts,
  and evidence and acts judiciously on a case-by-case basis.
               (4)  "Fraud" means an intentional deception or
  misrepresentation a person makes with the knowledge that the
  deception or misrepresentation could result in an unauthorized
  benefit to that person or another person.  The term does not include
  unintentional technical, clerical, or administrative errors.
               (5)  "Furnished" refers to the provision of items or
  services directly by or under the direct supervision of, or the
  ordering of items or services by:
                     (A)  a practitioner or other individual acting as
  an employee or in the individual's own capacity;
                     (B)  a provider; or
                     (C)  another supplier of services, excluding
  services ordered by one party but billed for and provided by or
  under the supervision of another.
               (6)  "Inspector general" means the inspector general
  the governor appoints under Section 544.0101.
               (7)  "Office of inspector general" means the
  commission's office of inspector general.
               (8)  "Payment hold" means the temporary denial of
  Medicaid reimbursement for items or services a specified provider
  furnished.
               (9)  "Physician" includes:
                     (A)  an individual licensed to practice medicine
  in this state;
                     (B)  a professional association composed solely
  of physicians;
                     (C)  a partnership composed solely of physicians;
                     (D)  a single legal entity authorized to practice
  medicine that is owned by two or more physicians; and
                     (E)  a nonprofit health corporation certified by
  the Texas Medical Board under Chapter 162, Occupations Code.
               (10)  "Practitioner" means a physician or other
  individual licensed under state law to practice the individual's
  profession.
               (11)  "Program exclusion" means the suspension of a
  provider's authorization under Medicaid to request reimbursement
  for items or services the provider furnished.
               (12)  "Provider" means, except as otherwise provided by
  this chapter, a person that was or is approved by the commission to:
                     (A)  provide Medicaid services under a contract or
  provider agreement with the commission; or
                     (B)  provide third-party billing vendor services
  under a contract or provider agreement with the commission.  (Gov.
  Code, Sec. 531.1011; New.)
         Sec. 544.0002.  REFERENCE TO OFFICE OF INVESTIGATIONS AND
  ENFORCEMENT. Notwithstanding any other law, a reference in law or
  rule to the commission's office of investigations and enforcement
  means the office of inspector general.  (Gov. Code, Sec.
  531.102(i).)
         Sec. 544.0003.  AUTHORITY OF STATE AGENCY OR GOVERNMENTAL
  ENTITY NOT LIMITED. Nothing in the following provisions limits the
  authority of any other state agency or governmental entity:
               (1)  Section 544.0052;
               (2)  Section 544.0101;
               (3)  Section 544.0102;
               (4)  Section 544.0103;
               (5)  Section 544.0104;
               (6)  Section 544.0105;
               (7)  Section 544.0106;
               (8)  Section 544.0108;
               (9)  Sections 544.0109(b) and (d);
               (10)  Section 544.0110;
               (11)  Section 544.0113;
               (12)  Section 544.0114;
               (13)  Section 544.0251;
               (14)  Section 544.0252(b);
               (15)  Section 544.0254;
               (16)  Section 544.0255;
               (17)  Section 544.0257;
               (18)  Section 544.0301;
               (19)  Section 544.0302;
               (20)  Section 544.0303; and
               (21)  Section 544.0304.  (Gov. Code, Sec. 531.102(o).)
  SUBCHAPTER B. HEALTH AND HUMAN SERVICES COMMISSION: ADMINISTRATIVE
  PROVISIONS
         Sec. 544.0051.  COORDINATION WITH OFFICE OF ATTORNEY
  GENERAL; ANNUAL REPORT. (a)  The commission, acting through the
  office of inspector general, and the office of the attorney general
  shall enter into a memorandum of understanding to develop and
  implement joint written procedures for processing:
               (1)  cases of suspected fraud, waste, or abuse, as
  those terms are defined by state or federal law; or
               (2)  other violations of state or federal law under
  Medicaid or another program the commission or a health and human
  services agency administers, including:
                     (A)  the financial assistance program under
  Chapter 31, Human Resources Code;
                     (B)  the supplemental nutrition assistance
  program under Chapter 33, Human Resources Code; and
                     (C)  the child health plan program.
         (b)  The memorandum of understanding must:
               (1)  require the office of inspector general and the
  office of the attorney general to:
                     (A)  set priorities and guidelines for referring
  cases to appropriate state agencies for investigation,
  prosecution, or other disposition to:
                           (i)  enhance deterrence of fraud, waste,
  abuse, or other violations of state or federal law under the
  programs described by Subsection (a)(2), including a violation of
  Chapter 102, Occupations Code; and
                           (ii)  maximize the imposition of penalties,
  the recovery of money, and the successful prosecution of cases; and
                     (B)  submit information the comptroller requests
  about each resolved case for the comptroller's use in improving
  fraud detection;
               (2)  require the office of inspector general to:
                     (A)  refer each case of suspected provider fraud,
  waste, or abuse to the office of the attorney general not later than
  the 20th business day after the date the office of inspector general
  determines that the existence of fraud, waste, or abuse is
  reasonably indicated;
                     (B)  keep detailed records for cases the office of
  inspector general or the office of the attorney general processes,
  including information on the total number of cases processed and,
  for each case:
                           (i)  the agency and division to which the
  case is referred for investigation;
                           (ii)  the date the case is referred; and
                           (iii)  the nature of the suspected fraud,
  waste, or abuse; and
                     (C)  notify each appropriate division of the
  office of the attorney general of each case the office of inspector
  general refers;
               (3)  require the office of the attorney general to:
                     (A)  take appropriate action in response to each
  case referred to the attorney general, which may include:
                           (i)  directly initiating prosecution, with
  the appropriate local district or county attorney's consent;
                           (ii)  directly initiating civil litigation;
                           (iii)  referring the case to an appropriate
  United States attorney, a district attorney, or a county attorney;
  or
                           (iv)  referring the case to a collections
  agency for initiation of civil litigation or other appropriate
  action;
                     (B)  ensure that information relating to each case
  the office of the attorney general investigates is available to
  each division of the office with responsibility for investigating
  suspected fraud, waste, or abuse; and
                     (C)  notify the office of inspector general of
  each case the attorney general declines to prosecute or prosecutes
  unsuccessfully;
               (4)  require representatives of the office of inspector
  general and of the office of the attorney general to meet not less
  than quarterly to share case information and determine the
  appropriate agency and division to investigate each case;
               (5)  ensure that barriers to direct fraud referrals to
  the office of the attorney general's Medicaid fraud control unit or
  unreasonable impediments to communication between Medicaid agency
  employees and the Medicaid fraud control unit are not imposed; and
               (6)  include procedures to facilitate the referral of
  cases directly to the office of the attorney general.
         (c)  An exchange of information under this section between
  the office of the attorney general and the commission, the office of
  inspector general, or a health and human services agency does not
  affect whether the information is subject to disclosure under
  Chapter 552.
         (d)  The commission and the office of the attorney general
  may not assess or collect investigation and attorney's fees on any
  state agency's behalf unless the office of the attorney general or
  another state agency collects a penalty, restitution, or other
  reimbursement payment to this state.
         (e)  A district attorney, county attorney, city attorney, or
  private collection agency may collect and retain:
               (1)  costs associated with a case referred to the
  attorney or agency in accordance with procedures adopted under this
  section; and
               (2)  20 percent of the amount of the penalty,
  restitution, or other reimbursement payment collected.
         (f)  The commission and the office of the attorney general
  shall jointly prepare and submit to the governor, lieutenant
  governor, and speaker of the house of representatives an annual
  report concerning the activities of those agencies in detecting and
  preventing fraud, waste, and abuse under Medicaid or another
  program the commission or a health and human services agency
  administers.  The commission and the office of the attorney general
  may consolidate the report with any other report relating to the
  same subject matter the commission or the office of the attorney
  general is required to submit under other law.  (Gov. Code, Sec.
  531.103.)
         Sec. 544.0052.  RULES REGARDING ENFORCEMENT AND PUNITIVE
  ACTIONS. (a) The executive commissioner, in consultation with the
  office of inspector general, shall adopt rules establishing
  criteria for determining enforcement and punitive actions
  regarding a provider who violated state law, program rules, or the
  provider's Medicaid provider agreement.
         (b)  The rules must include:
               (1)  direction for categorizing provider violations
  according to the nature of the violation and for scaling resulting
  enforcement actions, taking into consideration:
                     (A)  the seriousness of the violation;
                     (B)  the prevalence of errors by the provider;
                     (C)  the financial or other harm to this state or
  recipients resulting or potentially resulting from those errors;
  and
                     (D)  mitigating factors the office of inspector
  general determines appropriate; and
               (2)  a specific list of potential penalties, including
  the amount of the penalties, for fraud and other Medicaid
  violations. (Gov. Code, Sec. 531.102(x).)
         Sec. 544.0053.  PROVISION OF INFORMATION TO PHARMACY SUBJECT
  TO AUDIT; INFORMAL HEARING ON AUDIT FINDINGS.  (a)  To increase
  transparency, the office of inspector general shall, if the office
  has access to the information, provide to pharmacies that are
  subject to audit by the office or by an entity that contracts with
  the federal government to audit Medicaid providers information
  relating to the extrapolation methodology used as part of the audit
  and the methods used to determine whether the pharmacy has been
  overpaid under Medicaid in sufficient detail so that the audit
  results may be demonstrated to be statistically valid and are fully
  reproducible.
         (b)  A pharmacy has a right to request an informal hearing
  before the commission's appeals division to contest the findings of
  an audit that the office of inspector general or an entity that
  contracts with the federal government to audit Medicaid providers
  conducted if the audit findings do not include findings that the
  pharmacy engaged in Medicaid fraud.
         (c)  In an informal hearing held under this section, the
  commission's appeals division staff, assisted by staff responsible
  for the commission's vendor drug program with expertise in the law
  governing pharmacies' participation in Medicaid, make the final
  decision on whether the audit findings are accurate.  Office of
  inspector general staff may not serve on the panel that makes the
  decision on the accuracy of an audit.  (Gov. Code, Sec. 531.1203.)
         Sec. 544.0054.  RECORDS OF ALLEGATIONS OF FRAUD OR ABUSE.  
  The commission shall maintain a record of all allegations of fraud
  or abuse against a provider containing the date each allegation was
  received or identified and the source of the allegation, if
  available. The record is confidential under Section 544.0259(e)
  and is subject to Section 544.0259(f).  (Gov. Code, Sec.
  531.118(a).)
         Sec. 544.0055.  RECORD AND CONFIDENTIALITY OF INFORMAL
  RESOLUTION MEETINGS. (a)  On the written request of a provider who
  requests an informal resolution meeting held under Section 544.0304
  or 544.0506(b), the commission shall, at no expense to the
  provider, provide for the meeting to be recorded and for the
  recording to be made available to the provider.  The commission may
  not record an informal resolution meeting unless the commission
  receives a written request from a provider.
         (b)  Notwithstanding Section 544.0259(e) and except as
  provided by this section:
               (1)  an informal resolution meeting held under Section
  544.0304 or 544.0506(b) is confidential; and
               (2)  any information or materials the office of
  inspector general, including the office's employees or agents,
  obtains during or in connection with an informal resolution
  meeting, including a recording made under Subsection (a), are
  privileged, confidential, and not subject to disclosure under
  Chapter 552 or any other means of legal compulsion for release,
  including disclosure, discovery, or subpoena. (Gov. Code, Sec.
  531.1202.)
         Sec. 544.0056.  EXPUNCTION OF CHILD'S CHEMICAL DEPENDENCY
  DIAGNOSIS IN CERTAIN RECORDS. (a)  In this section:
               (1)  "Chemical dependency" has the meaning assigned by
  Section 461A.002, Health and Safety Code.
               (2)  "Child" means an individual who is 13 years of age
  or younger.
         (b)  After a chemical dependency treatment provider is
  finally convicted of an offense in which an element of the offense
  involves submitting a fraudulent claim for reimbursement for
  services under Medicaid, the commission or other health and human
  services agency that operates a portion of Medicaid shall expunge
  or provide for the expunction of a child's diagnosis of chemical
  dependency that the provider made and that has been entered in any:
               (1)  appropriate official record of the commission or
  agency;
               (2)  applicable medical record that is in the
  commission's or agency's custody; and
               (3)  applicable record of a company with which the
  commission contracts for processing and paying Medicaid claims.
  (Gov. Code, Sec. 531.112.)
  SUBCHAPTER C. OFFICE OF INSPECTOR GENERAL: GENERAL PROVISIONS
         Sec. 544.0101.  APPOINTMENT OF INSPECTOR GENERAL; TERM. (a)  
  The governor shall appoint an inspector general to serve as
  director of the office of inspector general.
         (b)  The inspector general serves a one-year term that
  expires February 1.  (Gov. Code, Sec. 531.102(a-1).)
         Sec. 544.0102.  COMMISSION POWERS AND DUTIES RELATED TO
  OFFICE OF INSPECTOR GENERAL. (a)  The executive commissioner shall
  work in consultation with the office of inspector general when the
  executive commissioner is required by law to adopt a rule or policy
  necessary to implement a power or duty of the office of inspector
  general, including a rule necessary to carry out a responsibility
  of the office of inspector general under Section 544.0103(a).
         (b)  The executive commissioner is responsible for
  performing all administrative support services functions necessary
  to operate the office of inspector general in the same manner that
  the executive commissioner is responsible for providing
  administrative support services functions for the health and human
  services system, including office functions related to:
               (1)  procurement processes;
               (2)  contracting policies;
               (3)  information technology services;
               (4)  legal services, but only those related to:
                     (A)  open records;
                     (B)  procurement;
                     (C)  contracting;
                     (D)  human resources;
                     (E)  privacy;
                     (F)  litigation support by the attorney general;
                     (G)  bankruptcy; and
                     (H)  other legal services as detailed in the
  memorandum of understanding or other written agreement required
  under Subchapter E, Chapter 524;
               (5)  budgeting; and
               (6)  personnel and employment policies.
         (c)  The commission's internal audit division shall:
               (1)  regularly audit the office of inspector general as
  part of the commission's internal audit program; and
               (2)  include the office of inspector general in the
  commission's risk assessments.
         (d)  The commission's chief counsel is the final authority
  for all legal interpretations related to statutes, rules, and
  commission policies on programs the commission administers.
         (e)  The commission shall:
               (1)  in consultation with the inspector general, set
  clear objectives, priorities, and performance standards for the
  office of inspector general that emphasize:
                     (A)  coordinating investigative efforts to
  aggressively recover money;
                     (B)  allocating resources to cases that have the
  strongest supportive evidence and greatest potential to recover
  money; and
                     (C)  maximizing opportunities for referral of
  cases to the office of the attorney general in accordance with
  Section 544.0051; and
               (2)  train office of inspector general staff to enable
  the staff to pursue priority Medicaid and other health and human
  services fraud and abuse cases as necessary.
         (f)  The commission may require employees of health and human
  services agencies to provide assistance to the office of inspector
  general in connection with its duties relating to the investigation
  of fraud and abuse in the provision of health and human services.
  The office of inspector general is entitled to access to any
  information a health and human services agency maintains that is
  relevant to the office of inspector general's functions, including
  internal records.
         (g)  To the extent permitted by federal law, the executive
  commissioner, on the office of inspector general's behalf, shall
  adopt rules establishing:
               (1)  criteria for:
                     (A)  initiating a full-scale fraud or abuse
  investigation;
                     (B)  conducting the investigation;
                     (C)  collecting evidence; and
                     (D)  accepting and approving a provider's request
  to post a surety bond to secure potential recoupments in lieu of a
  payment hold or other asset or payment guarantee; and
               (2)  minimum training requirements for Medicaid
  provider fraud or abuse investigators.
         (h)  The executive commissioner, in consultation with the
  office of inspector general, shall adopt rules establishing
  criteria:
               (1)  for opening a case;
               (2)  for prioritizing cases for the efficient
  management of the office of inspector general's workload, including
  rules that direct the office to prioritize:
                     (A)  provider cases according to the highest
  potential for recovery or risk to this state as indicated through:
                           (i)  the provider's volume of billings;
                           (ii)  the provider's history of
  noncompliance with the law; and
                           (iii)  identified fraud trends;
                     (B)  recipient cases according to the highest
  potential for recovery and federal timeliness requirements; and
                     (C)  internal affairs investigations according to
  the seriousness of the threat to recipient safety and the risk to
  program integrity in terms of the amount or scope of fraud, waste,
  and abuse the allegation that is the subject of the investigation
  poses; and
               (3)  to guide field investigators in closing a case
  that is not worth pursuing through a full investigation. (Gov.
  Code, Secs. 531.102(a-2), (a-3), (a-4), (a-7), (a-8), (b), (c),
  (d), (n), (p).)
         Sec. 544.0103.  OFFICE OF INSPECTOR GENERAL: GENERAL POWERS
  AND DUTIES. (a)  The office of inspector general is responsible
  for:
               (1)  preventing, detecting, auditing, inspecting,
  reviewing, and investigating fraud, waste, and abuse in the
  provision and delivery of all health and human services in this
  state, including services provided:
                     (A)  through any state-administered health or
  human services program that is wholly or partly federally funded;
  or
                     (B)  by the Department of Family and Protective
  Services; and
               (2)  enforcing state law relating to providing those
  services.
         (b)  The commission may obtain any information or technology
  necessary for the office of inspector general to meet its
  responsibilities under this chapter or other law.
         (c)  The office of inspector general shall closely
  coordinate with the executive commissioner and relevant staff of
  health and human services system programs the office of inspector
  general oversees in performing functions relating to preventing
  fraud, waste, and abuse in the delivery of health and human services
  and enforcing state law relating to the provision of those
  services, including audits, utilization reviews, provider
  education, and data analysis.
         (d)  The office of inspector general shall conduct audits,
  inspections, and investigations independent of the executive
  commissioner and the commission but shall rely on the coordination
  required by Subsection (c) to ensure that the office of inspector
  general has a thorough understanding of the health and human
  services system to knowledgeably and effectively perform its
  duties.
         (e)  The office of inspector general may:
               (1)  assess administrative penalties otherwise
  authorized by law on behalf of the commission or a health and human
  services agency;
               (2)  request that the attorney general obtain an
  injunction to prevent a person from disposing of an asset the office
  of inspector general identifies as potentially subject to recovery
  by the office of inspector general due to the person's fraud or
  abuse;
               (3)  provide for coordination between the office of
  inspector general and special investigative units formed by managed
  care organizations under Subchapter H or entities with which
  managed care organizations contract under that subchapter;
               (4)  audit the use and effectiveness of state or
  federal funds, including contract and grant funds, administered by
  a person or state agency receiving the funds from a health and human
  services agency;
               (5)  conduct investigations relating to the funds
  described by Subdivision (4); and
               (6)  recommend policies to:
                     (A)  promote the economical and efficient
  administration of the funds described by Subdivision (4); and
                     (B)  prevent and detect fraud and abuse in the
  administration of those funds. (Gov. Code, Secs. 531.102(a), (a-5),
  (a-6), (h).)
         Sec. 544.0104.  EMPLOYMENT OF MEDICAL DIRECTOR. (a) The
  office of inspector general shall employ a medical director who:
               (1)  is a licensed physician under Subtitle B, Title 3,
  Occupations Code, and the rules the Texas Medical Board adopts
  under that subtitle; and
               (2)  preferably has significant knowledge of Medicaid.
         (b)  The medical director shall ensure that any
  investigative findings based on medical necessity or the quality of
  medical care have been reviewed by a qualified expert as described
  by the Texas Rules of Evidence before the office of inspector
  general imposes a payment hold or seeks recoupment of an
  overpayment, damages, or penalties.  (Gov. Code, Sec. 531.102(l).)
         Sec. 544.0105.  EMPLOYMENT OF DENTAL DIRECTOR. (a) The
  office of inspector general shall employ a dental director who:
               (1)  is a licensed dentist under Subtitle D, Title 3,
  Occupations Code, and the rules the State Board of Dental Examiners
  adopts under that subtitle; and
               (2)  preferably has significant knowledge of Medicaid.
         (b)  The dental director shall ensure that any investigative
  findings based on the necessity of dental services or the quality of
  dental care have been reviewed by a qualified expert as described by
  the Texas Rules of Evidence before the office of inspector general
  imposes a payment hold or seeks recoupment of an overpayment,
  damages, or penalties.  (Gov. Code, Sec. 531.102(m).)
         Sec. 544.0106.  CONTRACT FOR REVIEW OF INVESTIGATIVE
  FINDINGS BY QUALIFIED EXPERT. (a) If the commission does not
  receive any responsive bids under Chapter 2155 on a competitive
  solicitation for the services of a qualified expert to review
  investigative findings under Section 544.0104 or 544.0105 and the
  number of contracts to be awarded under this subsection is not
  otherwise limited, the commission may negotiate with and award a
  contract for the services to a qualified expert on the basis of:
               (1)  the contractor's agreement to a set fee, either as
  a range or lump-sum amount; and
               (2)  the contractor's affirmation and the office of
  inspector general's verification that the contractor possesses the
  necessary occupational licenses and experience.
         (b)  Notwithstanding Sections 2155.083 and 2261.051, a
  contract awarded under Subsection (a) is not subject to competitive
  advertising and proposal evaluation requirements. (Gov. Code,
  Secs. 531.102(m-1), (m-2).)
         Sec. 544.0107.  EMPLOYMENT OF PEACE OFFICERS. (a)  The
  office of inspector general shall employ and commission not more
  than five peace officers at any given time to assist the office in
  carrying out the office's duties relating to the investigation of
  Medicaid fraud, waste, and abuse.
         (b)  A peace officer the office of inspector general employs
  and commissions is administratively attached to the Department of
  Public Safety.  The commission shall provide administrative support
  to the department as necessary to support the assignment of the
  peace officers.
         (c)  A peace officer the office of inspector general employs
  and commissions:
               (1)  is a peace officer for purposes of Article 2.12,
  Code of Criminal Procedure; and
               (2)  shall obtain the office of the attorney general's
  prior approval before carrying out any duties requiring peace
  officer status. (Gov. Code, Sec. 531.1022.)
         Sec. 544.0108.  INVESTIGATIVE PROCESS REVIEW. (a) Office
  of inspector general staff who are not directly involved in
  investigations the office conducts shall review the office's
  investigative process, including the office's use of sampling and
  extrapolation to audit provider records.
         (b)  The office of inspector general shall arrange for the
  Association of Inspectors General or a similar third party to
  conduct a peer review of the office's sampling and extrapolation
  techniques. Based on the review and generally accepted practices
  among other offices of inspectors general, the executive
  commissioner, in consultation with the office, shall by rule adopt
  sampling and extrapolation standards for the office's use in
  conducting audits. (Gov. Code, Secs. 531.102(r), (s).)
         Sec. 544.0109.  PERFORMANCE AUDITS AND COORDINATION OF AUDIT
  ACTIVITIES. (a) Notwithstanding any other law, the office of
  inspector general may conduct a performance audit of any program or
  project administered or agreement entered into by the commission or
  a health and human services agency, including an audit related to:
               (1)  the commission's or a health and human services
  agency's contracting procedures; or
               (2)  the commission's or a health and human services
  agency's performance.
         (b)  The office of inspector general shall coordinate all
  audit and oversight activities, including those relating to
  providers and including developing audit plans, risk assessments,
  and findings, with the commission to minimize duplicative
  activities. In coordinating the activities, the office shall:
               (1)  to determine whether to audit a Medicaid managed
  care organization, annually seek the commission's input and
  consider previous audits and on-site visits the commission made to
  determine whether to audit a Medicaid managed care organization;
  and
               (2)  request the results of an informal audit or
  on-site visit the commission performed that could inform the
  office's risk assessment when determining whether to conduct or the
  scope of an audit of a Medicaid managed care organization.
         (c)  In addition to the coordination required by Subsection
  (b), the office of inspector general shall coordinate the office's
  other audit activities with those of the commission, including
  developing audit plans, performing risk assessments, and reporting
  findings, to minimize duplicative audit activities. In
  coordinating audit activities with the commission under this
  subsection, the office shall:
               (1)  to determine whether to conduct a performance
  audit, seek the commission's input and consider previous audits the
  commission conducted; and
               (2)  request the results of an audit the commission
  conducted if those results could inform the office's risk
  assessment when determining whether to conduct or the scope of a
  performance audit.
         (d)  In accordance with Section 540.0057(b), the office of
  inspector general shall consult with the executive commissioner
  regarding the adoption of rules defining the office's role in and
  jurisdiction over, and the frequency of, audits of Medicaid managed
  care organizations that the office and commission conduct.  (Gov.
  Code, Secs. 531.102(q), (v), (w), 531.1025.)
         Sec. 544.0110.  REPORTS ON AUDITS, INSPECTIONS, AND
  INVESTIGATIONS. (a) The office of inspector general shall prepare
  a final report on each audit, inspection, or investigation
  conducted under Section 544.0102, 544.0103, 544.0252(b), 544.0254,
  or 544.0257.  The final report must include:
               (1)  a summary of the activities the office performed
  in conducting the audit, inspection, or investigation;
               (2)  a statement on whether the audit, inspection, or
  investigation resulted in a finding of any wrongdoing; and
               (3)  a description of any findings of wrongdoing.
         (b)  A final report on an audit, inspection, or investigation
  is subject to required disclosure under Chapter 552. All
  information and materials compiled during the audit, inspection, or
  investigation remain confidential and not subject to required
  disclosure in accordance with Section 544.0259(e).
         (c)  A confidential draft report on an audit, inspection, or
  investigation that concerns the death of a child may be shared with
  the Department of Family and Protective Services. A draft report
  that is shared with the Department of Family and Protective
  Services remains confidential and is not subject to disclosure
  under Chapter 552. (Gov. Code, Secs. 531.102(j), (k).)
         Sec. 544.0111.  COMPLIANCE WITH FEDERAL CODING GUIDELINES.
  (a) In this section, "federal coding guidelines" means the code
  sets and guidelines the United States Department of Health and
  Human Services adopts in accordance with the Health Insurance
  Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d
  et seq.).
         (b)  The office of inspector general, including office staff
  and any third party with which the office contracts to perform
  coding services, and the commission's medical and utilization
  review appeals unit shall comply with federal coding guidelines,
  including guidelines for diagnosis-related group (DRG) validation
  and related audits. (Gov. Code, Sec. 531.1023.)
         Sec. 544.0112.  HOSPITAL UTILIZATION REVIEWS AND AUDITS:
  PROVIDER EDUCATION PROCESS. The executive commissioner, in
  consultation with the office of inspector general, shall develop by
  rule a process for the office, including office staff and any third
  party with which the office contracts to perform coding services,
  to communicate with and educate providers about the
  diagnosis-related group (DRG) validation criteria that the office
  uses in conducting hospital utilization reviews and audits. (Gov.
  Code, Sec. 531.1024.)
         Sec. 544.0113.  PROGRAM EXCLUSIONS. The office of inspector
  general, in consultation with this state's Medicaid fraud control
  unit, shall establish guidelines under which program exclusions:
               (1)  may permissively be imposed on a provider; or
               (2)  shall automatically be imposed on a provider.
  (Gov. Code, Sec. 531.102(g)(7).)
         Sec. 544.0114.  REPORT. (a) At each quarterly meeting of
  any advisory council responsible for advising the executive
  commissioner on the commission's operation, the inspector general
  shall submit to the executive commissioner, the governor, and the
  legislature a report on:
               (1)  the office of inspector general's activities;
               (2)  the office's performance with respect to
  performance measures the executive commissioner establishes for
  the office;
               (3)  fraud trends the office has identified;
               (4)  any recommendations for policy changes to prevent
  or address fraud, waste, and abuse in the delivery of health and
  human services in this state; and
               (5)  the amount of money recovered during the preceding
  quarter as a result of investigations involving peace officers
  employed and commissioned by the office for each program for which
  the office has investigative authority.
         (b)  The office of inspector general shall publish each
  report required under this section on the office's Internet
  website. (Gov. Code, Secs. 531.102(t), (u).)
  SUBCHAPTER D. MEDICAID PROVIDER CRIMINAL HISTORY RECORD
  INFORMATION AND ELIGIBILITY
         Sec. 544.0151.  DEFINITIONS. In this subchapter:
               (1)  "Health care professional" means an individual
  issued a license to engage in a health care profession.
               (2)  "License" means a license, certificate,
  registration, permit, or other authorization that:
                     (A)  a licensing authority issues; and
                     (B)  must be obtained before a person may practice
  or engage in a particular business, occupation, or profession.
               (3)  "Licensing authority" means a department,
  commission, board, office, or other state agency that issues a
  license.
               (4)  "Participating agency" means:
                     (A)  the Medicaid fraud enforcement divisions of
  the office of the attorney general;
                     (B)  each licensing authority with authority to
  issue a license to a health care professional or managed care
  organization that may participate in Medicaid; and
                     (C)  the office of inspector general.
               (5)  "Provider" means a person that was or is approved
  by the commission to provide Medicaid services under a contract or
  provider agreement with the commission. (Gov. Code, Secs.
  531.1011(10) (part), 531.1031(a)(1), (1-a), (1-b), (2), (3).)
         Sec. 544.0152.  EXCHANGE OF CRIMINAL HISTORY RECORD
  INFORMATION BETWEEN PARTICIPATING AGENCIES. (a)  This section
  applies only to:
               (1)  criminal history record information a
  participating agency holds that relates to a health care
  professional; and
               (2)  information a participating agency holds that
  relates to a health care professional or managed care organization
  that is the subject of an investigation by a participating agency
  for alleged Medicaid fraud or abuse.
         (b)  A participating agency may submit to another
  participating agency a written request for information to which
  this section applies.  The participating agency that receives the
  request shall provide the requesting agency with the requested
  information unless releasing the information:
               (1)  would jeopardize an ongoing investigation or
  prosecution by the participating agency that possesses the
  information; or
               (2)  is prohibited by other law.
         (c)  Notwithstanding any other law, a participating agency
  may enter into a memorandum of understanding or agreement with
  another participating agency for exchanging criminal history
  record information relating to a health care professional that both
  participating agencies are authorized access to under Chapter 411.  
  Confidential criminal history record information in a
  participating agency's possession that is provided to another
  participating agency remains confidential while in the possession
  of the participating agency that receives the information.
         (d)  A participating agency that discovers information that
  may indicate fraud or abuse by a health care professional or managed
  care organization may provide the information to any other
  participating agency unless the release of the information is
  prohibited by other law.
         (e)  If after receiving a request for information under
  Subsection (b) a participating agency determines that the agency is
  prohibited from releasing the information, the agency shall, not
  later than the 30th day after the date the agency received the
  request, inform the requesting agency of that determination in
  writing.
         (f)  Confidential information shared under this section is
  subject to the same confidentiality requirements and legal
  restrictions on access to the information that are imposed by law on
  the participating agency that originally obtained or collected the
  information.  Sharing information under this section does not
  affect whether the information is subject to disclosure under
  Chapter 552.
         (g)  A participating agency that receives information from
  another participating agency under this section must obtain written
  permission from the agency that shared the information before using
  the information in a licensure or enforcement action.
         (h)  This section does not affect a participating agency's
  authority to exchange information under other law.  (Gov. Code,
  Secs. 531.1031(b), (c), (c-1), (d), (e), (f), (g), (h).)
         Sec. 544.0153.  PROVIDER ELIGIBILITY FOR MEDICAID
  PARTICIPATION: CRIMINAL HISTORY RECORD INFORMATION.  (a)  The
  office of inspector general and each licensing authority that
  requires the submission of fingerprints to conduct a criminal
  history record information check of a health care professional
  shall enter into a memorandum of understanding to ensure that only
  individuals who are licensed and in good standing as health care
  professionals participate as Medicaid providers.  The memorandum
  under this section may be combined with a memorandum authorized
  under Section 544.0152(c) and must include a process by which:
               (1)  to determine a health care professional's
  eligibility to participate in Medicaid, the office may confirm with
  a licensing authority that the professional is licensed and in good
  standing; and
               (2)  the licensing authority immediately notifies the
  office if:
                     (A)  a provider's license has been revoked or
  suspended; or
                     (B)  the licensing authority has taken
  disciplinary action against a provider.
         (b)  To determine a health care professional's eligibility
  to participate as a Medicaid provider, the office of inspector
  general may not conduct a criminal history record information check
  of a health care professional who the office has confirmed under
  Subsection (a) is licensed and in good standing.  This subsection
  does not prohibit the office from conducting a criminal history
  record information check of a provider that is required or
  appropriate for other reasons, including for conducting an
  investigation of fraud, waste, or abuse.
         (c)  To determine a provider's eligibility to participate in
  Medicaid and subject to Subsection (d), the office of inspector
  general, after seeking public input, shall establish and the
  executive commissioner by rule shall adopt guidelines for
  evaluating criminal history record information of providers and
  potential providers.  The guidelines must outline conduct, by
  provider type, that may be contained in criminal history record
  information that will result in excluding a person as a Medicaid
  provider, taking into consideration:
               (1)  the extent to which the underlying conduct relates
  to the services provided through Medicaid;
               (2)  the degree to which the person would interact with
  Medicaid recipients as a provider; and
               (3)  any previous evidence that the person engaged in
  Medicaid fraud, waste, or abuse.
         (d)  The guidelines adopted under Subsection (c) may not
  impose stricter standards for an individual's eligibility to
  participate in Medicaid than a licensing authority described by
  Subsection (a) requires for the individual to engage in a health
  care profession without restriction in this state.
         (e)  The office of inspector general and the commission shall
  use the guidelines the executive commissioner adopts under
  Subsection (c) to determine whether a Medicaid provider continues
  to be eligible to participate as a Medicaid provider.
         (f)  The provider enrollment contractor, if applicable, and
  a Medicaid managed care organization shall defer to the office of
  inspector general on whether an individual's criminal history
  record information precludes the individual from participating as a
  Medicaid provider.  (Gov. Code, Secs. 531.1032(a), (b), (c), as
  added Acts 84th Leg., R.S., Ch. 945, (d), (e), (f).)
         Sec. 544.0154.  MONITORING OF CERTAIN FEDERAL DATABASES.
  The office of inspector general shall routinely check appropriate
  federal databases, including databases referenced in 42 C.F.R.
  Section 455.436, to ensure that a person excluded by the federal
  government from participating in Medicaid or Medicare is not
  participating as a Medicaid provider.  (Gov. Code, Sec. 531.1033.)
         Sec. 544.0155.  PERIOD FOR DETERMINING PROVIDER ELIGIBILITY
  FOR MEDICAID.  (a)  Not later than the 10th day after the date the
  office of inspector general receives a health care professional's
  complete application seeking to participate in Medicaid, the office
  shall inform the commission or the health care professional, as
  appropriate, of the office's determination of whether the health
  care professional should be denied participation in Medicaid based
  on:
               (1)  information concerning the health care
  professional's licensing status obtained as described by Section
  544.0153(a);
               (2)  information contained in the criminal history
  record information check that is evaluated in accordance with
  guidelines the executive commissioner adopts under Section
  544.0153(c);
               (3)  a review of federal databases under Section
  544.0154;
               (4)  the pendency of an open investigation by the
  office; or
               (5)  any other reason the office determines
  appropriate.
         (b)  Completion of an on-site visit of a health care
  professional during the period prescribed by Subsection (a) is not
  required.
         (c)  The office of inspector general shall develop
  performance metrics to measure the length of time for conducting a
  determination described by Subsection (a) with respect to:
               (1)  applications that are complete when submitted; and
               (2)  all other applications.  (Gov. Code, Sec.
  531.1034.)
  SUBCHAPTER E. PREVENTION AND DETECTION OF FRAUD, WASTE, AND ABUSE
         Sec. 544.0201.  SELECTION AND REVIEW OF MEDICAID CLAIMS TO
  DETERMINE RESOURCE ALLOCATION.  (a)  The commission shall annually
  select and review a random, statistically valid sample of all
  claims for Medicaid reimbursement, including under the vendor drug
  program, for potential cases of fraud, waste, or abuse.
         (b)  In conducting the annual review of claims, the
  commission may directly contact a recipient by telephone, in
  person, or both to verify that the services for which a provider
  submitted a reimbursement claim were actually provided to the
  recipient.
         (c)  Based on the results of the annual review of claims, the
  commission shall determine the types of claims toward which
  commission resources for fraud and abuse detection should be
  primarily directed.
         (d)  Absent an allegation of fraud, waste, or abuse, the
  commission may conduct an annual review of claims only after the
  commission completes the prior year's annual review of claims.
  (Gov. Code, Sec. 531.109.)
         Sec. 544.0202.  DUTIES RELATED TO FRAUD PREVENTION. (a) The
  office of inspector general shall compile and disseminate accurate
  information and statistics relating to:
               (1)  fraud prevention; and
               (2)  post-fraud referrals received and accepted or
  rejected from the commission's or a health and human services
  agency's case management system.
         (b)  The commission shall:
               (1)  aggressively publicize successful fraud
  prosecutions and fraud-prevention programs through all available
  means, including the use of statewide press releases; and
               (2)  ensure that the commission or a health and human
  services agency maintains and promotes a toll-free telephone
  hotline for reporting suspected fraud in programs the commission or
  a health and human services agency administers.
         (c)  The commission shall develop a cost-effective method to
  identify applicants for public assistance in counties bordering
  other states and in metropolitan areas the commission selects who
  are already receiving benefits in other states. If economically
  feasible, the commission may develop a computerized matching
  system.
         (d)  The commission shall:
               (1)  verify automobile information that is used as
  eligibility criteria; and
               (2)  establish with the Texas Department of Criminal
  Justice a computerized matching system to prevent an incarcerated
  individual from illegally receiving public assistance benefits the
  commission administers.
         (e)  Not later than October 1 of each year, the commission
  shall submit to the governor and Legislative Budget Board a report
  on the results of computerized matching of commission information
  with information from neighboring states, if any, and information
  from the Texas Department of Criminal Justice.  The commission may
  consolidate the report with any other report relating to the same
  subject matter the commission is required to submit under other
  law.
         (f)  The commission and each health and human services agency
  that administers part of Medicaid shall maintain statistics on the
  number, type, and disposition of fraudulent benefits claims
  submitted under the part of the program the agency administers.
  (Gov. Code, Secs. 531.0215, 531.108.)
         Sec. 544.0203.  FRAUD, WASTE, AND ABUSE DETECTION TRAINING.
  (a) The commission shall develop and implement a program to provide
  annual training on identifying potential cases of Medicaid fraud,
  waste, or abuse to:
               (1)  contractors who process Medicaid claims; and
               (2)  appropriate health and human services agency
  staff.
         (b)  The training must include clear criteria that specify:
               (1)  the circumstances under which a person should
  refer a potential case to the commission; and
               (2)  the time by which a referral should be made. (Gov.
  Code, Sec. 531.105(a).)
         Sec. 544.0204.  HEALTH AND HUMAN SERVICES AGENCY MEDICAID
  FRAUD, WASTE, AND ABUSE DETECTION GOAL. (a)  The health and human
  services agencies, in cooperation with the commission, shall
  periodically set a goal for the number of potential cases of
  Medicaid fraud, waste, or abuse that each agency will attempt to
  identify and refer to the commission.
         (b)  The commission shall include in the report required by
  Section 544.0051(f) information on the health and human services
  agencies' goals and the success of each agency in meeting the
  agency's goal. (Gov. Code, Sec. 531.105(b).)
         Sec. 544.0205.  AWARD FOR REPORTING MEDICAID FRAUD, ABUSE,
  OR OVERCHARGES. (a) The commission may grant an award to an
  individual who reports activity that constitutes fraud or abuse of
  Medicaid funds or who reports Medicaid overcharges if the
  commission determines that the disclosure results in the recovery
  of an administrative penalty imposed under Section 32.039, Human
  Resources Code. The commission may not grant an award to an
  individual in connection with a report if the commission or
  attorney general had independent knowledge of the activity the
  individual reported.
         (b)  The commission shall determine the amount of an award.
  The award may not exceed five percent of the amount of the
  administrative penalty imposed under Section 32.039, Human
  Resources Code, that resulted from the individual's disclosure. In
  determining the award amount, the commission:
               (1)  shall consider how important the disclosure is in
  ensuring the fiscal integrity of Medicaid; and
               (2)  may consider whether the individual participated
  in the fraud, abuse, or overcharge.
         (c)  A person who brings an action under Subchapter C,
  Chapter 36, Human Resources Code, is not eligible for an award under
  this section. (Gov. Code, Sec. 531.101.)
  SUBCHAPTER F. INVESTIGATION OF FRAUD, WASTE, ABUSE, AND
  OVERCHARGES
         Sec. 544.0251.  CLAIMS CRITERIA REQUIRING COMMENCEMENT OF
  INVESTIGATION. The executive commissioner, in consultation with
  the inspector general, by rule shall set specific claims criteria
  that, when met, require the office of inspector general to begin an
  investigation. (Gov. Code, Sec. 531.102(e).)
         Sec. 544.0252.  CIRCUMSTANCES REQUIRING COMMENCEMENT OF
  PRELIMINARY INVESTIGATION OF ALLEGED FRAUD OR ABUSE. (a) The
  office of inspector general shall conduct a preliminary
  investigation of an allegation of fraud or abuse against a provider
  that the commission receives from any source to determine whether
  there is a sufficient basis to warrant a full investigation. The
  office must begin a preliminary investigation not later than the
  30th day and complete the preliminary investigation not later than
  the 45th day after the date the commission receives or identifies an
  allegation of fraud or abuse.
         (b)  The office of inspector general shall conduct a
  preliminary investigation as provided by Section 544.0253 of a
  complaint or allegation of Medicaid fraud or abuse that the
  commission receives from any source to determine whether there is a
  sufficient basis to warrant a full investigation. The office must
  begin a preliminary investigation not later than the 30th day and
  complete the preliminary investigation not later than the 45th day
  after the date the commission receives a complaint or allegation or
  has reason to believe that fraud or abuse has occurred.  (Gov. Code,
  Secs. 531.102(f)(1), 531.118(b).)
         Sec. 544.0253.  CONDUCT OF PRELIMINARY INVESTIGATION OF
  ALLEGED FRAUD OR ABUSE. In conducting a preliminary investigation
  of an allegation of fraud or abuse and before the allegation may
  proceed to a full investigation, the office of inspector general
  must:
               (1)  review the allegation and all facts and evidence
  relating to the allegation; and
               (2)  prepare a preliminary investigation report that
  documents:
                     (A)  the allegation;
                     (B)  the evidence the office reviewed, if
  available;
                     (C)  the procedures the office used to conduct the
  preliminary investigation;
                     (D)  the preliminary investigation findings; and
                     (E)  the office's determination of whether a full
  investigation is warranted.  (Gov. Code, Sec. 531.118(c).)
         Sec. 544.0254.  FINDING OF CERTAIN MEDICAID FRAUD OR ABUSE
  FOLLOWING PRELIMINARY INVESTIGATION: CRIMINAL REFERRAL OR FULL
  INVESTIGATION.  If the findings of a preliminary investigation give
  the office of inspector general reason to believe that an incident
  of Medicaid fraud or abuse involving possible criminal conduct has
  occurred, not later than the 30th day after completing the
  preliminary investigation, the office, as appropriate:
               (1)  must refer the case to this state's Medicaid fraud
  control unit if a provider is suspected of fraud or abuse involving
  criminal conduct, provided that the criminal referral does not
  preclude the office from continuing the office's investigation of
  the provider that may lead to the imposition of appropriate
  administrative or civil sanctions; or
               (2)  may conduct a full investigation, subject to
  Section 544.0253, if there is reason to believe that a recipient has
  defrauded Medicaid.  (Gov. Code, Sec. 531.102(f)(2).)
         Sec. 544.0255.  IMMEDIATE CRIMINAL REFERRAL UNDER CERTAIN
  CIRCUMSTANCES. If the office of inspector general learns or has
  reason to suspect that a provider's records are being withheld,
  concealed, destroyed, fabricated, or in any way falsified, the
  office shall immediately refer the case to this state's Medicaid
  fraud control unit.  The criminal referral does not preclude the
  office from continuing the office's investigation of the provider
  that may lead to the imposition of appropriate administrative or
  civil sanctions. (Gov. Code, Sec. 531.102(g)(1).)
         Sec. 544.0256.  CONTINUATION OF PAYMENT HOLD FOLLOWING
  REFERRAL TO LAW ENFORCEMENT AGENCY.  (a)  If this state's Medicaid
  fraud control unit or another law enforcement agency accepts a
  fraud referral from the office of inspector general for
  investigation, a payment hold based on a credible allegation of
  fraud may be continued until:
               (1)  the investigation and any associated enforcement
  proceedings are complete; or
               (2)  the Medicaid fraud control unit, another law
  enforcement agency, or another prosecuting authority determines
  that there is insufficient evidence of fraud by the provider that is
  the subject of the investigation.
         (b)  If this state's Medicaid fraud control unit or another
  law enforcement agency declines to accept a fraud referral from the
  office of inspector general for investigation, a payment hold based
  on a credible allegation of fraud must be discontinued unless:
               (1)  the commission has alternative federal or state
  authority under which the commission may impose a payment hold; or
               (2)  the office makes a fraud referral to another law
  enforcement agency.
         (c)  On a quarterly basis, the office of inspector general
  shall request a certification from this state's Medicaid fraud
  control unit and other law enforcement agencies as to whether each
  matter the unit or agency accepted on the basis of a credible
  allegation of fraud referral continues to be under investigation
  and that the continuation of a payment hold is warranted. (Gov.
  Code, Secs. 531.118(d), (e), (f).)
         Sec. 544.0257.  COMPLETION OF FULL INVESTIGATION OF ALLEGED
  MEDICAID FRAUD OR ABUSE.  (a)  The office of inspector general shall
  complete a full investigation of a complaint or allegation of
  Medicaid fraud or abuse against a provider not later than the 180th
  day after the date the full investigation begins unless the office
  determines that more time is needed to complete the investigation.
         (b)  Except as otherwise provided by this subsection, if the
  office of inspector general determines that more time is needed to
  complete a full investigation, the office shall provide notice to
  the provider who is the subject of the investigation stating that
  the length of the investigation will exceed 180 days and specifying
  the reasons why the office was unable to complete the investigation
  within the 180-day period. The office is not required to provide
  notice to the provider under this subsection if the office
  determines that providing notice would jeopardize the
  investigation. (Gov. Code, Sec. 531.102(f-1).)
         Sec. 544.0258.  MEMORANDUM OF UNDERSTANDING FOR ASSISTING
  ATTORNEY GENERAL INVESTIGATIONS RELATED TO MEDICAID. (a) The
  commission and the attorney general shall enter into a memorandum
  of understanding under which the commission shall:
               (1)  provide investigative support to the attorney
  general as required in connection with cases under Subchapter B,
  Chapter 36, Human Resources Code; and
               (2)  assist in performing preliminary investigations
  and ongoing investigations for actions the attorney general
  prosecutes under Subchapter C, Chapter 36, Human Resources Code.
         (b)  The memorandum of understanding must specify the type,
  scope, and format of the investigative support the commission
  provides to the attorney general.
         (c)  The memorandum of understanding must ensure that
  barriers to direct fraud referrals to this state's Medicaid fraud
  control unit by Medicaid agencies or unreasonable impediments to
  communication between Medicaid agency employees and the Medicaid
  fraud control unit are not imposed. (Gov. Code, Sec. 531.104.)
         Sec. 544.0259.  SUBPOENAS. (a) The office of inspector
  general may issue a subpoena in connection with an investigation
  the office conducts.  The subpoena may be:
               (1)  issued to compel the attendance of a relevant
  witness or the production, for inspection or copying, of relevant
  evidence in this state; and
               (2)  served personally or by certified mail.
         (b)  The office of inspector general, acting through the
  attorney general, may file suit in a district court in this state to
  enforce a subpoena with which a person fails to comply. On finding
  that good cause exists for issuing the subpoena, the court shall
  order the person to comply with the subpoena. The court may punish
  a person who fails to obey the court order.
         (c)  Reimbursement of the expenses of a witness whose
  attendance is compelled under this section is governed by Section
  2001.103.
         (d)  The office of inspector general shall pay a reasonable
  fee for subpoenaed photocopies. The fee may not exceed the amount
  the office of inspector general may charge for copies of its
  records.
         (e)  Except for the disclosure of information to the state
  auditor's office, law enforcement agencies, and other entities as
  permitted by other law, all information and materials subpoenaed or
  compiled by the office of inspector general in connection with an
  audit, inspection, or investigation or by the office of the
  attorney general in connection with a Medicaid fraud investigation
  are:
               (1)  confidential and not subject to disclosure under
  Chapter 552; and
               (2)  not subject to disclosure, discovery, subpoena, or
  other means of legal compulsion for release to anyone other than the
  office of inspector general, the attorney general, or the office's
  or attorney general's employees or agents involved in the audit,
  inspection, or investigation.
         (f)  A person who receives information under Subsection (e)
  may disclose the information only in accordance with Subsection (e)
  and in a manner that is consistent with the authorized purpose for
  which the person first received the information. (Gov. Code, Sec.
  531.1021.)
  SUBCHAPTER G. PAYMENT HOLDS
         Sec. 544.0301.  IMPOSITION OF PAYMENT HOLD. (a) As
  authorized by state and federal law and except as provided by
  Subsections (d) and (e), the office of inspector general shall
  impose, as a serious enforcement tool to mitigate ongoing financial
  risk to this state, a payment hold on claims for reimbursement
  submitted by a provider only:
               (1)  to compel production of records;
               (2)  when requested by this state's Medicaid fraud
  control unit; or
               (3)  on the determination that a credible allegation of
  fraud exists, subject to Sections 544.0104(b) and 544.0105(b), as
  applicable.
         (b)  The office of inspector general shall impose a payment
  hold under this section without prior notice, and the payment hold
  takes effect immediately.
         (c)  The office of inspector general shall, in consultation
  with this state's Medicaid fraud control unit, establish guidelines
  regarding the imposition of payment holds authorized under this
  section.
         (d)  On the determination that a credible allegation of fraud
  exists and in accordance with 42 C.F.R. Sections 455.23(e) and (f),
  the office of inspector general may find that good cause exists to
  not impose a payment hold, to not continue a payment hold, to impose
  a payment hold only in part, or to convert a payment hold imposed in
  whole to one imposed only in part if:
               (1)  law enforcement officials specifically requested
  that a payment hold not be imposed because a payment hold would
  compromise or jeopardize an investigation;
               (2)  available remedies implemented by this state other
  than a payment hold would more effectively or quickly protect
  Medicaid funds;
               (3)  the office of inspector general determines, based
  on the submission of written evidence by the provider who is the
  subject of the payment hold, that the payment hold should be
  removed;
               (4)  Medicaid recipients' access to items or services
  would be jeopardized by a full or partial payment hold because the
  provider who is the subject of the payment hold:
                     (A)  is the sole community physician or the sole
  source of essential specialized services in a community; or
                     (B)  serves a large number of Medicaid recipients
  within a designated medically underserved area;
               (5)  the attorney general declines to certify that a
  matter continues to be under investigation; or
               (6)  the office of inspector general determines that a
  full or partial payment hold is not in the best interests of
  Medicaid.
         (e)  Unless the office of inspector general has evidence that
  a provider materially misrepresented documentation relating to
  medically necessary services, the office of inspector general may
  not impose a payment hold on claims for reimbursement the provider
  submits for those services if the provider obtained prior
  authorization from the commission or a commission contractor.
  (Gov. Code, Secs. 531.102(g)(2) (part), (7-a), (8), (9).)
         Sec. 544.0302.  NOTICE. (a) The office of inspector general
  shall notify a provider of a payment hold imposed under Section
  544.0301(a) in accordance with 42 C.F.R. Section 455.23(b) and,
  except as provided by that regulation, not later than the fifth day
  after the date the office imposes the payment hold.
         (b)  In addition to the requirements of 42 C.F.R. Section
  455.23(b), the payment hold notice must also include:
               (1)  the specific basis for the hold, including:
                     (A)  the claims supporting the allegation at that
  point in the investigation;
                     (B)  a representative sample of any documents that
  form the basis for the hold; and
                     (C)  a detailed summary of the office of inspector
  general's evidence relating to the allegation;
               (2)  a description of administrative and judicial due
  process rights and remedies, including:
                     (A)  the provider's option to seek informal
  resolution;
                     (B)  the provider's right to seek a formal
  administrative appeal hearing; or
                     (C)  the provider's ability to seek both an
  informal resolution and a formal administrative appeal hearing; and
               (3)  a detailed timeline for the provider to pursue the
  rights and remedies described in Subdivision (2). (Gov. Code, Sec.
  531.102(g)(2) (part).)
         Sec. 544.0303.  EXPEDITED ADMINISTRATIVE HEARING. (a) A
  provider subject to a payment hold imposed under Section
  544.0301(a), other than a hold this state's Medicaid fraud control
  unit requested, must request an expedited administrative hearing
  not later than the 10th day after the date the provider receives
  notice of the hold from the office of inspector general under
  Section 544.0302.
         (b)  On a provider's timely written request, the office of
  inspector general shall, not later than the third day after the date
  the office of inspector general receives the request, file a
  request with the State Office of Administrative Hearings for an
  expedited administrative hearing regarding the payment hold for
  which the provider submitted the request.
         (c)  Not later than the 45th day after the date the State
  Office of Administrative Hearings receives a request from the
  office of inspector general for an expedited administrative
  hearing, the State Office of Administrative Hearings shall hold the
  hearing.
         (d)  In an expedited administrative hearing held under this
  section:
               (1)  the provider and the office of inspector general
  are each limited to four hours of testimony, excluding time for
  responding to questions from the administrative law judge;
               (2)  the provider and the office of inspector general
  are each entitled to two continuances under reasonable
  circumstances; and
               (3)  the office of inspector general is required to
  show probable cause that:
                     (A)  the credible allegation of fraud that is the
  basis of the imposed payment hold has an indicia of reliability; and
                     (B)  continuing to pay the provider presents an
  ongoing significant financial risk to this state and a threat to the
  integrity of Medicaid.
         (e)  The office of inspector general is responsible for the
  costs of the expedited administrative hearing, but a provider is
  responsible for the provider's own costs incurred in preparing for
  the hearing.
         (f)  In the expedited administrative hearing, the
  administrative law judge shall decide whether the payment hold
  should continue but may not adjust the amount or percent of the
  payment hold.
         (g)  Notwithstanding any other law, including Section
  2001.058(e), the administrative law judge's decision in the
  expedited administrative hearing is final and may not be appealed.
  (Gov. Code, Secs. 531.102(g)(3), (4), (5).)
         Sec. 544.0304.  INFORMAL RESOLUTION. (a) The executive
  commissioner, in consultation with the office of inspector general,
  shall adopt rules that allow a provider subject to a payment hold
  imposed under Section 544.0301(a), other than a hold this state's
  Medicaid fraud control unit requested, to seek an informal
  resolution of the issues the office identifies in the notice
  provided under Section 544.0302.
         (b)  A provider must request an initial informal resolution
  meeting under this section not later than the deadline prescribed
  by Section 544.0303(a) for requesting an expedited administrative
  hearing.
         (c)  On receipt of a timely request, the office of inspector
  general shall:
               (1)  decide whether to grant the provider's request for
  an initial informal resolution meeting; and
               (2)  if the office decides to grant the request,
  schedule the initial informal resolution meeting and give notice to
  the provider of the time and place of the meeting.
         (d)  A provider may request a second informal resolution
  meeting after the date of an initial informal resolution meeting.
  On receipt of a timely request, the office of inspector general
  shall:
               (1)  decide whether to grant the provider's request for
  a second informal resolution meeting; and
               (2)  if the office decides to grant the request,
  schedule the second informal resolution meeting and give notice to
  the provider of the time and place of the second meeting.
         (e)  Before a second informal resolution meeting is held, a
  provider must have an opportunity to provide additional information
  for the office of inspector general to consider.
         (f)  A provider's decision to seek an informal resolution
  under this section does not extend the time by which the provider
  must request an expedited administrative hearing under Section
  544.0303(a). The informal resolution process shall run
  concurrently with the administrative hearing process, and the
  informal resolution process shall be discontinued when the State
  Office of Administrative Hearings issues a final determination on
  the payment hold. (Gov. Code, Sec. 531.102(g)(6).)
         Sec. 544.0305.  WEBSITE POSTING. The office of inspector
  general shall post on the office's publicly available Internet
  website a description in plain English of, and a video explaining,
  the processes and procedures the office uses to determine whether
  to impose a payment hold on a provider under this subchapter. (Gov.
  Code, Sec. 531.119.)
  SUBCHAPTER H. MANAGED CARE ORGANIZATION PREVENTION AND
  INVESTIGATION OF FRAUD AND ABUSE
         Sec. 544.0351.  APPLICABILITY OF SUBCHAPTER. This
  subchapter applies only to a managed care organization that
  provides or arranges for the provision of health care services to an
  individual under a government-funded program, including Medicaid
  and the child health plan program. (Gov. Code, Sec. 531.113(a)
  (part).)
         Sec. 544.0352.  SPECIAL INVESTIGATIVE UNIT OR CONTRACTED
  ENTITY TO INVESTIGATE FRAUD AND ABUSE.  (a)  A managed care
  organization to which this subchapter applies shall:
               (1)  establish and maintain a special investigative
  unit within the organization to investigate fraudulent claims and
  other types of program abuse by recipients or enrollees, as
  applicable, and service providers; or
               (2)  contract with another entity to investigate
  fraudulent claims and other types of program abuse by recipients or
  enrollees, as applicable, and service providers.
         (b)  A managed care organization that contracts for the
  investigation of fraudulent claims and other types of program abuse
  by recipients or enrollees, as applicable, and service providers
  under Subsection (a)(2) shall file with the office of inspector
  general:
               (1)  a copy of the written contract;
               (2)  the names, addresses, telephone numbers, and fax
  numbers of the principals of the entity with which the organization
  contracts; and
               (3)  a description of the qualifications of the
  principals of the entity with which the organization contracts.  
  (Gov. Code, Secs. 531.113(a) (part), (c).)
         Sec. 544.0353.  FRAUD AND ABUSE PREVENTION PLAN. (a) A
  managed care organization to which this subchapter applies shall:
               (1)  adopt a plan to prevent and reduce fraud and abuse;
  and
               (2)  annually file the plan with the office of
  inspector general for approval.
         (b)  The plan must include:
               (1)  a description of the organization's procedures
  for:
                     (A)  detecting and investigating possible acts of
  fraud or abuse;
                     (B)  mandatory reporting of possible acts of fraud
  or abuse to the office of inspector general; and
                     (C)  educating and training personnel to prevent
  fraud and abuse;
               (2)  the name, address, telephone number, and fax
  number of the individual responsible for carrying out the plan;
               (3)  a description or chart outlining the
  organizational arrangement of the organization's personnel
  responsible for investigating and reporting possible acts of fraud
  or abuse;
               (4)  a detailed description of the results of fraud and
  abuse investigations the organization's special investigative unit
  or the entity with which the organization contracts under Section
  544.0352(a)(2) conducts; and
               (5)  provisions for maintaining the confidentiality of
  any patient information relevant to a fraud or abuse investigation.
  (Gov. Code, Sec. 531.113(b).)
         Sec. 544.0354.  ASSISTANCE AND OVERSIGHT BY OFFICE OF
  INSPECTOR GENERAL.  (a)  The office of inspector general may review
  the records of a managed care organization to which this subchapter
  applies to determine compliance with this subchapter.
         (b)  The office of inspector general, in consultation with
  the commission, shall:
               (1)  investigate, including by means of regular audits,
  possible fraud, waste, and abuse by managed care organizations to
  which this subchapter applies;
               (2)  establish requirements for providing training to
  and regular oversight of special investigative units established by
  managed care organizations under Section 544.0352(a)(1) and
  entities with which managed care organizations contract under
  Section 544.0352(a)(2);
               (3)  establish requirements for approving plans to
  prevent and reduce fraud and abuse that managed care organizations
  adopt under Section 544.0353;
               (4)  evaluate statewide Medicaid fraud, waste, and
  abuse trends and communicate those trends to special investigative
  units and contracted entities to determine the prevalence of those
  trends;
               (5)  as needed, assist managed care organizations in
  discovering or investigating fraud, waste, and abuse; and
               (6)  provide ongoing, regular training to appropriate
  commission and office staff concerning fraud, waste, and abuse in a
  managed care setting, including training relating to fraud, waste,
  and abuse by service providers, recipients, and enrollees.  (Gov.
  Code, Secs. 531.113(d), (d-1).)
         Sec. 544.0355.  RULES.  (a)  The executive commissioner, in
  consultation with the office of inspector general, shall adopt
  rules as necessary to accomplish the purposes of this subchapter,
  including rules defining the investigative role of the office with
  respect to the investigative role of special investigative units
  established by managed care organizations under Section
  544.0352(a)(1) and entities with which managed care organizations
  contract under Section 544.0352(a)(2).
         (b)  The rules must specify the office of inspector general's
  role in:
               (1)  reviewing the findings of special investigative
  units and contracted entities;
               (2)  investigating cases in which the overpayment
  amount sought to be recovered exceeds $100,000; and
               (3)  investigating providers who are enrolled in more
  than one managed care organization. (Gov. Code, Sec. 531.113(e).)
  SUBCHAPTER I. FINANCIAL ASSISTANCE FRAUD
         Sec. 544.0401.  DEFINITION. In this subchapter, "financial
  assistance" means assistance provided under the financial
  assistance program under Chapter 31, Human Resources Code. (Gov.
  Code, Sec. 531.114(a) (part).)
         Sec. 544.0402.  FALSE OR MISLEADING INFORMATION RELATED TO
  FINANCIAL ASSISTANCE ELIGIBILITY. To establish or maintain the
  eligibility of an individual and the individual's family for
  financial assistance or to increase or prevent a reduction in the
  amount of that assistance, an individual may not intentionally:
               (1)  make a statement that the individual knows is
  false or misleading;
               (2)  misrepresent, conceal, or withhold a fact; or
               (3)  knowingly misrepresent a statement as being true.
  (Gov. Code, Sec. 531.114(a) (part).)
         Sec. 544.0403.  COMMISSION ACTION FOLLOWING DETERMINATION
  OF VIOLATION. If after an investigation the commission determines
  that an individual violated Section 544.0402, the commission shall:
               (1)  notify the individual of the alleged violation not
  later than the 30th day after the date the commission completes the
  investigation and provide the individual with an opportunity for a
  hearing on the matter; or
               (2)  refer the matter to the appropriate prosecuting
  attorney for prosecution. (Gov. Code, Sec. 531.114(b).)
         Sec. 544.0404.  INELIGIBILITY FOR FINANCIAL ASSISTANCE
  FOLLOWING VIOLATION; RIGHT TO APPEAL.  (a) An individual is not
  eligible to receive financial assistance as provided by Subsection
  (b) if the individual waives the right to a hearing or a hearing
  officer at an administrative hearing held under this subchapter
  determines that the individual violated Section 544.0402. An
  individual who a hearing officer determines violated Section
  544.0402 may appeal that determination by filing a petition in the
  district court in the county in which the violation occurred not
  later than the 30th day after the date the hearing officer makes the
  determination.
         (b)  An individual determined under Subsection (a) to have
  violated Section 544.0402 is not eligible for financial assistance:
               (1)  before the first anniversary of the date of that
  determination if the individual has no previous violations; and
               (2)  permanently if the individual was previously
  determined to have committed a violation.
         (c)  An individual who is convicted of a state or federal
  offense for conduct described by Section 544.0402 or who is granted
  deferred adjudication or placed on community supervision for that
  conduct is permanently disqualified from receiving financial
  assistance. (Gov. Code, Secs. 531.114(c), (d), (e).)
         Sec. 544.0405.  HOUSEHOLD ELIGIBILITY FOR FINANCIAL
  ASSISTANCE NOT AFFECTED.  This subchapter does not affect the
  eligibility for financial assistance of any other member of the
  household of an individual who is ineligible as a result of Section
  544.0404(b) or (c).  (Gov. Code, Sec. 531.114(f).)
         Sec. 544.0406.  RULES. The executive commissioner shall
  adopt rules as necessary to implement this subchapter. (Gov. Code,
  Sec. 531.114(g).)
  SUBCHAPTER J.  USE OF TECHNOLOGY TO DETECT, INVESTIGATE, AND
  PREVENT FRAUD, ABUSE, AND OVERCHARGES
         Sec. 544.0451.  LEARNING, NEURAL NETWORK, OR OTHER
  TECHNOLOGY RELATING TO MEDICAID.  (a) The commission shall:
               (1)  use learning, neural network, or other technology
  to identify and deter Medicaid fraud throughout this state; and
               (2)  require each health and human services agency that
  performs any part of Medicaid to participate in implementing and
  using the technology.
         (b)  The commission shall contract with a private or public
  entity to develop and implement the technology. The commission may
  require the contracted entity to install and operate the technology
  at locations the commission specifies, including commission
  offices.
         (c)  The commission shall maintain all information necessary
  to apply the technology to claims data covering a period of at least
  two years. The data used for data processing shall be maintained as
  an independent subset for security purposes.
         (d)  The commission shall refer cases the technology
  identifies to the office of inspector general or the office of the
  attorney general, as appropriate.
         (e)  Each month, the technology must match vital statistics
  unit death records with Medicaid claims filed by a provider.  If the
  commission determines that a provider filed a claim for services
  provided to an individual after the individual's date of death, as
  determined by the vital statistics unit death records, the
  commission shall refer the case to the office of inspector general
  for investigation. (Gov. Code, Sec. 531.106.)
         Sec. 544.0452.  MEDICAID FRAUD INVESTIGATION TRACKING
  SYSTEM.  (a)  The commission shall use an automated fraud
  investigation tracking system through the office of inspector
  general to monitor the progress of an investigation of suspected
  fraud, abuse, or insufficient quality of care in Medicaid.
         (b)  For each case of suspected fraud, abuse, or insufficient
  quality of care the technology required under Section 544.0451
  identifies, the automated fraud investigation tracking system
  must:
               (1)  receive from the technology electronically
  transferred records relating to the case;
               (2)  record the details and monitor the status of an
  investigation of the case, including maintaining a record of the
  beginning and completion dates for each phase of the case
  investigation;
               (3)  generate documents and reports related to the
  status of the case investigation; and
               (4)  generate standard letters to a provider regarding
  the status or outcome of an investigation.
         (c)  The commission shall require each health and human
  services agency that performs any part of Medicaid to participate
  in implementing and using the automated fraud investigation
  tracking system. (Gov. Code, Sec. 531.1061.)
         Sec. 544.0453.  MEDICAID FRAUD DETECTION TECHNOLOGY.  The
  commission may contract with a contractor who specializes in
  developing technology capable of identifying fraud patterns
  exhibited by Medicaid recipients to:
               (1)  develop and implement the fraud detection
  technology; and
               (2)  determine whether a fraud pattern by Medicaid
  recipients is present in the recipients' eligibility files the
  commission maintains. (Gov. Code, Sec. 531.111.)
         Sec. 544.0454.  DATA MATCHING AGAINST FEDERAL FELON LIST.
  The commission shall develop and implement a system to
  cross-reference the list of fugitive felons the federal government
  maintains with data collected for the following programs:
               (1)  the child health plan program;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code;
               (3)  Medicaid;
               (4)  nutritional assistance programs under Chapter 33,
  Human Resources Code;
               (5)  long-term care services, as defined by Section
  22.0011, Human Resources Code;
               (6)  community-based support services identified or
  provided in accordance with Subchapter D, Chapter 546; and
               (7)  other health and human services programs, as
  appropriate. (Gov. Code, Sec. 531.115.)
         Sec. 544.0455.  ELECTRONIC DATA MATCHING. (a) In this
  section, "public assistance program" includes:
               (1)  Medicaid;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code; and
               (3)  a nutritional assistance program under Chapter 33,
  Human Resources Code, including the supplemental nutrition
  assistance program under that chapter.
         (b)  At least quarterly, the commission shall conduct
  electronic data matches for a recipient of public assistance
  program benefits to verify the identity, income, employment status,
  and other factors that affect the recipient's eligibility. To
  verify a recipient's eligibility, the electronic data matching must
  match information the recipient provided with information
  contained in databases appropriate federal and state agencies
  maintain.
         (c)  Health and human services agencies shall cooperate with
  the commission by providing data or any other assistance necessary
  to conduct the electronic data matches required by this section.
         (d)  The commission shall enter into a memorandum of
  understanding with each state agency from which data is required to
  conduct electronic data matches under this section and Section
  544.0456.
         (e)  The commission may contract with a public or private
  entity to conduct the electronic data matches required by this
  section.
         (f)  The executive commissioner shall establish procedures
  by which the commission or a health and human services agency the
  commission designates verifies the electronic data matches the
  commission conducts under this section. Not later than the 20th day
  after the date an electronic data match is verified, the commission
  shall remove from eligibility a recipient who is determined to be
  ineligible for a public assistance program. (Gov. Code, Sec.
  531.110.)
         Sec. 544.0456.  METHODS TO REDUCE FRAUD, WASTE, AND ABUSE IN
  CERTAIN PUBLIC ASSISTANCE PROGRAMS. (a) In this section:
               (1)  "Financial assistance benefits" means monetary
  payments under:
                     (A)  the federal Temporary Assistance for Needy
  Families program operated under Chapter 31, Human Resources Code;
  or
                     (B)  this state's temporary assistance and
  support services program operated under Chapter 34, Human Resources
  Code.
               (2)  "Supplemental nutrition assistance benefits"
  means monetary payments under the supplemental nutrition
  assistance program operated under Chapter 33, Human Resources Code.
         (b)  To the extent not otherwise provided by this subtitle or
  Title 2, Human Resources Code, and in accordance with this section,
  the commission shall develop and implement methods for reducing
  fraud, waste, and abuse in public assistance programs.
         (c)  On a monthly basis, the commission shall:
               (1)  conduct electronic data matches with the Texas
  Lottery Commission to determine whether a recipient of supplemental
  nutrition assistance benefits or a recipient's household member
  received reportable lottery winnings;
               (2)  use the database system developed under Section
  532.0201 to:
                     (A)  match vital statistics unit death records
  with a list of individuals eligible for financial assistance or
  supplemental nutrition assistance benefits; and
                     (B)  ensure that any individual receiving
  assistance under either program who is discovered to be deceased
  has the individual's eligibility for assistance promptly
  terminated; and
               (3)  review the out-of-state electronic benefit
  transfer card transactions a recipient of supplemental nutrition
  assistance benefits made to determine whether those transactions
  indicate a possible change in the recipient's residence.
         (d)  The commission shall immediately review a recipient's
  eligibility for public assistance benefits if the commission
  discovers information under this section that affects the
  recipient's eligibility.
         (e)  A recipient presumptively commits a program violation
  if the recipient fails to disclose lottery winnings that are
  required to be reported to the commission under a public assistance
  program.
         (f)  The executive commissioner shall adopt rules necessary
  to implement this section. (Gov. Code, Sec. 531.1081.)
  SUBCHAPTER K.  RECOVERY AND RECOUPMENT IN CASES OF FRAUD, ABUSE, AND
  OVERCHARGES
         Sec. 544.0501.  RECOVERY MONITORING SYSTEM. (a)  The
  commission shall use an automated recovery monitoring system to
  monitor the collections process for a settled case of fraud, abuse,
  or insufficient quality of care in Medicaid.
         (b)  The recovery monitoring system must:
               (1)  monitor the collection of funds resulting from
  settled cases, including by recording:
                     (A)  monetary payments received from a provider
  who agreed to a monetary payment plan; and
                     (B)  deductions taken through the recoupment
  program from subsequent Medicaid claims the provider filed; and
               (2)  provide immediate notice of a provider who:
                     (A)  agreed to a monetary payment plan or to
  deductions through the recoupment program from subsequent Medicaid
  claims; and
                     (B)  fails to comply with the settlement
  agreement, including by providing notice of a provider who:
                           (i)  does not make a scheduled payment; or
                           (ii)  pays less than a scheduled amount.
  (Gov. Code, Sec. 531.1062.)
         Sec. 544.0502.  PAYMENT RECOVERY EFFORTS BY CERTAIN PERSONS;
  RETENTION OF RECOVERED AMOUNTS. (a) In this section, "contracted
  entity" means an entity with which a managed care organization
  contracts under Section 544.0352(a)(2).
         (b)  A managed care organization or the organization's
  contracted entity that discovers Medicaid or child health plan
  program fraud or abuse shall:
               (1)  immediately submit written notice to the office of
  inspector general and the office of the attorney general that:
                     (A)  is in the form and manner the office of
  inspector general prescribes; and
                     (B)  contains a detailed description of:
                           (i)  the fraud or abuse; and
                           (ii)  each payment made to a provider as a
  result of the fraud or abuse;
               (2)  subject to Subsection (c), begin payment recovery
  efforts; and
               (3)  ensure that any payment recovery efforts in which
  the organization engages are in accordance with rules the executive
  commissioner adopts.
         (c)  A managed care organization or the organization's
  contracted entity may not engage in payment recovery efforts if:
               (1)  the amount sought to be recovered under Subsection
  (b)(2) exceeds $100,000; and
               (2)  not later than the 10th business day after the date
  the organization or entity notifies the office of inspector general
  and the office of the attorney general under Subsection (b)(1), the
  organization or entity receives a notice from either office
  indicating that the organization or entity is not authorized to
  proceed with recovery efforts.
         (d)  A managed care organization may retain one-half of any
  money the organization or the organization's contracted entity
  recovers under Subsection (b)(2). The organization shall remit the
  remaining amount of recovered money to the office of inspector
  general for deposit to the credit of the general revenue fund.
         (e)  If the office of inspector general notifies a managed
  care organization in accordance with Subsection (c), proceeds with
  recovery efforts, and recovers all or part of the payments the
  organization identified as required by Subsection (b)(1), the
  organization is entitled to one-half of the amount recovered for
  each payment the organization identified after any applicable
  federal share is deducted.  The organization may not receive more
  than one-half of the total amount recovered after any applicable
  federal share is deducted.
         (f)  Notwithstanding this section, if the office of
  inspector general discovers Medicaid or child health plan program
  fraud, waste, or abuse in performing the office's duties, the
  office of inspector general may recover payments made to a provider
  as a result of the fraud, waste, or abuse as otherwise provided by
  this chapter.  All payments the office of inspector general
  recovers under this subsection shall be deposited to the credit of
  the general revenue fund.
         (g)  The office of inspector general shall coordinate with
  appropriate managed care organizations to ensure that the office of
  inspector general and an organization or an organization's
  contracted entity do not both begin payment recovery efforts under
  this section for the same case of fraud, waste, or abuse.
         (h)  A managed care organization shall submit a quarterly
  report to the office of inspector general detailing the amount of
  money the organization recovered under Subsection (b)(2).
         (i)  The executive commissioner shall adopt rules necessary
  to implement this section, including rules establishing due process
  procedures that a managed care organization must follow when
  engaging in payment recovery efforts as provided by this section.
  In adopting the rules establishing due process procedures, the
  executive commissioner shall require that a managed care
  organization or an organization's contracted entity that engages in
  payment recovery efforts as provided by this section and Section
  544.0503 provide to a provider required to use electronic visit
  verification:
               (1)  written notice of the organization's intent to
  recoup overpayments in accordance with Section 544.0503; and
               (2)  at least 60 days to cure any defect in a claim
  before the organization may begin efforts to collect overpayments.
  (Gov. Code, Sec. 531.1131.)
         Sec. 544.0503.  PROCESS FOR MANAGED CARE ORGANIZATIONS TO
  RECOUP OVERPAYMENTS RELATED TO ELECTRONIC VISIT VERIFICATION
  TRANSACTIONS.  (a)  The executive commissioner shall adopt rules
  that standardize the process by which a managed care organization
  collects alleged overpayments that are made to a health care
  provider and discovered through an audit or investigation the
  organization conducts secondary to missing electronic visit
  verification information. The rules must require that the
  organization:
               (1)  provide written notice to a provider:
                     (A)  of the organization's intent to recoup
  overpayments not later than the 30th day after the date an audit is
  complete;
                     (B)  of the specific claims and electronic visit
  verification transactions that are the basis of the overpayment;
                     (C)  of the process the provider should use to
  communicate with the organization to provide information about the
  electronic visit verification transactions;
                     (D)  of the provider's option to seek an informal
  resolution of the alleged overpayment;
                     (E)  of the process to appeal the determination
  that an overpayment was made; and
                     (F)  if the provider intends to respond to the
  notice, that the provider must respond not later than the 30th day
  after the date the provider receives the notice; and
               (2)  limit the duration of audits to 24 months.
         (b)  Notwithstanding any other law, a managed care
  organization may not attempt to recover an overpayment described by
  Subsection (a) until the provider exhausts all rights to an appeal.
  (Gov. Code, Sec. 531.1135.)
         Sec. 544.0504.  RECOVERY AUDIT CONTRACTORS. To the extent
  required under Section 1902(a)(42), Social Security Act (42 U.S.C.
  Section 1396a(a)(42)), the commission shall establish a program
  under which the commission contracts with one or more recovery
  audit contractors to identify Medicaid underpayments and
  overpayments and recover the overpayments. (Gov. Code, Sec.
  531.117.)
         Sec. 544.0505.  ANNUAL REPORT ON CERTAIN FRAUD AND ABUSE
  RECOVERIES. Not later than December 1 of each year, the commission
  shall prepare and submit to the legislature a report on the amount
  of money recovered during the preceding 12-month period as a result
  of investigations and recovery efforts made under Subchapter H and
  Section 544.0502 by special investigative units or entities with
  which a managed care organization contracts under Section
  544.0352(a)(2).  The report must specify the amount of money each
  managed care organization retained under Section 544.0502(d).
  (Gov. Code, Sec. 531.1132.)
         Sec. 544.0506.  NOTICE AND INFORMAL RESOLUTION OF PROPOSED
  RECOUPMENT OF OVERPAYMENT OR DEBT. (a)  The commission or the
  office of inspector general shall provide a provider with written
  notice of any proposed recoupment of an overpayment or debt and any
  damages or penalties relating to a proposed recoupment of an
  overpayment or debt arising out of a fraud or abuse investigation.  
  The notice must include:
               (1)  the specific basis for the overpayment or debt;
               (2)  a description of facts and supporting evidence;
               (3)  a representative sample of any documents that form
  the basis for the overpayment or debt;
               (4)  the extrapolation methodology;
               (5)  information relating to the extrapolation
  methodology used as part of the investigation and the methods used
  to determine the overpayment or debt in sufficient detail so that
  the extrapolation results may be demonstrated to be statistically
  valid and are fully reproducible;
               (6)  the calculation of the overpayment or debt amount;
               (7)  the amount of damages and penalties, if
  applicable; and
               (8)  a description of administrative and judicial due
  process remedies, including the provider's option to seek informal
  resolution, the provider's right to seek a formal administrative
  appeal hearing, or that the provider may seek both.
         (b)  A provider may request an informal resolution meeting.
  On receipt of the request, the office of inspector general shall
  schedule the meeting and give notice to the provider of the time and
  place of the meeting.  The informal resolution process shall run
  concurrently with the administrative hearing process, and the
  administrative hearing process may not be delayed on account of the
  informal resolution process.
         (c)  The commission shall provide the notice required by
  Subsection (a) to a provider that is a hospital not later than the
  90th day before the date the overpayment or debt that is the subject
  of the notice must be paid. (Gov. Code, Sec. 531.120.)
         Sec. 544.0507.  APPEAL OF DETERMINATION TO RECOUP
  OVERPAYMENT OR DEBT. (a)  A provider must request an appeal under
  this section not later than the 30th day after the date the provider
  is notified that the commission or the office of inspector general
  will seek to recover an overpayment or debt from the provider.
         (b)  On receipt of a timely written request by a provider who
  is the subject of a recoupment of overpayment or debt arising out of
  a fraud or abuse investigation, the office of inspector general
  shall file a docketing request with the State Office of
  Administrative Hearings or the commission's appeals division, as
  the provider requests, for an administrative hearing regarding the
  proposed recoupment amount and any associated damages or penalties.  
  The office of inspector general shall file the docketing request
  not later than the 60th day after the date of the provider's request
  or not later than the 60th day after completing the informal
  resolution process, if applicable.
         (c)  The office of inspector general is responsible for the
  costs of an administrative hearing, but a provider is responsible
  for the provider's own costs incurred in preparing for the hearing.
         (d)  A provider who is the subject of a recoupment of
  overpayment or debt arising out of a fraud or abuse investigation
  may appeal a final administrative order issued after an
  administrative hearing by filing a petition for judicial review in a district court in Travis County. (Gov. Code, Sec. 531.1201.)
 
  CHAPTER 545. CERTAIN PUBLIC ASSISTANCE BENEFITS
  SUBCHAPTER A. PUBLIC ASSISTANCE BENEFITS PROGRAM ELIGIBILITY
  DETERMINATION AND SERVICE DELIVERY INTEGRATION
  Sec. 545.0001.  DEFINITIONS
  Sec. 545.0002.  DEVELOPMENT AND IMPLEMENTATION OF INTEGRATION PLAN
  Sec. 545.0003.  METHODS TO ADDRESS FRAUD AND ELIGIBILITY ERROR
                   RATE
  Sec. 545.0004.  CONTRACT FOR INTEGRATION PLAN IMPLEMENTATION
  Sec. 545.0005.  USE OF OTHER AGENCIES' STAFF AND RESOURCES
  Sec. 545.0006.  FUNDING
  SUBCHAPTER B. ADMINISTRATION OF CERTAIN PUBLIC ASSISTANCE BENEFITS
  PROGRAMS
  Sec. 545.0051.  CONSOLIDATED RECIPIENT IDENTIFICATION AND
                   BENEFITS ISSUANCE METHOD
  Sec. 545.0052.  EXPANSION OF BILLING COORDINATION AND INFORMATION
                   COLLECTION ACTIVITIES
  Sec. 545.0053.  SERVICE DELIVERY AREA ALIGNMENT
  Sec. 545.0054.  PROGRAM TO IMPROVE AND MONITOR CERTAIN OUTCOMES OF
                   MEDICAID RECIPIENTS AND CHILD HEALTH PLAN
                   PROGRAM ENROLLEES
  Sec. 545.0055.  MINIMUM COLLECTION GOAL FOR RECOVERY OF CERTAIN
                   BENEFITS
  Sec. 545.0056.  DISTRIBUTION OF EARNED INCOME TAX CREDIT
                   INFORMATION
  Sec. 545.0057.  APPLICATION ASSISTANCE FOR FINANCIAL ASSISTANCE
                   RECIPIENTS ELIGIBLE FOR FEDERAL PROGRAMS
  SUBCHAPTER C.  CERTAIN PUBLIC ASSISTANCE BENEFITS PROGRAM
  ELIGIBILITY
  Sec. 545.0101.  MEMORANDUM OF UNDERSTANDING REGARDING MEDICAID AND
                   CHILD HEALTH PLAN PROGRAM ELIGIBILITY
                   DETERMINATIONS FOR CERTAIN CHILDREN
  Sec. 545.0102.  VERIFICATION OF IMMIGRATION STATUS OF CERTAIN
                   APPLICANTS FOR PUBLIC ASSISTANCE BENEFITS
  Sec. 545.0103.  VERIFICATION OF SPONSORSHIP INFORMATION FOR
                   CERTAIN BENEFITS RECIPIENTS OR ENROLLEES;
                   REIMBURSEMENT
  Sec. 545.0104.  CALL CENTERS
  SUBCHAPTER D.  ADMINISTRATIVE AND JUDICIAL REVIEW OF CERTAIN PUBLIC
  ASSISTANCE BENEFITS DECISIONS
  Sec. 545.0151.  DEFINITION
  Sec. 545.0152.  ELECTRONIC RECORDING OF HEARING
  Sec. 545.0153.  ADMINISTRATIVE REVIEW
  Sec. 545.0154.  JUDICIAL REVIEW
  SUBCHAPTER E.  CERTAIN PUBLIC ASSISTANCE BENEFITS PROGRAM PROVIDERS
  Sec. 545.0201.  COMPLIANCE WITH SOLICITATION PROHIBITIONS
  Sec. 545.0202.  MARKETING ACTIVITIES BY MEDICAID OR CHILD HEALTH
                   PLAN PROGRAM PROVIDERS
  Sec. 545.0203.  REIMBURSEMENT CLAIMS FOR CERTAIN MEDICAID OR CHILD
                   HEALTH PLAN SERVICES INVOLVING SUPERVISED
                   PROVIDERS
  Sec. 545.0204.  PARTICIPATION OF DIAGNOSTIC LABORATORY SERVICE
                   PROVIDERS IN CERTAIN PROGRAMS
  CHAPTER 545.  CERTAIN PUBLIC ASSISTANCE BENEFITS
  SUBCHAPTER A. PUBLIC ASSISTANCE BENEFITS PROGRAM ELIGIBILITY
  DETERMINATION AND SERVICE DELIVERY INTEGRATION
         Sec. 545.0001.  DEFINITIONS. In this subchapter:
               (1)  "Integrated system" means the integrated
  eligibility determination and service delivery system that is
  implemented under the integration plan.
               (2)  "Integration plan" means the plan to integrate
  services and functions relating to eligibility determination and
  service delivery required by Section 545.0002. (New.)
         Sec. 545.0002.  DEVELOPMENT AND IMPLEMENTATION OF
  INTEGRATION PLAN.  (a)  The commission, subject to the approval of
  the governor and the Legislative Budget Board, shall develop and
  implement a plan to integrate services and functions relating to
  eligibility determination and service delivery by health and human
  services agencies, the Texas Workforce Commission, and other
  agencies. The integration plan must include:
               (1)  a reengineering of eligibility determination
  business processes;
               (2)  streamlined service delivery;
               (3)  a unified and integrated process for the
  transition from welfare to work; and
               (4)  improved access to benefits and services for
  clients.
         (b)  In developing and implementing the integration plan,
  the commission:
               (1)  shall give priority to the design and development
  of computer hardware and software for and provide technical support
  relating to the integrated eligibility determination system;
               (2)  shall consult with agencies whose programs are
  included in the plan, including the Department of State Health
  Services and the Texas Workforce Commission; and
               (3)  may contract for appropriate professional and
  technical assistance.
         (c)  The commission shall develop and implement the
  integrated system to achieve:
               (1)  increased quality of and client access to
  services; and
               (2)  savings in the cost of providing administrative
  and other services and staff as a result of streamlining and
  eliminating duplication of services. (Gov. Code, Secs. 531.191(a)
  (part), (b) (part).)
         Sec. 545.0003.  METHODS TO ADDRESS FRAUD AND ELIGIBILITY
  ERROR RATE.  The commission shall examine cost-effective methods to
  address:
               (1)  fraud in assistance programs; and
               (2)  the error rate in eligibility determination.
  (Gov. Code, Sec. 531.191(c).)
         Sec. 545.0004.  CONTRACT FOR INTEGRATION PLAN
  IMPLEMENTATION. (a) On receipt by this state of any necessary
  federal approval and subject to the approval of the governor and the
  Legislative Budget Board, the commission may contract to implement
  all or part of the integration plan if the commission determines
  that contracting:
               (1)  may advance the objectives of Sections 545.0002
  and 545.0006(b); and
               (2)  meets the criteria set out in the cost-benefit
  analysis described by this section.
         (b)  Before awarding a contract, the commission shall
  provide to the governor and the Legislative Budget Board a detailed
  cost-benefit analysis that demonstrates:
               (1)  the integration plan's cost-effectiveness;
               (2)  mechanisms for monitoring performance under the
  plan; and
               (3)  specific improvements the plan makes to the
  service delivery system and client access.
         (c)  The commission shall make the cost-benefit analysis
  described by Subsection (b) available to the public.
         (d)  On or before the 10th day after releasing a request for
  bids, proposals, offers, or other applicable expressions of
  interest relating to developing or implementing the integration
  plan, the commission shall hold a public hearing and receive public
  comment on the request. (Gov. Code, Sec. 531.191(d).)
         Sec. 545.0005.  USE OF OTHER AGENCIES' STAFF AND RESOURCES.  
  (a)  The commission, in developing and implementing the integration
  plan, may use the staff and resources of agencies whose programs are
  included in the plan.
         (b)  The agencies whose programs are included in the
  integration plan shall cooperate with a commission request to
  provide available staff and resources that will be subject to the
  commission's direction. (Gov. Code, Secs. 531.191(a) (part), (e).)
         Sec. 545.0006.  FUNDING. (a) The design, development, and
  operation of an automated data processing system to support the
  integration plan may be financed through the issuance of bonds or
  other obligations under Chapter 1232.
         (b)  The commission, subject to any spending limitation
  prescribed in the General Appropriations Act, may use savings
  described by Section 545.0002(c)(2) to further develop the
  integrated system and provide other health and human services.
  (Gov. Code, Secs. 531.191(b) (part), (f).)
  SUBCHAPTER B. ADMINISTRATION OF CERTAIN PUBLIC ASSISTANCE BENEFITS
  PROGRAMS
         Sec. 545.0051.  CONSOLIDATED RECIPIENT IDENTIFICATION AND
  BENEFITS ISSUANCE METHOD.  (a)  If the commission determines that
  the implementation would be feasible and cost-effective, the
  commission may develop and implement a method to consolidate, to
  the extent possible, recipient identification and benefits
  issuance for the commission and health and human services agencies.
         (b)  The method may:
               (1)  provide for the use of a single integrated
  benefits issuance card or multiple cards capable of integrating
  benefits issuance or other program functions;
               (2)  incorporate a fingerprint image identifier to
  enable personal identity verification at a point of service and
  reduce fraud;
               (3)  enable immediate electronic verification of
  recipient eligibility; and
               (4)  replace multiple forms, cards, or other methods
  used for fraud reduction or provision of health and human services
  benefits, including:
                     (A)  electronic benefits transfer cards; and
                     (B)  smart cards used in Medicaid.
         (c)  In developing and implementing the method, the
  commission shall:
               (1)  to the extent possible, use industry-standard
  communication, messaging, and electronic benefits transfer
  protocols;
               (2)  ensure that all identifying and descriptive
  information of recipients of each health and human services program
  included in the method can be accessed only by a provider or other
  entity participating in the particular program;
               (3)  ensure that a provider or other entity
  participating in a health and human services program included in
  the method cannot identify whether a program recipient is receiving
  benefits under another program included in the method; and
               (4)  ensure that the storage and communication of all
  identifying and descriptive information included in the method
  comply with existing federal and state privacy laws governing
  individually identifiable information for recipients of public
  benefits programs. (Gov. Code, Sec. 531.091.)
         Sec. 545.0052.  EXPANSION OF BILLING COORDINATION AND
  INFORMATION COLLECTION ACTIVITIES.  (a)  If cost-effective, the
  commission may:
               (1)  contract to expand all or part of the billing
  coordination system established under Section 532.0058 to process
  claims for services provided through other benefits programs the
  commission or a health and human services agency administers;
               (2)  expand any other billing coordination tools and
  resources used to process claims for health care services provided
  through Medicaid to process claims for services provided through
  other benefits programs the commission or a health and human
  services agency administers; and
               (3)  expand the scope of individuals about whom
  information is collected under Section 32.042, Human Resources
  Code, to include recipients of services provided through other
  benefits programs the commission or a health and human services
  agency administers.
         (b)  Notwithstanding any other state law, each health and
  human services agency shall provide the commission with information
  necessary to allow the commission or the commission's designee to
  perform the billing coordination and information collection
  activities authorized by this section.  (Gov. Code, Sec.
  531.024131.)
         Sec. 545.0053.  SERVICE DELIVERY AREA ALIGNMENT.
  Notwithstanding Section 540.0701(d) or any other law and to the
  extent possible, the commission shall align Medicaid and the child
  health plan program service delivery areas.  (Gov. Code, Sec.
  531.024115.)
         Sec. 545.0054.  PROGRAM TO IMPROVE AND MONITOR CERTAIN
  OUTCOMES OF MEDICAID RECIPIENTS AND CHILD HEALTH PLAN PROGRAM
  ENROLLEES. The commission may design and implement a program to
  improve and monitor clinical and functional outcomes of a Medicaid
  recipient or child health plan program enrollee. The program may
  use financial, clinical, and other criteria based on pharmacy,
  medical services, and other claims data related to Medicaid or the
  child health plan program. (Gov. Code, Sec. 531.067.)
         Sec. 545.0055.  MINIMUM COLLECTION GOAL FOR RECOVERY OF
  CERTAIN BENEFITS. (a) Not later than August 30 of each year, the
  executive commissioner by rule shall set a minimum goal for the
  commission specifying the percentage of the amount of benefits the
  commission granted in error under the supplemental nutrition
  assistance program under Chapter 33, Human Resources Code, or the
  financial assistance program under Chapter 31, Human Resources
  Code, that the commission should recover. The executive
  commissioner shall set the percentage based on:
               (1)  comparable recovery rates other states reported;
  or
               (2)  other appropriate factors the executive
  commissioner identifies.
         (b)  If the commission fails to meet the goal set under
  Subsection (a) for the fiscal year, the executive commissioner
  shall notify the comptroller, and the comptroller shall reduce the
  commission's general revenue appropriation by an amount equal to
  the difference between the amount of state funds the commission
  would have collected had the commission met the goal and the amount
  of state funds the commission actually collected.
         (c)  The executive commissioner, the governor, and the
  Legislative Budget Board shall monitor the commission's
  performance in meeting the goal set under Subsection (a). The
  commission shall cooperate by providing to the governor and the
  Legislative Budget Board, on request, information concerning the
  commission's collection efforts. (Gov. Code, Sec. 531.050.)
         Sec. 545.0056.  DISTRIBUTION OF EARNED INCOME TAX CREDIT
  INFORMATION.  (a)  The commission shall ensure that educational
  materials relating to the federal earned income tax credit are
  provided in accordance with this section to each individual
  receiving assistance or benefits under:
               (1)  the child health plan program;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code;
               (3)  Medicaid;
               (4)  the supplemental nutrition assistance program
  under Chapter 33, Human Resources Code; or
               (5)  another appropriate health and human services
  program.
         (b)  In accordance with Section 526.0002, the commission
  shall, by mail or through the Internet, provide an individual
  described by Subsection (a) with access to:
               (1)  Internal Revenue Service publications relating to
  the federal earned income tax credit or information the comptroller
  prepares under Section 403.025 relating to that credit;
               (2)  federal income tax forms necessary to claim the
  federal earned income tax credit; and
               (3)  where feasible, the location of at least one
  program that:
                     (A)  is in close geographic proximity to the
  individual; and
                     (B)  provides free federal income tax preparation
  services to low-income and other eligible persons.
         (c)  In January of each year, the commission or a commission
  representative shall mail to each individual described by
  Subsection (a) information about the federal earned income tax
  credit that provides the individual with referrals to the resources
  described by Subsection (b).  (Gov. Code, Sec. 531.087.)
         Sec. 545.0057.  APPLICATION ASSISTANCE FOR FINANCIAL
  ASSISTANCE RECIPIENTS ELIGIBLE FOR FEDERAL PROGRAMS. The
  commission shall assist recipients of financial assistance under
  Chapter 31, Human Resources Code, who are eligible for assistance
  under federal programs to apply for benefits under those federal
  programs. The commission may delegate this responsibility to a
  health and human services agency, contract with a unit of local
  government, or use any other cost-effective method to assist
  financial assistance recipients who are eligible for federal
  programs.  (Gov. Code, Sec. 531.044.)
  SUBCHAPTER C.  CERTAIN PUBLIC ASSISTANCE BENEFITS PROGRAM
  ELIGIBILITY
         Sec. 545.0101.  MEMORANDUM OF UNDERSTANDING REGARDING
  MEDICAID AND CHILD HEALTH PLAN PROGRAM ELIGIBILITY DETERMINATIONS
  FOR CERTAIN CHILDREN.  (a)  The commission shall enter into a
  memorandum of understanding with the Texas Juvenile Justice
  Department to ensure that the commission assesses each individual
  who is committed, placed, or detained under Title 3, Family Code,
  for Medicaid and child health plan program eligibility before that
  individual's release from commitment, placement, or detention.  A
  local juvenile probation department is subject to the requirements
  of the memorandum.
         (b)  The memorandum of understanding must specify:
               (1)  the information that must be provided to the
  commission;
               (2)  the process by which and time frame within which
  the information must be provided; and
               (3)  the roles and responsibilities of all parties to
  the memorandum, including a requirement that the commission pursue
  the actions necessary to complete eligibility applications.
         (c)  The memorandum of understanding must be tailored to:
               (1)  achieve the goal of ensuring that an individual
  described by Subsection (a) who the commission determines is
  eligible for Medicaid or the child health plan program:
                     (A)  is enrolled in the program for which the
  individual is eligible; and
                     (B)  may begin receiving services through the
  program as soon as possible after the eligibility determination is
  made; and
               (2)  if possible, achieve the goal of ensuring that the
  individual may begin receiving services through the program on the
  date of the individual's release from commitment, placement, or
  detention.
         (d)  The executive commissioner may adopt rules as necessary
  to implement this section.  (Gov. Code, Sec. 531.02418.)
         Sec. 545.0102.  VERIFICATION OF IMMIGRATION STATUS OF
  CERTAIN APPLICANTS FOR PUBLIC ASSISTANCE BENEFITS.  (a)  This
  section applies only with respect to the following benefits
  programs:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code;
               (3)  Medicaid; and
               (4)  the supplemental nutrition assistance program
  under Chapter 33, Human Resources Code.
         (b)  If an individual states at the time of application for
  benefits under a program to which this section applies that the
  individual is a qualified alien, as that term is defined by 8 U.S.C.
  Section 1641(b), the commission shall, to the extent allowed by
  federal law, verify information regarding the individual's
  immigration status using an automated system where available.
         (c)  The executive commissioner shall adopt rules necessary
  to implement this section.
         (d)  Nothing in this section adds to or changes the
  eligibility requirements for a benefits program to which this
  section applies.  (Gov. Code, Sec. 531.024181.)
         Sec. 545.0103.  VERIFICATION OF SPONSORSHIP INFORMATION FOR
  CERTAIN BENEFITS RECIPIENTS OR ENROLLEES; REIMBURSEMENT.  (a)  In
  this section, "sponsored alien" means an individual who:
               (1)  has been lawfully admitted to the United States
  for permanent residence under the Immigration and Nationality Act
  (8 U.S.C. Section 1101 et seq.); and
               (2)  as a condition of that admission, was sponsored by
  another individual who executed an affidavit of support on the
  lawfully admitted individual's behalf.
         (b)  This section applies only with respect to the following
  benefits programs:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code;
               (3)  Medicaid; and
               (4)  the supplemental nutrition assistance program
  under Chapter 33, Human Resources Code.
         (c)  If an individual states at the time of application for
  benefits under a program to which this section applies that the
  individual is a sponsored alien, the commission:
               (1)  shall make a reasonable effort to notify the
  individual that the commission may seek reimbursement from the
  individual's sponsor for any program benefits the individual
  receives; and
               (2)  may, to the extent allowed by federal law and using
  an automated system where available, verify information relating to
  the sponsorship after the individual is determined eligible for and
  begins receiving program benefits.
         (d)  If the commission verifies that an individual who
  receives benefits under a program to which this section applies is a
  sponsored alien and determines that seeking reimbursement is
  cost-effective, the commission may seek reimbursement from the
  individual's sponsor for the program benefits provided to the
  individual to the extent allowed by federal law.
         (e)  The executive commissioner shall adopt rules necessary
  to implement this section, including rules that specify the most
  cost-effective procedures by which the commission may seek
  reimbursement under Subsection (d).
         (f)  Nothing in this section adds to or changes the
  eligibility requirements for a benefits program to which this
  section applies.  (Gov. Code, Sec. 531.024182.)
         Sec. 545.0104.  CALL CENTERS.  (a)  If cost-effective, the
  executive commissioner by rule shall establish at least one but not
  more than four call centers to determine and certify or recertify an
  individual's eligibility and need for services related to the
  following programs:
               (1)  the child health plan program;
               (2)  the financial assistance program under Chapter 31,
  Human Resources Code;
               (3)  Medicaid;
               (4)  nutritional assistance programs under Chapter 33,
  Human Resources Code;
               (5)  long-term care services, as defined by Section
  22.0011, Human Resources Code;
               (6)  community-based support services identified or
  provided in accordance with Subchapter D, Chapter 546; and
               (7)  other health and human services programs, as
  appropriate.
         (b)  The commission shall contract with at least one but not
  more than four private entities to operate the call centers unless
  the commission determines that contracting would not be
  cost-effective.
         (c)  Each call center:
               (1)  must be located in this state, except that this
  subdivision does not prohibit a call center located in this state
  from processing overflow calls through a center located in another
  state; and
               (2)  shall provide translation services as required by
  federal law for consumers who are unable to speak, hear, or
  comprehend the English language.
         (d)  The commission shall develop consumer service and
  performance standards for the operation of each call center and
  make those standards available to the public.  The standards must
  address a call center's:
               (1)  ability to serve consumers in a timely manner,
  including consideration of:
                     (A)  consumers' ability to access the call center;
                     (B)  whether the call center has toll-free
  telephone access;
                     (C)  the average amount of time a consumer spends
  on hold;
                     (D)  the frequency of call transfers;
                     (E)  whether a consumer is able to communicate
  with a live individual at the call center; and
                     (F)  whether the call center makes mail
  correspondence available;
               (2)  staff, including employee courtesy, friendliness,
  training, and knowledge about the programs listed under Subsection
  (a); and
               (3)  complaint handling procedures, including:
                     (A)  the level of difficulty involved in filing a
  complaint; and
                     (B)  whether the call center's complaint
  responses are timely.
         (e)  The commission shall develop:
               (1)  mechanisms for measuring consumer service
  satisfaction; and
               (2)  performance measures to evaluate whether each call
  center meets the standards the commission develops under Subsection
  (d).
         (f)  The commission may inspect a call center and analyze the
  call center's consumer service performance through a consumer
  service evaluator posing as a consumer.
         (g)  Notwithstanding Subsection (a), the executive
  commissioner shall develop and implement policies that provide an
  applicant for services related to a program listed under Subsection
  (a) with an opportunity to appear in person to establish initial
  eligibility or comply with periodic eligibility recertification
  requirements if the applicant requests a personal interview.  In
  implementing the policies, the commission shall maintain offices to
  serve applicants who request a personal interview.  This subsection
  does not affect a law or rule that requires an applicant to appear
  in person to establish initial eligibility or comply with periodic
  eligibility recertification requirements.  (Gov. Code, Sec.
  531.063.)
  SUBCHAPTER D.  ADMINISTRATIVE AND JUDICIAL REVIEW OF CERTAIN PUBLIC
  ASSISTANCE BENEFITS DECISIONS
         Sec. 545.0151.  DEFINITION.  In this subchapter, "public
  assistance benefits" means benefits provided under a public
  assistance program under Chapter 31, 32, or 33, Human Resources
  Code.  (Gov. Code, Sec. 531.019(a).)
         Sec. 545.0152.  ELECTRONIC RECORDING OF HEARING.  A hearing
  conducted by the commission, or by a health and human services
  agency to which the commission delegates a function related to
  public assistance benefits, that relates to a decision regarding
  public assistance benefits that is contested by an applicant for or
  recipient of the benefits must be recorded electronically.  (Gov.
  Code, Sec. 531.019(b) (part).)
         Sec. 545.0153.  ADMINISTRATIVE REVIEW.  (a)  Before an
  applicant for or recipient of public assistance benefits may appeal
  a decision of a hearing officer for the commission or a health and
  human services agency related to those benefits and in accordance
  with rules of the executive commissioner, the applicant or
  recipient must request an administrative review by an appropriate
  attorney of the commission or a health and human services agency, as
  applicable.
         (b)  Not later than the 15th business day after the date the
  appropriate attorney described by Subsection (a) receives the
  request for administrative review, the attorney shall:
               (1)  complete an administrative review of the decision;
  and
               (2)  notify the applicant or recipient in writing of
  the results of that review.  (Gov. Code, Sec. 531.019(c).)
         Sec. 545.0154.  JUDICIAL REVIEW.  (a)  An appeal of a
  decision made by a hearing officer for the commission or a health
  and human services agency related to public assistance benefits
  brought by an applicant for or recipient of the benefits:
               (1)  is governed by Subchapters G and H, Chapter 2001,
  except as provided by this subchapter; and
               (2)  takes precedence over all civil cases except
  workers' compensation and unemployment compensation cases.
         (b)  For purposes of Section 2001.171, an applicant for or
  recipient of public assistance benefits has exhausted all available
  administrative remedies and a decision, including a decision under
  Section 31.034 or 32.035, Human Resources Code, is final and
  appealable on the date that, after a hearing:
               (1)  the hearing officer for the commission or a health
  and human services agency reaches a final decision related to the
  benefits; and
               (2)  the appropriate attorney completes an
  administrative review of the decision and notifies the applicant or
  recipient in writing of the results of that review.
         (c)  For purposes of Section 2001.171, an applicant for or
  recipient of public assistance benefits is not required to file a
  motion for rehearing with the commission or a health and human
  services agency, as applicable.
         (d)  Notwithstanding Section 2001.177, the cost of preparing
  the record and transcript of a hearing described by Section
  545.0152 that is required to be sent to a reviewing court may not be
  charged to the applicant for or recipient of the public assistance
  benefits.
         (e)  Judicial review of a decision described by Subsection
  (a) is:
               (1)  instituted by filing a petition with a district
  court in Travis County, as provided by Subchapter G, Chapter 2001;
  and
               (2)  under the substantial evidence rule.
         (f)  The appellee is the commission.  (Gov. Code, Secs.
  531.019(b) (part), (d), (e), (f), (g), (h), (i).)
  SUBCHAPTER E.  CERTAIN PUBLIC ASSISTANCE BENEFITS PROGRAM PROVIDERS
         Sec. 545.0201.  COMPLIANCE WITH SOLICITATION PROHIBITIONS.
  (a)  In this section, "furnish" and "provider" have the meanings
  assigned by Section 544.0001.
         (b)  A provider who furnishes Medicaid or child health plan
  program services is subject to Chapter 102, Occupations Code.  The
  provider's compliance with that chapter is a condition of the
  provider's eligibility to participate as a provider under those
  programs. (Gov. Code, Sec. 531.116; New.)
         Sec. 545.0202.  MARKETING ACTIVITIES BY MEDICAID OR CHILD
  HEALTH PLAN PROGRAM PROVIDERS. (a) A Medicaid or child health plan
  program provider, including a provider participating in the network
  of a managed care organization that contracts with the commission
  to provide services under Medicaid or the child health plan
  program, may not engage in any marketing activity, including
  engaging in the dissemination of material or another attempt to
  communicate, that:
               (1)  involves unsolicited personal contact with a
  Medicaid recipient or a parent whose child is a Medicaid recipient
  or child health plan program enrollee, including by:
                     (A)  door-to-door solicitation;
                     (B)  solicitation at a child-care facility or
  other type of facility;
                     (C)  direct mail; or
                     (D)  telephone;
               (2)  is directed at an individual solely because the
  individual is a Medicaid recipient or is a parent of a child who is a
  Medicaid recipient or child health plan program enrollee; and
               (3)  is intended to influence the Medicaid recipient's
  or parent's choice of provider.
         (b)  A provider participating in the network of a managed
  care organization that contracts with the commission to provide
  services under Medicaid or the child health plan program must
  comply with the marketing guidelines the commission establishes
  under Section 540.0055.
         (c)  Nothing in this section prohibits:
               (1)  a Medicaid or child health plan program provider
  from:
                     (A)  engaging in a marketing activity, including
  engaging in the dissemination of material or another attempt to
  communicate, that is intended to influence the choice of provider
  by a Medicaid recipient or a parent whose child is a Medicaid
  recipient or child health plan program enrollee, if the marketing
  activity:
                           (i)  is conducted at a community-sponsored
  educational event, health fair, outreach activity, or other similar
  community or nonprofit event in which the provider participates and
  does not involve unsolicited personal contact or promotion of the
  provider's practice; or
                           (ii)  involves only the general
  dissemination of information, including by television, radio,
  newspaper, or billboard advertisement, and does not involve
  unsolicited personal contact;
                     (B)  as permitted under the provider's contract,
  engaging in the dissemination of material or another attempt to
  communicate with a Medicaid recipient or a parent whose child is a
  Medicaid recipient or child health plan program enrollee, including
  communication in person or by direct mail or telephone, to:
                           (i)  provide an appointment reminder;
                           (ii)  distribute promotional health
  materials;
                           (iii)  provide information about the types
  of services the provider offers; or
                           (iv)  coordinate patient care; or
                     (C)  engaging in a marketing activity that the
  provider has submitted for review and for which the provider has
  received a notice of prior authorization under Subsection (d); or
               (2)  a STAR+PLUS Medicaid managed care program provider
  from, as permitted under the provider's contract, engaging in a
  marketing activity, including engaging in the dissemination of
  material or another attempt to communicate, that is intended to
  educate a Medicaid recipient about available long-term services and
  supports.
         (d)  The commission shall establish a process by which a
  provider may submit a proposed marketing activity for review and
  prior authorization to ensure that the provider is in compliance
  with the requirements of this section and, if applicable, Section
  540.0055, or to determine whether the provider is exempt from a
  requirement of this section and, if applicable, Section 540.0055.
  The commission may grant or deny a provider's request for
  authorization to engage in a proposed marketing activity.
         (e)  The executive commissioner shall adopt rules as
  necessary to implement this section, including rules relating to
  provider marketing activities that are exempt from the requirements
  of this section and, if applicable, Section 540.0055. (Gov. Code,
  Sec. 531.02115.)
         Sec. 545.0203.  REIMBURSEMENT CLAIMS FOR CERTAIN MEDICAID OR
  CHILD HEALTH PLAN SERVICES INVOLVING SUPERVISED PROVIDERS.  (a)  In
  this section, "national provider identifier" means the national
  provider identifier required under Section 1128J(e), Social
  Security Act (42 U.S.C. Section 1320a-7k(e)).
         (b)  If a Medicaid or child health plan program provider,
  including a nurse practitioner or physician assistant, provides a
  referral or orders health care services for a Medicaid recipient or
  child health plan program enrollee at the direction or under the
  supervision of another provider and the referral or order is based
  on the supervised provider's evaluation of the recipient or
  enrollee, the names and associated national provider identifier
  numbers of the supervised provider and the supervising provider
  must be included on any claim for reimbursement a provider submits
  based on the referral or order.
         (c)  The executive commissioner shall adopt rules necessary
  to implement this section. (Gov. Code, Sec. 531.024161.)
         Sec. 545.0204.  PARTICIPATION OF DIAGNOSTIC LABORATORY
  SERVICE PROVIDERS IN CERTAIN PROGRAMS. Notwithstanding any other
  law, a diagnostic laboratory may participate as an in-state
  provider under any program a health and human services agency or the
  commission administers that involves diagnostic laboratory
  services, regardless of the location where any specific service is
  performed or where the laboratory's facilities are located, if:
               (1)  the laboratory or an entity that is a parent,
  subsidiary, or other affiliate of the laboratory maintains
  diagnostic laboratory operations in this state;
               (2)  the laboratory and each entity that is a parent,
  subsidiary, or other affiliate of the laboratory collectively
  employ at least 1,000 individuals at places of employment located
  in this state;
               (3)  the laboratory is otherwise qualified to provide
  the services under the program; and
               (4)  the laboratory is not prohibited from
  participating as a provider under any benefits program a health and
  human services agency or the commission administers based on
  conduct that constitutes fraud, waste, or abuse. (Gov. Code, Sec. 531.066.)
 
  CHAPTER 546.  LONG-TERM CARE AND SUPPORT OPTIONS FOR INDIVIDUALS
  WITH DISABILITIES AND ELDERLY INDIVIDUALS
  SUBCHAPTER A.  GENERAL PROVISIONS
  Sec. 546.0001.  DEFINITIONS
  Sec. 546.0002.  LONG-TERM CARE PLAN; COORDINATION OF SERVICES
  Sec. 546.0003.  EMPLOYMENT-FIRST POLICY
  Sec. 546.0004.  LONG-TERM CARE INSURANCE AWARENESS AND EDUCATION
                   CAMPAIGN
  SUBCHAPTER B. CARE SETTINGS AND SERVICE AND SUPPORT OPTIONS
  Sec. 546.0051.  DEFINITIONS
  Sec. 546.0052.  COMPREHENSIVE PLAN FOR ENSURING APPROPRIATE CARE
                   SETTING FOR INDIVIDUALS WITH DISABILITIES;
                   BIENNIAL REPORT
  Sec. 546.0053.  INFORMATION AND ASSISTANCE REGARDING CARE AND
                   SUPPORT OPTIONS FOR INDIVIDUALS WITH
                   DISABILITIES
  Sec. 546.0054.  COMMUNITY LIVING OPTIONS INFORMATION PROCESS FOR
                   CERTAIN INDIVIDUALS WITH INTELLECTUAL
                   DISABILITY
  Sec. 546.0055.  IMPLEMENTATION OF COMMUNITY LIVING OPTIONS
                   INFORMATION PROCESS AT STATE INSTITUTIONS FOR
                   CERTAIN ADULT RESIDENTS
  Sec. 546.0056.  VOUCHER PROGRAM FOR TRANSITIONAL LIVING ASSISTANCE
                   FOR INDIVIDUALS WITH DISABILITIES
  Sec. 546.0057.  TRANSITION SERVICES FOR YOUTH WITH DISABILITIES
  Sec. 546.0058.  TRANSFER OF MONEY FOR COMMUNITY-BASED SERVICES
  SUBCHAPTER C. CONSUMER DIRECTION MODELS
  Sec. 546.0101.  DEFINITIONS
  Sec. 546.0102.  IMPLEMENTATION OF CONSUMER DIRECTION MODELS
  Sec. 546.0103.  RULES
  Sec. 546.0104.  APPLICABILITY OF CERTAIN NURSING LICENSURE
                   REQUIREMENTS
  Sec. 546.0105.  LEGALLY AUTHORIZED REPRESENTATIVE SERVICE
                   OVERSIGHT REQUIRED
  Sec. 546.0106.  PROCEDURE TO PROVIDE NOTICE TO MEDICAID RECIPIENTS
  SUBCHAPTER D. COMMUNITY-BASED SUPPORT AND SERVICE DELIVERY SYSTEM
  INITIATIVES AND GRANT PROGRAM
  Sec. 546.0151.  DEFINITION
  Sec. 546.0152.  COMMUNITY-BASED SUPPORT AND SERVICE DELIVERY
                   SYSTEMS FOR LONG-TERM CARE SERVICES
  Sec. 546.0153.  AREA AGENCIES ON AGING: MINIMUM NUMBER
  Sec. 546.0154.  PROPOSALS
  Sec. 546.0155.  PROPOSAL REVIEW AND APPROVAL
  Sec. 546.0156.  STANDARD AND PRIORITY OF REVIEW
  Sec. 546.0157.  COMMUNITY-BASED ORGANIZATION MATCHING
                   CONTRIBUTION REQUIRED
  Sec. 546.0158.  PROPOSALS INVOLVING MULTIPLE COMMUNITY-BASED
                   ORGANIZATIONS
  Sec. 546.0159.  GUIDELINES
  Sec. 546.0160.  CERTAIN AGENCIES' DUTY TO PROVIDE RESOURCES AND
                   ASSISTANCE
  SUBCHAPTER E.  PERMANENCY PLANNING
  Sec. 546.0201.  DEFINITIONS
  Sec. 546.0202.  POLICY STATEMENT
  Sec. 546.0203.  DEVELOPMENT OF PERMANENCY PLAN PROCEDURES
  Sec. 546.0204.  PERMANENCY PLANNING FOR CERTAIN CHILDREN
  Sec. 546.0205.  INSTITUTION TO ASSIST WITH PERMANENCY PLANNING
                   EFFORTS
  Sec. 546.0206.  IMPLEMENTATION SYSTEM: LOCAL PERMANENCY PLANNING
                   SITES
  Sec. 546.0207.  DESIGNATION OF VOLUNTEER ADVOCATE
  Sec. 546.0208.  PREADMISSION NOTICE AND INFORMATION
  Sec. 546.0209.  REQUIREMENTS OF PARENT OR GUARDIAN ON CHILD'S
                   ADMISSION TO CERTAIN INSTITUTIONS
  Sec. 546.0210.  DUTIES OF CERTAIN INSTITUTIONS: NOTIFICATION
                   REQUIREMENTS AND PARENT OR GUARDIAN
                   ACCOMMODATIONS
  Sec. 546.0211.  NOTIFICATION OF PLACEMENT REQUIRED
  Sec. 546.0212.  NOTICE TO PARENT OR GUARDIAN REGARDING PLACEMENT
                   OPTIONS AND SERVICES
  Sec. 546.0213.  PLACEMENT ON WAIVER PROGRAM WAITING LIST
  Sec. 546.0214.  INTERFERENCE WITH PERMANENCY PLANNING EFFORTS
  Sec. 546.0215.  INITIAL PLACEMENT OF CHILD IN INSTITUTION AND
                   PLACEMENT EXTENSIONS
  Sec. 546.0216.  REVIEW OF CERTAIN PLACEMENT DATA
  Sec. 546.0217.  PROCEDURES FOR PLACEMENT REVIEWS
  Sec. 546.0218.  ANNUAL REAUTHORIZATION OF PLANS OF CARE FOR
                   CERTAIN CHILDREN
  Sec. 546.0219.  TRANSFER OF CHILD BETWEEN INSTITUTIONS
  Sec. 546.0220.  COMPLIANCE WITH PERMANENCY PLAN REQUIREMENTS AS
                   PART OF INSPECTION, SURVEY, OR INVESTIGATION
  Sec. 546.0221.  SEARCH FOR CHILD'S PARENT OR GUARDIAN
  Sec. 546.0222.  DOCUMENTATION OF ONGOING PERMANENCY PLANNING
                   EFFORTS
  Sec. 546.0223.  ACCESS TO RECORDS
  Sec. 546.0224.  COLLECTION OF INFORMATION REGARDING INVOLVEMENT OF
                   CERTAIN PARENTS AND GUARDIANS
  Sec. 546.0225.  REPORTING SYSTEMS: SEMIANNUAL REPORTING
  Sec. 546.0226.  EFFECT ON OTHER LAW
  SUBCHAPTER F. FAMILY-BASED ALTERNATIVES FOR CHILDREN
  Sec. 546.0251.  DEFINITIONS
  Sec. 546.0252.  FAMILY-BASED ALTERNATIVES SYSTEM: PURPOSE,
                   IMPLEMENTATION, AND ADMINISTRATION
  Sec. 546.0253.  FAMILY-BASED ALTERNATIVES SYSTEM DESIGN
                   REQUIREMENTS
  Sec. 546.0254.  MEDICAID WAIVER PROGRAM ALIGNMENT
  Sec. 546.0255.  COMMUNITY ORGANIZATION ELIGIBILITY; CONTRACT AND
                   REQUIREMENTS
  Sec. 546.0256.  PLACEMENT OPTIONS
  Sec. 546.0257.  AGENCY COOPERATION
  Sec. 546.0258.  DISPUTE RESOLUTION
  Sec. 546.0259.  GIFTS, GRANTS, AND DONATIONS
  Sec. 546.0260.  ANNUAL REPORT
  SUBCHAPTER G.  LONG-TERM CARE INSTITUTIONS AND FACILITIES
  Sec. 546.0301.  PROCEDURES TO REVIEW CONDUCT RELATED TO CERTAIN
                   INSTITUTIONS AND FACILITIES
  Sec. 546.0302.  ISSUANCE OF MATERIALS TO CERTAIN LONG-TERM CARE
                   FACILITIES
  SUBCHAPTER H.  INCENTIVE PAYMENT PROGRAM FOR CERTAIN NURSING
  FACILITIES
  Sec. 546.0351.  DEFINITIONS
  Sec. 546.0352.  INCENTIVE PAYMENT PROGRAM
  Sec. 546.0353.  COMMON PERFORMANCE MEASURES
  Sec. 546.0354.  SUBJECT TO APPROPRIATIONS
  SUBCHAPTER I. MEDICAID GENERALLY
  Sec. 546.0401.  MEDICAID LONG-TERM CARE SYSTEM
  Sec. 546.0402.  ADMINISTRATION AND DELIVERY OF CERTAIN WAIVER
                   PROGRAMS; PUBLIC INPUT
  Sec. 546.0403.  RECOVERY OF CERTAIN ASSISTANCE; MEDICAID ACCOUNT
  SUBCHAPTER J. MEDICAID WAIVER PROGRAMS
  Sec. 546.0451.  COMPETITIVE AND INTEGRATED EMPLOYMENT INITIATIVE
                   FOR CERTAIN RECIPIENTS; BIENNIAL REPORT
  Sec. 546.0452.  RISK MANAGEMENT CRITERIA FOR CERTAIN WAIVER
                   PROGRAMS
  Sec. 546.0453.  PROTOCOL FOR MAINTAINING CONTACT INFORMATION OF
                   INDIVIDUALS INTERESTED IN MEDICAID WAIVER
                   PROGRAMS
  Sec. 546.0454.  INTEREST LIST MANAGEMENT FOR CERTAIN MEDICAID
                   WAIVER PROGRAMS
  Sec. 546.0455.  INTEREST LIST MANAGEMENT FOR CERTAIN CHILDREN
                   ENROLLED IN MEDICALLY DEPENDENT CHILDREN (MDCP)
                   WAIVER PROGRAM
  Sec. 546.0456.  ELIGIBILITY OF CERTAIN CHILDREN FOR MEDICALLY
                   DEPENDENT CHILDREN (MDCP) OR DEAF-BLIND WITH
                   MULTIPLE DISABILITIES (DBMD) WAIVER PROGRAM;
                   INTEREST LIST PLACEMENT
  SUBCHAPTER K. MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER PROGRAM
  Sec. 546.0501.  LIMITATION ON NURSING FACILITY LEVEL OF CARE
                   REQUIREMENT
  Sec. 546.0502.  CONSUMER DIRECTION OF SERVICES
  Sec. 546.0503.  ASSESSMENTS AND REASSESSMENTS
  Sec. 546.0504.  QUALITY MONITORING BY EXTERNAL QUALITY REVIEW
                   ORGANIZATION
  Sec. 546.0505.  QUARTERLY REPORT
  SUBCHAPTER L. QUALITY ASSURANCE FEE PROGRAM
  Sec. 546.0551.  QUALITY ASSURANCE FEE FOR CERTAIN MEDICAID WAIVER
                   PROGRAM SERVICES
  Sec. 546.0552.  WAIVER PROGRAM QUALITY ASSURANCE FEE ACCOUNT
  Sec. 546.0553.  REIMBURSEMENT UNDER CERTAIN MEDICAID WAIVER
                   PROGRAMS
  Sec. 546.0554.  INVALIDITY; FEDERAL MONEY
  Sec. 546.0555.  EXPIRATION OF QUALITY ASSURANCE FEE PROGRAM
  SUBCHAPTER M. VOLUNTEER ADVOCATE PROGRAM FOR CERTAIN ELDERLY
  INDIVIDUALS
  Sec. 546.0601.  DEFINITIONS
  Sec. 546.0602.  PROGRAM PRINCIPLES
  Sec. 546.0603.  AGREEMENTS WITH NONPROFIT ORGANIZATIONS;
                   ORGANIZATION ELIGIBILITY
  Sec. 546.0604.  FUNDING
  Sec. 546.0605.  RULES
  SUBCHAPTER N. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT PROGRAM
  Sec. 546.0651.  DEFINITION
  Sec. 546.0652.  PILOT PROGRAM
  Sec. 546.0653.  FEDERAL GUIDANCE AND FUNDING
  Sec. 546.0654.  REPORT
  Sec. 546.0655.  EXPIRATION
  SUBCHAPTER O. MORTALITY REVIEW FOR CERTAIN INDIVIDUALS WITH
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY
  Sec. 546.0701.  DEFINITION
  Sec. 546.0702.  MORTALITY REVIEW SYSTEM
  Sec. 546.0703.  ACCESS TO INFORMATION AND RECORDS
  Sec. 546.0704.  MORTALITY REVIEW REPORTS
  Sec. 546.0705.  USE AND PUBLICATION RESTRICTIONS; CONFIDENTIALITY
  Sec. 546.0706.  LIMITATION ON LIABILITY
  CHAPTER 546.  LONG-TERM CARE AND SUPPORT OPTIONS FOR INDIVIDUALS
  WITH DISABILITIES AND ELDERLY INDIVIDUALS
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 546.0001.  DEFINITIONS. In this chapter:
               (1)  "ICF-IID" and "local intellectual and
  developmental disability authority" have the meanings assigned by
  Section 531.002, Health and Safety Code.
               (2)  "Recipient" means a Medicaid recipient. (New.)
         Sec. 546.0002.  LONG-TERM CARE PLAN; COORDINATION OF
  SERVICES.  (a)  In this section, "long-term care" means the
  provision of health care, personal care, and assistance related to
  health and social services over a sustained period to individuals
  of all ages and their families, regardless of the setting in which
  the care is provided.
         (b)  In conjunction with appropriate state agencies, the
  executive commissioner shall develop a plan for access to
  individualized long-term care services for individuals with
  functional limitations or medical needs and their families that
  assists those individuals in achieving and maintaining the greatest
  possible independence, autonomy, and quality of life.
         (c)  The guiding principles and goals of the plan that focus
  on the individual and the individual's family must:
               (1)  recognize that it is the policy of this state that:
                     (A)  children should grow up in families; and
                     (B)  individuals with disabilities and elderly
  individuals should reside in the setting of their choice; and
               (2)  ensure that an individual needing assistance and
  the individual's family will have:
                     (A)  the maximum possible control over their
  services;
                     (B)  a choice of a broad, comprehensive array of
  services designed to meet individual needs; and
                     (C)  the easiest possible access to appropriate
  care and support, regardless of the area of this state in which they
  reside.
         (d)  The guiding principles and goals of the plan that focus
  on services and delivery of those services by the state must:
               (1)  emphasize the development of home-based and
  community-based services and housing alternatives to complement
  the long-term care services already in existence;
               (2)  ensure that the services will be of the highest
  possible quality, with a minimum amount of regulation, structure,
  and complexity at the service level;
               (3)  recognize that maximum independence and autonomy
  represent major goals, and with those comes a certain degree of
  risk;
               (4)  maximize resources to the greatest extent
  possible, with the consumer receiving only the services that the
  consumer prefers and that are indicated by a functional needs
  assessment; and
               (5)  structure the service delivery system to support
  these goals, ensuring that any necessary system complexity is at
  the administrative level rather than at the client level.
         (e)  The commission shall coordinate state services to
  ensure that:
               (1)  the roles and responsibilities of agencies
  providing long-term care are clarified; and
               (2)  duplication of services and resources is
  minimized. (Gov. Code, Sec. 531.043.)
         Sec. 546.0003.  EMPLOYMENT-FIRST POLICY. (a) It is the
  policy of this state that earning a living wage through competitive
  employment in the general workforce is the priority and preferred
  outcome for working-age individuals with disabilities who receive
  public benefits.
         (b)  The commission, the Texas Education Agency, and the
  Texas Workforce Commission shall jointly adopt and implement an
  employment-first policy in accordance with the state's policy under
  Subsection (a). The policy must:
               (1)  affirm that an individual with a disability is
  able to meet the same employment standards as an individual who does
  not have a disability;
               (2)  ensure that all working-age individuals with
  disabilities, including young adults, are offered factual
  information regarding employment as an individual with a
  disability, including the relationship between an individual's
  earned income and the individual's public benefits;
               (3)  ensure that individuals with disabilities are
  given the opportunity to understand and explore options for
  education or training, including postsecondary, graduate, and
  postgraduate education, vocational or technical training, or other
  training, as pathways to employment;
               (4)  promote the availability and accessibility of
  individualized training designed to prepare an individual with a
  disability for the individual's preferred employment;
               (5)  promote partnerships with employers to overcome
  barriers in meeting workforce needs with the creative use of
  technology and innovation;
               (6)  ensure that staff of public schools, vocational
  service programs, and community providers are supported and trained
  to assist in achieving the goal of competitive employment for all
  individuals with disabilities; and
               (7)  ensure that competitive employment, while being
  the priority and preferred outcome, is not required of an
  individual with a disability to secure or maintain public benefits
  for which the individual is otherwise eligible. (Gov. Code, Sec.
  531.02447.)
         Sec. 546.0004.  LONG-TERM CARE INSURANCE AWARENESS AND
  EDUCATION CAMPAIGN.  (a)  The commission, in consultation with the
  Texas Department of Insurance, shall develop and implement a public
  awareness and education campaign designed to:
               (1)  educate the public on:
                     (A)  the cost of long-term care, including the
  limits of Medicaid eligibility and the limits of Medicare benefits;
  and
                     (B)  the value and availability of long-term care
  insurance; and
               (2)  encourage individuals to obtain long-term care
  insurance.
         (b)  The Texas Department of Insurance shall cooperate with
  and assist the commission in implementing the campaign.
         (c)  The commission may coordinate the implementation of the
  campaign with any other state outreach campaign or activity
  relating to long-term care issues. (Gov. Code, Sec. 531.0841.)
  SUBCHAPTER B. CARE SETTINGS AND SERVICE AND SUPPORT OPTIONS
         Sec. 546.0051.  DEFINITIONS. In this subchapter:
               (1)  "General residential operation" has the meaning
  assigned by Section 42.002, Human Resources Code.
               (2)  "Legally authorized representative" has the
  meaning assigned by Section 241.151, Health and Safety Code. (New.)
         Sec. 546.0052.  COMPREHENSIVE PLAN FOR ENSURING APPROPRIATE
  CARE SETTING FOR INDIVIDUALS WITH DISABILITIES; BIENNIAL REPORT.
  (a) The commission and appropriate health and human services
  agencies shall implement a comprehensive, effectively working plan
  that provides a system of services and support to foster
  independence and productivity and provide meaningful opportunities
  for an individual with a disability to reside in the most
  appropriate care setting, considering:
               (1)  the individual's physical, medical, and behavioral
  needs;
               (2)  the least restrictive care setting in which the
  individual can reside;
               (3)  the individual's choice of care settings in which
  to reside;
               (4)  the availability of state resources; and
               (5)  the availability of state programs for which the
  individual qualifies that can assist the individual.
         (b)  The plan must require appropriate health and human
  services agencies to:
               (1)  provide to an individual with a disability
  residing in an institution or another individual as required by
  Sections 546.0053 and 546.0054 information regarding care and
  support options available to the individual with a disability,
  including community-based services appropriate to that
  individual's needs;
               (2)  recognize that certain individuals with
  disabilities are represented by a legally authorized
  representative, whom the agencies must include in any
  decision-making facilitated by the plan's implementation;
               (3)  facilitate a timely and appropriate transfer of an
  individual with a disability from an institution to an appropriate
  community setting if:
                     (A)  the individual chooses to reside in the
  community;
                     (B)  the individual's treating professionals
  determine the transfer is appropriate; and
                     (C)  the transfer can be reasonably accommodated,
  considering this state's available resources and the needs of other
  individuals with disabilities; and
               (4)  develop strategies to prevent the unnecessary
  placement in an institution of an individual with a disability who
  is:
                     (A)  residing in the community; and
                     (B)  in imminent risk of requiring placement in an
  institution because of a lack of community services.
         (c)  In implementing the plan, a health and human services
  agency may not deny an eligible individual with a disability access
  to an institution or remove an eligible individual with a
  disability from an institution if the individual prefers the type
  and degree of care provided in the institution and that care is
  appropriate for the individual. A health and human services agency
  may deny the individual with a disability access to an institution
  or remove the individual from an institution to protect the
  individual's health or safety.
         (d)  Subject to the availability of funds, each appropriate
  health and human services agency shall implement the strategies and
  recommendations under the plan.
         (e)  To determine the appropriateness of transfers under
  Subsection (b)(3) and develop the strategies described by
  Subsection (b)(4), a health and human services agency shall presume
  that a child residing in a general residential operation is
  eligible for transfer to an appropriate community-based setting.
         (f)  To develop the strategies described by Subsection
  (b)(4), an individual with a mental illness who is admitted to a
  commission facility for inpatient mental health services three or
  more times during a 180-day period is presumed to be in imminent
  risk of requiring placement in an institution. The strategies must
  be developed in a manner that presumes the individual's eligibility
  for and the appropriateness of intensive community-based services
  and support.
         (g)  Not later than December 1 of each even-numbered year,
  the executive commissioner shall submit to the governor and the
  legislature a report on the status of the implementation of the
  plan. The report must include recommendations on any statutory or
  other action necessary to implement the plan.
         (h)  This section does not create a cause of action. (Gov.
  Code, Sec. 531.0244.)
         Sec. 546.0053.  INFORMATION AND ASSISTANCE REGARDING CARE
  AND SUPPORT OPTIONS FOR INDIVIDUALS WITH DISABILITIES. (a)  The
  executive commissioner by rule shall require each health and human
  services agency to provide to each patient or client of the agency
  and to at least one family member of the patient or client, if
  possible, information regarding all care and support options
  available to the patient or client, including community-based
  services appropriate to the patient's or client's needs, before the
  agency allows the patient or client to be placed in a care setting,
  including a nursing facility, an intermediate care facility for
  individuals with an intellectual disability, or a general
  residential operation for children with an intellectual disability
  that is licensed by the commission, to receive care or services
  provided by the agency or by a person under an agreement with the
  agency.
         (b)  The rules must require each health and human services
  agency to provide information about all long-term care and
  long-term support options available to the patient or client,
  including community-based options and options available through
  another agency or a private provider. The information must be
  provided in a manner designed to maximize the patient's or client's
  understanding of all available options. If the patient or client
  has a legally authorized representative, the information must also
  be provided to that representative. If the patient or client is in
  the conservatorship of a health and human services agency or the
  Department of Family and Protective Services, the information must
  be provided to the patient's or client's agency caseworker and
  foster parents, if applicable.
         (c)  A health and human services agency that provides a
  patient, client, or other individual with information regarding
  care and support options available to the patient or client shall
  assist the patient, client, or other individual in taking advantage
  of an option selected by the patient, client, or other individual,
  subject to the availability of funds. If the selected option is not
  immediately available for any reason, the agency shall provide
  assistance in placing the patient or client on a waiting list for
  that option. (Gov. Code, Sec. 531.042.)
         Sec. 546.0054.  COMMUNITY LIVING OPTIONS INFORMATION
  PROCESS FOR CERTAIN INDIVIDUALS WITH INTELLECTUAL DISABILITY. (a)
  In this section, "institution" means:
               (1)  a residential care facility the commission
  operates or maintains to provide 24-hour services, including
  residential services, to individuals with an intellectual
  disability; or
               (2)  an ICF-IID.
         (b)  In addition to providing information regarding care and
  support options as required by Section 546.0053, the commission
  shall implement a community living options information process in
  each institution to inform individuals with an intellectual
  disability who reside in the institution and the individuals'
  legally authorized representatives of alternative community living
  options.
         (c)  The commission shall:
               (1)  at least annually provide the information required
  by Subsection (b) through the community living options information
  process; and
               (2)  provide the information at any other time on
  request by an individual with an intellectual disability who
  resides in an institution or the individual's legally authorized
  representative.
         (d)  If an individual with an intellectual disability
  residing in an institution or the individual's legally authorized
  representative indicates a desire to pursue an alternative
  community living option after receiving the information provided
  under this section, the commission shall refer the individual or
  the individual's legally authorized representative to the local
  intellectual and developmental disability authority. The local
  authority shall place the individual:
               (1)  in an alternative community living option, subject
  to the availability of funds; or
               (2)  on a waiting list for those options if for any
  reason the options are not available to the individual on or before
  the 30th day after the date the individual or the individual's
  legally authorized representative is referred to the local
  authority.
         (e)  The commission shall document in the records of each
  individual with an intellectual disability who resides in an
  institution:
               (1)  the information provided to the individual or the
  individual's legally authorized representative through the
  community living options information process; and
               (2)  the results of that process. (Gov. Code, Secs.
  531.02442(a)(1-a), (b), (c), (d), (e).)
         Sec. 546.0055.  IMPLEMENTATION OF COMMUNITY LIVING OPTIONS
  INFORMATION PROCESS AT STATE INSTITUTIONS FOR CERTAIN ADULT
  RESIDENTS. (a)  In this section:
               (1)  "Adult resident" means an individual with an
  intellectual disability who:
                     (A)  is at least 22 years of age; and
                     (B)  resides in a state supported living center.
               (2)  "State supported living center" has the meaning
  assigned by Section 531.002, Health and Safety Code.
         (b)  This section applies only to the community living
  options information process for an adult resident.
         (c)  The commission shall contract with local intellectual
  and developmental disability authorities to implement the
  community living options information process required by Section
  546.0054 for an adult resident.
         (d)  The commission's contract with a local intellectual and
  developmental disability authority must:
               (1)  delegate to the local authority the commission's
  duties under Section 546.0054 with regard to implementing the
  community living options information process at a state supported
  living center;
               (2)  include performance measures designed to assist
  the commission in evaluating the effectiveness of the local
  authority in implementing the community living options information
  process; and
               (3)  ensure that the local authority provides service
  coordination and relocation services to an adult resident who
  chooses, is eligible for, and is recommended by the
  interdisciplinary team for a community living option to facilitate
  a timely, appropriate, and successful transition from the state
  supported living center to the community living option.
         (e)  The commission, with the advice and assistance of
  representatives of family members or legally authorized
  representatives of adult residents, individuals with an
  intellectual disability, state supported living centers, and local
  intellectual and developmental disability authorities, shall:
               (1)  develop an effective community living options
  information process;
               (2)  create uniform procedures for implementing the
  community living options information process; and
               (3)  minimize any potential conflict of interest
  regarding the community living options information process between
  a state supported living center and an adult resident, an adult
  resident's legally authorized representative, or a local
  intellectual and developmental disability authority.
         (f)  A state supported living center shall:
               (1)  allow a local intellectual and developmental
  disability authority to participate in the interdisciplinary
  planning process involving the consideration of community living
  options for an adult resident;
               (2)  to the extent not otherwise prohibited by state or
  federal confidentiality laws, provide a local intellectual and
  developmental disability authority with access to an adult resident
  and an adult resident's records to assist the authority in
  implementing the community living options information process; and
               (3)  provide an adult resident or the adult resident's
  legally authorized representative with accurate information
  regarding the risks of moving the adult resident to a community
  living option. (Gov. Code, Secs. 531.02443(a)(1), (5), (b), (c),
  (d), (e), (f).)
         Sec. 546.0056.  VOUCHER PROGRAM FOR TRANSITIONAL LIVING
  ASSISTANCE FOR INDIVIDUALS WITH DISABILITIES. (a) In this
  section:
               (1)  "Institutional housing" means:
                     (A)  an ICF-IID;
                     (B)  a nursing facility;
                     (C)  a state hospital, state supported living
  center, or state center the commission maintains and manages;
                     (D)  a general residential operation for children
  with an intellectual disability that the commission licenses; or
                     (E)  a general residential operation.
               (2)  "Integrated housing" means housing in which an
  individual with a disability resides or may reside that is:
                     (A)  located in the community; and
                     (B)  not exclusively occupied by individuals with
  disabilities and their care providers.
         (b)  Subject to the availability of funds, the commission
  shall coordinate with the Texas Department of Housing and Community
  Affairs to develop a housing assistance program to assist
  individuals with disabilities in moving from institutional housing
  to integrated housing. In developing the program, the agencies
  shall address:
               (1)  eligibility requirements for assistance;
               (2)  the period during which an individual with a
  disability may receive assistance;
               (3)  the types of housing expenses the program will
  cover; and
               (4)  the locations at which the program will operate.
         (c)  Subject to the availability of funds, the commission
  shall administer the housing assistance program. The commission
  shall coordinate with the Texas Department of Housing and Community
  Affairs in:
               (1)  administering the program;
               (2)  determining the availability of funding from the
  United States Department of Housing and Urban Development; and
               (3)  obtaining that funding.
         (d)  The Texas Department of Housing and Community Affairs
  shall provide information to the commission as necessary to
  facilitate the administration of the housing assistance program.
  (Gov. Code, Sec. 531.059.)
         Sec. 546.0057.  TRANSITION SERVICES FOR YOUTH WITH
  DISABILITIES. (a) The executive commissioner shall monitor
  programs and services offered through health and human services
  agencies designed to assist youth with disabilities to transition
  from school-oriented living to:
               (1)  post-schooling activities;
               (2)  services for adults; or
               (3)  community living.
         (b)  In monitoring the programs and services, the executive
  commissioner shall:
               (1)  consider whether the programs or services result
  in positive outcomes in the employment, community integration,
  health, and quality of life of individuals with disabilities; and
               (2)  collect information regarding the outcomes of the
  transition process as necessary to assess the programs and
  services. (Gov. Code, Sec. 531.02445.)
         Sec. 546.0058.  TRANSFER OF MONEY FOR COMMUNITY-BASED
  SERVICES. (a) The commission shall quantify the amount of money
  the legislature appropriates that would have been spent during the
  remainder of a state fiscal biennium to care for an individual who
  resides in a nursing facility but who is leaving that facility
  before the end of the biennium to reside in the community with the
  assistance of community-based services.
         (b)  Notwithstanding any other state law and to the maximum
  extent allowed by federal law, the executive commissioner shall
  direct, as appropriate:
               (1)  the comptroller, at the time an individual
  described by Subsection (a) leaves a nursing facility, to transfer
  an amount not to exceed the amount quantified under that subsection
  among the health and human services agencies and the commission as
  necessary to comply with this section; or
               (2)  the commission or a health and human services
  agency, at the time an individual described by Subsection (a)
  leaves a nursing facility, to transfer an amount not to exceed the
  amount quantified under that subsection within the agency's budget
  as necessary to comply with this section.
         (c)  The commission shall ensure that the amount transferred
  under this section is redirected by the commission or a health and
  human services agency, as applicable, to one or more
  community-based programs in the amount necessary to provide
  community-based services to the individual after the individual
  leaves a nursing facility. (Gov. Code, Sec. 531.092.)
  SUBCHAPTER C. CONSUMER DIRECTION MODELS
         Sec. 546.0101.  DEFINITIONS. In this subchapter:
               (1)  "Consumer" means an individual who receives
  services through a consumer direction model the commission
  establishes under this subchapter.
               (2)  "Consumer direction model" means a service
  delivery model under which a consumer or the consumer's legally
  authorized representative exercises control over the development
  and implementation of the consumer's individual service plan or
  over the persons delivering the services directly to the consumer.  
  The term includes the consumer-directed service option, the service
  responsibility option, and other types of service delivery models
  the commission develops under this subchapter.
               (3)  "Consumer-directed service option" means a type of
  consumer direction model in which:
                     (A)  a consumer or the consumer's legally
  authorized representative, as the employer, exercises control
  over:
                           (i)  recruiting, hiring, managing, or
  dismissing persons providing services directly to the consumer; or
                           (ii)  retaining contractors or vendors for
  other authorized program services; and
                     (B)  the consumer-directed services agency serves
  as fiscal agent and performs employer-related administrative
  functions for the consumer or the consumer's legally authorized
  representative, including payroll and filing tax and related
  reports.
               (4)  "Designated representative" means an adult
  volunteer appointed by a consumer or the consumer's legally
  authorized representative, as an employer, to perform all or part
  of the consumer's or the representative's duties as employer as
  approved by the consumer or the representative.
               (5)  "Legally authorized representative":
                     (A)  means:
                           (i)  a parent or legal guardian if the
  individual is a minor;
                           (ii)  a legal guardian if the individual has
  been adjudicated as incapacitated to manage the individual's
  personal affairs; or
                           (iii)  any other person authorized or
  required by law to act on the individual's behalf with regard to the
  individual's care; and
                     (B)  does not include a designated
  representative.
               (6)  "Service responsibility option" means a type of
  consumer direction model in which:
                     (A)  a consumer or the consumer's legally
  authorized representative participates in selecting, training, and
  managing persons providing services directly to the consumer; and
                     (B)  the provider agency, as the employer,
  performs employer-related administrative functions for the
  consumer or the consumer's legally authorized representative,
  including hiring and dismissing persons providing services
  directly to the consumer. (Gov. Code, Sec. 531.051(a).)
         Sec. 546.0102.  IMPLEMENTATION OF CONSUMER DIRECTION
  MODELS. (a) The commission shall develop and oversee the
  implementation of consumer direction models under which an
  individual with a disability or an elderly individual who is
  receiving certain state-funded or Medicaid-funded services, or the
  individual's legally authorized representative, exercises control
  over:
               (1)  developing and implementing the individual's
  service plan; or
               (2)  the persons who directly deliver the services.
         (b)  The consumer direction models the commission
  establishes under this subchapter may be implemented in appropriate
  and suitable commission or health and human services agency
  programs. (Gov. Code, Secs. 531.051(b), (d).)
         Sec. 546.0103.  RULES. In adopting rules for consumer
  direction models, the executive commissioner shall:
               (1)  determine which services are appropriate and
  suitable for delivery through a consumer direction model;
               (2)  ensure that each consumer direction model is
  designed to comply with applicable federal and state laws;
               (3)  maintain procedures to ensure that a potential
  consumer or the consumer's legally authorized representative has
  adequate and appropriate information, including the
  responsibilities of a consumer or representative under each service
  delivery option, to make an informed choice among the types of
  consumer direction models;
               (4)  require each consumer or the consumer's legally
  authorized representative to sign a statement acknowledging
  receipt of the information required by Subdivision (3);
               (5)  maintain procedures to monitor delivery of
  services through a consumer direction model to ensure:
                     (A)  adherence to existing applicable program
  standards;
                     (B)  appropriate use of funds; and
                     (C)  consumer satisfaction with the delivery of
  services;
               (6)  ensure that authorized program services that are
  not being delivered to a consumer through a consumer direction
  model are provided by a provider agency the consumer or the
  consumer's legally authorized representative chooses; and
               (7)  set a timetable to complete the implementation of
  the consumer direction models. (Gov. Code, Sec. 531.051(c).)
         Sec. 546.0104.  APPLICABILITY OF CERTAIN NURSING LICENSURE
  REQUIREMENTS. Section 301.251(a), Occupations Code, does not apply
  to delivery of a service for which payment is provided under the
  consumer-directed service option developed under this subchapter
  if:
               (1)  the individual who delivers the service:
                     (A)  has not been denied a license under Chapter
  301, Occupations Code;
                     (B)  has not been issued a license under Chapter
  301, Occupations Code, that is revoked or suspended; and
                     (C)  performs a service that is not expressly
  prohibited from delegation by the Texas Board of Nursing; and
               (2)  the consumer who receives the service:
                     (A)  has a disability and the service would have
  been performed by the consumer or the consumer's legally authorized
  representative except for that disability; and
                     (B)  is:
                           (i)  capable of training the individual to
  properly perform the service and the consumer directs the
  individual to deliver the service; or
                           (ii)  not capable of training the individual
  to properly perform the service, the consumer's legally authorized
  representative is capable of training the individual to properly
  perform the service, and the legally authorized representative
  directs the individual to deliver the service. (Gov. Code, Sec.
  531.051(e).)
         Sec. 546.0105.  LEGALLY AUTHORIZED REPRESENTATIVE SERVICE
  OVERSIGHT REQUIRED. If an individual delivers a service under
  Section 546.0104(2)(B)(ii), the legally authorized representative
  must be present when the service is performed or be immediately
  accessible to the individual who delivers the service.  If the
  individual will perform the service when the representative is not
  present, the representative must observe the individual performing
  the service at least once to assure the representative that the
  individual can competently perform that service. (Gov. Code, Sec.
  531.051(f).)
         Sec. 546.0106.  PROCEDURE TO PROVIDE NOTICE TO MEDICAID
  RECIPIENTS. The commission shall:
               (1)  develop a procedure to:
                     (A)  verify that a recipient or the recipient's
  parent or legal guardian is informed of the consumer direction
  model and provided the option to choose to receive care under that
  model; and
                     (B)  if the individual declines to receive care
  under the consumer direction model, document the decision to
  decline; and
               (2)  ensure that each Medicaid managed care
  organization implements the procedure. (Gov. Code, Sec. 531.0512.)
  SUBCHAPTER D. COMMUNITY-BASED SUPPORT AND SERVICE DELIVERY SYSTEM
  INITIATIVES AND GRANT PROGRAM
         Sec. 546.0151.  DEFINITION.  In this subchapter,
  "community-based organization" includes:
               (1)  an area agency on aging;
               (2)  an independent living center;
               (3)  a municipality, county, or other local government;
               (4)  a nonprofit or for-profit organization; or
               (5)  a community mental health and intellectual
  disability center.  (Gov. Code, Sec. 531.02481(f) (part).)
         Sec. 546.0152.  COMMUNITY-BASED SUPPORT AND SERVICE
  DELIVERY SYSTEMS FOR LONG-TERM CARE SERVICES.  (a)  The commission
  shall assist communities in this state to develop comprehensive,
  community-based support and service delivery systems for long-term
  care services.  At a community's request, the commission shall
  provide resources and assistance to the community to enable the
  community to:
               (1)  identify and overcome institutional barriers to
  developing more comprehensive community support systems, including
  barriers that result from the policies and procedures of state
  health and human services agencies;
               (2)  develop a system of blended funds, consistent with
  federal law and the General Appropriations Act, to allow the
  community to customize services to fit individual community needs;
  and
               (3)  develop a local system of access and assistance to
  aid clients in accessing the full range of long-term care services.
         (b)  At the request of a community-based organization or a
  combination of community-based organizations, the commission may
  provide a grant to the organization or organizations in accordance
  with this subchapter.
         (c)  In implementing this subchapter, the commission shall
  consider models used in other service delivery systems. (Gov. Code,
  Secs. 531.02481(a), (d).)
         Sec. 546.0153.  AREA AGENCIES ON AGING: MINIMUM NUMBER.  The
  executive commissioner shall assure the maintenance of no fewer
  than 28 area agencies on aging in order to assure the continuation
  of a local system of access and assistance that is sensitive to the
  aging population.  (Gov. Code, Sec. 531.02481(e).)
         Sec. 546.0154.  PROPOSALS.  A community-based organization
  or a combination of organizations may make a proposal under this
  subchapter.  (Gov. Code, Sec. 531.02481(f) (part).)
         Sec. 546.0155.  PROPOSAL REVIEW AND APPROVAL.  (a)  A health
  and human services agency that receives or develops a proposal for a
  community initiative shall submit the initiative to the commission
  for review and approval.
         (b)  The commission shall review the initiative to ensure
  that the initiative is:
               (1)  consistent with other similar programs offered in
  communities; and
               (2)  not duplicative of other services provided in the
  community.  (Gov. Code, Sec. 531.02481(c).)
         Sec. 546.0156.  STANDARD AND PRIORITY OF REVIEW.  (a)  In
  making a grant to a community-based organization, the commission
  shall evaluate the organization's proposal based on demonstrated
  need and the proposal's merit.
         (b)  The commission shall give priority to proposals that
  will use the Internet and related information technologies to
  provide to clients:
               (1)  referral services;
               (2)  other information regarding local long-term care
  services; and
               (3)  needs assessments.  (Gov. Code, Sec. 531.02481(g)
  (part).)
         Sec. 546.0157.  COMMUNITY-BASED ORGANIZATION MATCHING
  CONTRIBUTION REQUIRED.  To receive a grant under this subchapter, a
  community-based organization must at least partially match the
  state grant with money or other resources obtained from a
  nongovernmental entity, from a local government, or if the
  community-based organization is a local government, from fees or
  taxes collected by the local government. The community-based
  organization may then combine the money or resources the
  organization obtains from a variety of federal, state, local, or
  private sources to accomplish the proposal's purpose.  (Gov. Code,
  Sec. 531.02481(g) (part).)
         Sec. 546.0158.  PROPOSALS INVOLVING MULTIPLE
  COMMUNITY-BASED ORGANIZATIONS.  (a)  If a combination of
  community-based organizations makes a proposal, the organizations
  must designate a single organization to receive and administer the
  grant.
         (b)  If a community-based organization receives a grant on
  behalf of a combination of community-based organizations or if the
  community-based organization's proposal involves coordination with
  other entities to accomplish the proposal's purpose, the commission
  may condition receipt of the grant on the organization's making a
  good faith effort to coordinate with other entities in the manner
  indicated in the proposal.  (Gov. Code, Sec. 531.02481(g) (part).)
         Sec. 546.0159.  GUIDELINES.  The commission may adopt
  guidelines for proposals.  (Gov. Code, Sec. 531.02481(g) (part).)
         Sec. 546.0160.  CERTAIN AGENCIES' DUTY TO PROVIDE RESOURCES
  AND ASSISTANCE.  At the commission's request, a health and human
  services agency shall provide resources and assistance to a
  community as necessary to perform the commission's duties under
  Section 546.0152(a).  (Gov. Code, Sec. 531.02481(b).)
  SUBCHAPTER E.  PERMANENCY PLANNING
         Sec. 546.0201.  DEFINITIONS. In this subchapter:
               (1)  "Child" means an individual with a developmental
  disability who is younger than 22 years of age.
               (2)  "Community resource coordination group" means a
  coordination group established under the memorandum of
  understanding adopted under Subchapter D, Chapter 522.
               (3)  "Department" means the Department of Family and
  Protective Services.
               (4)  "Institution" means:
                     (A)  an ICF-IID;
                     (B)  a group home operated under the commission's
  authority, including a residential service provider under a Section
  1915(c) waiver program that provides services at a residence other
  than the child's home or agency foster home;
                     (C)  a nursing facility;
                     (D)  a general residential operation for children
  with an intellectual disability that the commission licenses; or
                     (E)  another residential arrangement other than a
  foster home that provides care to four or more children who are
  unrelated to each other.
               (5)  "Permanency planning" means a philosophy and
  planning process that focuses on the outcome of family support by
  facilitating a permanent living arrangement with the primary
  feature of an enduring and nurturing parental relationship.  (Gov.
  Code, Sec. 531.151; New.)
         Sec. 546.0202.  POLICY STATEMENT. It is the policy of this
  state to strive to ensure that the basic needs for safety, security,
  and stability are met for each child in this state. A successful
  family is the most efficient and effective way to meet those needs.  
  This state and local communities must work together to provide
  encouragement and support for well-functioning families and ensure
  that each child receives the benefits of being a part of a
  successful permanent family as soon as possible. (Gov. Code, Sec.
  531.152.)
         Sec. 546.0203.  DEVELOPMENT OF PERMANENCY PLAN PROCEDURES.
  (a)  To further the policy stated in Section 546.0202 and except as
  provided by Subsection (b), the commission and each appropriate
  health and human services agency shall develop procedures to ensure
  that a permanency plan is developed for each child:
               (1)  who resides in an institution in this state on a
  temporary or long-term basis; or
               (2)  with respect to whom the commission or appropriate
  health and human services agency is notified in advance that
  institutional care is sought.
         (b)  The department shall develop a permanency plan as
  required by this subchapter for each child who resides in an
  institution in this state for whom the department has been
  appointed permanent managing conservator. The department is not
  required to develop a permanency plan under this subchapter for a
  child for whom the department has been appointed temporary managing
  conservator, but may incorporate the requirements of this
  subchapter in a permanency plan developed for the child under
  Section 263.3025, Family Code.
         (c)  In developing procedures under Subsection (a), the
  commission and other appropriate health and human services agencies
  shall develop to the extent possible uniform procedures applicable
  to each of the agencies and each child who is the subject of a
  permanency plan that promote efficiency for the agencies and
  stability for each child.
         (d)  In implementing permanency planning procedures, the
  commission shall:
               (1)  delegate the commission's duty to develop a
  permanency plan to a local intellectual and developmental
  disability authority or enter into a memorandum of understanding
  with the local intellectual and developmental disability authority
  to develop the permanency plan for each child who resides in an
  institution in this state or with respect to whom the commission is
  notified in advance that institutional care is sought;
               (2)  contract with a private entity, other than an
  entity that provides long-term institutional care, to develop a
  permanency plan for a child who resides in an institution in this
  state or with respect to whom the commission is notified in advance
  that institutional care is sought; or
               (3)  perform the commission's duties regarding
  permanency planning procedures using commission personnel.
         (e)  A contract or memorandum of understanding under
  Subsection (d) must include performance measures by which the
  commission may evaluate the effectiveness of permanency planning
  efforts of a local intellectual and developmental disability
  authority or a private entity.
         (f)  In implementing permanency planning procedures, the
  commission shall engage in appropriate activities in addition to
  those required by Subsection (d) to minimize the potential
  conflicts of interest that, in developing the plan, may exist or
  arise between:
               (1)  the institution in which the child resides or in
  which institutional care is sought for the child; and
               (2)  the best interest of the child.
         (g)  The commission and the department may solicit and accept
  gifts, grants, and donations to support the development of
  permanency plans for children residing in institutions by
  individuals or organizations not employed by or affiliated with
  those institutions.
         (h)  A health and human services agency that contracts with a
  private entity under Subsection (d) to develop a permanency plan
  shall ensure that the entity is provided:
               (1)  training regarding the permanency planning
  philosophy described by Section 546.0201; and
               (2)  available resources that will assist a child
  residing in an institution in making a successful transition to a
  community-based residence. (Gov. Code, Sec. 531.153.)
         Sec. 546.0204.  PERMANENCY PLANNING FOR CERTAIN CHILDREN.
  (a) Notwithstanding Section 546.0201, in this section,
  "institution" has the meaning assigned by Section 242.002, Health
  and Safety Code.
         (b)  The commission and each appropriate health and human
  services agency shall develop procedures to ensure that permanency
  planning is provided for each child:
               (1)  residing in an institution in this state on a
  temporary or long-term basis; or
               (2)  for whom institutional care is sought.  (Gov.
  Code, Secs. 531.0245(a), (b)(1).)
         Sec. 546.0205.  INSTITUTION TO ASSIST WITH PERMANENCY
  PLANNING EFFORTS. An institution in which a child resides shall
  assist with providing effective permanency planning for the child
  by:
               (1)  cooperating with the health and human services
  agency, local intellectual and developmental disability authority,
  or private entity responsible for developing the child's permanency
  plan; and
               (2)  participating in meetings to review the child's
  permanency plan as requested by a health and human services agency,
  local intellectual and developmental disability authority, or
  private entity responsible for developing the child's permanency
  plan. (Gov. Code, Sec. 531.1531.)
         Sec. 546.0206.  IMPLEMENTATION SYSTEM: LOCAL PERMANENCY
  PLANNING SITES. The commission shall develop an implementation
  system that initially consists of four or more local sites and that
  is designed to coordinate planning for a permanent living
  arrangement and relationship for a child with a family. In
  developing the system, the commission shall:
               (1)  include criteria to identify children who need
  permanency plans;
               (2)  require the establishment of a permanency plan for
  each child who resides outside the child's family or for whom care
  or protection is sought in an institution;
               (3)  include a process to determine the agency or
  entity responsible for developing and overseeing implementation of
  a child's permanency plan;
               (4)  identify, blend, and use funds from all available
  sources to provide customized services and programs to implement a
  child's permanency plan;
               (5)  clarify and expand the role of a local community
  resource coordination group in ensuring accountability for a child
  who resides in an institution or who is at risk of being placed in an
  institution;
               (6)  require reporting of each placement or potential
  placement of a child in an institution or other living arrangement
  outside of the child's home; and
               (7)  assign in each local permanency planning site area
  a single gatekeeper for all children in the area for whom placement
  in an institution through a state-funded program is sought with
  authority to ensure that:
                     (A)  family members of each child are aware of:
                           (i)  intensive services that could prevent
  placement of the child in an institution; and
                           (ii)  available placement options; and
                     (B)  permanency planning is initiated for each
  child. (Gov. Code, Sec. 531.158.)
         Sec. 546.0207.  DESIGNATION OF VOLUNTEER ADVOCATE. (a)  The
  commission shall designate an individual, including a member of a
  community-based organization, to serve as a volunteer advocate for
  a child residing in an institution to assist in developing a
  permanency plan for the child if:
               (1)  the child's parent or guardian requests the
  assistance of an advocate;
               (2)  the institution in which the child is placed
  cannot locate the child's parent or guardian; or
               (3)  the child resides in an institution the commission
  operates.
         (b)  The individual designated to serve as the child's
  volunteer advocate may be:
               (1)  an individual the child's parent or guardian
  selects, except that the individual may not be employed by or under
  a contract with the institution in which the child resides;
               (2)  an adult relative of the child; or
               (3)  a child advocacy group representative.
         (c)  The commission shall provide to each individual
  designated to serve as a child's volunteer advocate information
  regarding permanency planning under this subchapter.  (Gov. Code,
  Sec. 531.156.)
         Sec. 546.0208.  PREADMISSION NOTICE AND INFORMATION. (a)  
  The requirements of this section do not apply to a request to place
  a child in an institution if the child:
               (1)  is involved in an emergency situation, as defined
  by rules the executive commissioner adopts; or
               (2)  has been committed to an institution under:
                     (A)  Chapter 46B, Code of Criminal Procedure; or
                     (B)  Chapter 55, Family Code.
         (b)  The executive commissioner by rule shall develop and
  implement a system by which the commission ensures that, for each
  child with respect to whom the commission or a local intellectual
  and developmental disability authority is notified of a request for
  placement in an institution, the child's parent or guardian is
  fully informed before the child is placed in the institution of all
  community-based services and any other service and support options
  for which the child may be eligible. The system must be designed to
  ensure that the commission provides the information through:
               (1)  a local intellectual and developmental disability
  authority;
               (2)  any private entity that has knowledge and
  expertise regarding the needs of and full spectrum of care options
  available to children with disabilities as well as the philosophy
  and purpose of permanency planning; or
               (3)  a commission employee.
         (c)  The commission shall develop comprehensive information
  consistent with the policy stated in Section 546.0202 to explain to
  a parent or guardian considering placing a child in an institution:
               (1)  options for community-based services;
               (2)  the benefits to the child of residing in a family
  or community setting;
               (3)  that the child's placement in an institution is
  considered temporary in accordance with Section 546.0215; and
               (4)  that an ongoing permanency planning process is
  required under this subchapter and other state law.
         (d)  An institution in which a child's parent or guardian is
  considering placing the child may provide the information required
  under Subsection (b), but the information must also be provided by a
  local intellectual and developmental disability authority, private
  entity, or employee of the commission as required by that
  subsection.
         (e)  Except as otherwise provided by this subsection and
  Subsection (a), the commission shall ensure that, not later than
  the 14th working day after the date the commission is notified of a
  request for a child's placement in an institution, the child's
  parent or guardian is provided the information described by
  Subsections (b) and (c). The commission may provide the information
  after the 14th working day after the date the commission is notified
  of the request if the child's parent or guardian waives the
  requirement that the information be provided within the period
  otherwise required by this subsection. (Gov. Code, Sec. 531.1521.)
         Sec. 546.0209.  REQUIREMENTS OF PARENT OR GUARDIAN ON
  CHILD'S ADMISSION TO CERTAIN INSTITUTIONS. On the admission of a
  child to an institution described by Section 546.0201(4)(A), (B),
  or (D), the commission shall require the child's parent or guardian
  to submit:
               (1)  an admission form that includes:
                     (A)  the parent's or guardian's:
                           (i)  name, address, and telephone number;
                           (ii)  driver's license number and state of
  issuance or personal identification card number the Department of
  Public Safety issued; and
                           (iii)  place of employment and the
  employer's address and telephone number; and
                     (B)  the name, address, and telephone number of a
  relative of the child or other individual whom the commission or
  institution may contact in an emergency, a statement indicating the
  relation between that individual and the child, and at the parent's
  or guardian's option:
                           (i)  that individual's driver's license
  number and state of issuance or personal identification card number
  the Department of Public Safety issued; and
                           (ii)  the name, address, and telephone
  number of that individual's employer; and
               (2)  a signed acknowledgment of responsibility stating
  that the parent or guardian agrees to:
                     (A)  notify the institution in which the child is
  placed of any changes to the information submitted under
  Subdivision (1)(A); and
                     (B)  make reasonable efforts to participate in the
  child's life and in planning activities for the child. (Gov. Code,
  Sec. 531.1533.)
         Sec. 546.0210.  DUTIES OF CERTAIN INSTITUTIONS:
  NOTIFICATION REQUIREMENTS AND PARENT OR GUARDIAN ACCOMMODATIONS.
  (a)  This section applies only to an institution described by
  Section 546.0201(4)(A), (B), or (D).
         (b)  An institution described by Section 546.0201(4)(A) or
  (B) shall notify the local intellectual and developmental
  disability authority for the region in which the institution is
  located of a request for a child's placement in the institution. An
  institution described by Section 546.0201(4)(D) shall notify the
  commission of a request for a child's placement in the institution.
         (c)  An institution must make reasonable accommodations to
  promote the participation of the parent or guardian of a child
  residing in the institution in all planning and decision-making
  regarding the child's care, including participation in:
               (1)  the initial development of the child's permanency
  plan and periodic review of the plan;
               (2)  an annual review and reauthorization of the
  child's service plan;
               (3)  routine interdisciplinary team meetings;
               (4)  decision-making regarding the child's medical
  care; and
               (5)  decision-making and other activities involving
  the child's health and safety.
         (d)  Reasonable accommodations that an institution must make
  include:
               (1)  conducting a meeting in person or by telephone, as
  mutually agreed upon by the institution and the parent or guardian;
               (2)  conducting a meeting at a time and, if the meeting
  is in person, at a location that is mutually agreed upon by the
  institution and the parent or guardian;
               (3)  if a parent or guardian has a disability,
  providing reasonable accommodations in accordance with the
  Americans with Disabilities Act (42 U.S.C. Section 12101 et seq.),
  including providing an accessible meeting location or a sign
  language interpreter, as applicable; and
               (4)  providing a language interpreter, if applicable.
         (e)  Except as otherwise provided by Subsection (f):
               (1)  an ICF-IID must:
                     (A)  attempt to notify the parent or guardian of a
  child who resides in the ICF-IID in writing of a periodic permanency
  planning meeting or annual service plan review and reauthorization
  meeting not later than the 21st day before the date the meeting is
  scheduled to be held; and
                     (B)  request a response from the parent or
  guardian; and
               (2)  a nursing facility must:
                     (A)  attempt to notify the parent or guardian of a
  child who resides in the facility in writing of an annual service
  plan review and reauthorization meeting not later than the 21st day
  before the date the meeting is scheduled to be held; and
                     (B)  request a response from the parent or
  guardian.
         (f)  If an emergency situation involving a child residing in
  an ICF-IID or nursing facility occurs, the ICF-IID or nursing
  facility, as applicable, must:
               (1)  attempt to notify the child's parent or guardian as
  soon as possible; and
               (2)  request a response from the parent or guardian.
         (g)  If a child's parent or guardian does not respond to the
  notice provided under Subsection (e) or (f), the ICF-IID or nursing
  facility, as applicable, must attempt to locate the parent or
  guardian by contacting another individual whose information was
  provided by the parent or guardian under Section 546.0209(1)(B).
         (h)  Not later than the 30th day after the date an ICF-IID or
  nursing facility determines that the ICF-IID or nursing facility is
  unable to locate a child's parent or guardian for participation in
  activities listed under Subsection (e)(1) or (2), the ICF-IID or
  nursing facility must notify the commission of that determination
  and request that the commission initiate a search for the child's
  parent or guardian. (Gov. Code, Sec. 531.164.)
         Sec. 546.0211.  NOTIFICATION OF PLACEMENT REQUIRED. (a)  
  Not later than the third day after the date a child is initially
  placed in an institution, the institution shall notify:
               (1)  the commission, if the child is placed in a nursing
  facility;
               (2)  the local intellectual and developmental
  disability authority for the region in which the institution is
  located, if the child:
                     (A)  is placed in an ICF-IID; or
                     (B)  is placed by a child protective services
  agency in a general residential operation for children with an
  intellectual disability that the commission licenses;
               (3)  the community resource coordination group in the
  county of residence of the child's parent or guardian;
               (4)  if the child is at least three years of age, the
  school district for the area in which the institution is located;
  and
               (5)  if the child is less than three years of age, the
  local early childhood intervention program for the area in which
  the institution is located.
         (b)  The commission shall notify the local intellectual and
  developmental disability authority of a child's placement in a
  nursing facility if the child is known or suspected to have an
  intellectual disability or another disability for which the child
  may receive services through the commission. (Gov. Code, Sec.
  531.154.)
         Sec. 546.0212.  NOTICE TO PARENT OR GUARDIAN REGARDING
  PLACEMENT OPTIONS AND SERVICES. Each entity receiving notice of a
  child's initial placement in an institution under Section 546.0211
  may contact the child's parent or guardian to ensure that the parent
  or guardian is aware of:
               (1)  services and support that could provide
  alternatives to placing the child in the institution;
               (2)  available placement options; and
               (3)  opportunities for permanency planning. (Gov.
  Code, Sec. 531.155.)
         Sec. 546.0213.  PLACEMENT ON WAIVER PROGRAM WAITING LIST. A
  state agency that receives notice of a child's placement in an
  institution shall ensure that, on or before the third day after the
  date the agency is notified of the child's placement in the
  institution, the child is also placed on a waiting list for Section
  1915(c) waiver program services appropriate to the child's needs.
  (Gov. Code, Sec. 531.157.)
         Sec. 546.0214.  INTERFERENCE WITH PERMANENCY PLANNING
  EFFORTS. An entity that provides information to a child's parent or
  guardian relating to permanency planning shall refrain from
  providing the child's parent or guardian with inaccurate or
  misleading information regarding the risks of moving the child to
  another facility or community setting. (Gov. Code, Sec. 531.1532.)
         Sec. 546.0215.  INITIAL PLACEMENT OF CHILD IN INSTITUTION
  AND PLACEMENT EXTENSIONS. (a) The chief executive officer of each
  appropriate health and human services agency or the officer's
  designee must approve a child's placement in an institution.  The
  child's initial placement in the institution is temporary and may
  not exceed six months unless the appropriate chief executive
  officer or the officer's designee approves an extension of an
  additional six months after conducting a review of documented
  permanency planning efforts to unite the child with a family in a
  permanent living arrangement.
         (b)  After the initial six-month extension of a child's
  placement in an institution approved under Subsection (a), the
  chief executive officer or the officer's designee shall conduct a
  review of the child's placement in the institution at least
  semiannually to determine whether continuing that placement is
  warranted.  If, based on the review, the chief executive officer or
  the officer's designee determines that an additional extension is
  warranted, the officer or the officer's designee shall recommend to
  the executive commissioner that the child continue residing in the
  institution.
         (c)  On receipt of a recommendation made under Subsection
  (b), the executive commissioner, the executive commissioner's
  designee, or another person with whom the commission contracts
  shall conduct a review of the child's placement.  Based on the
  results of the review, the executive commissioner or the executive
  commissioner's designee may approve a six-month extension of the
  child's placement if the extension is appropriate.
         (d)  A child may continue residing in an institution after
  the six-month extension approved under Subsection (c) only if the
  chief executive officer of the appropriate health and human
  services agency or the officer's designee makes subsequent
  recommendations as provided by Subsection (b) for each additional
  six-month extension and the executive commissioner or the executive
  commissioner's designee approves each extension as provided by
  Subsection (c). (Gov. Code, Secs. 531.159(b), (c), (d).)
         Sec. 546.0216.  REVIEW OF CERTAIN PLACEMENT DATA. (a)  The
  executive commissioner or the executive commissioner's designee
  shall conduct a semiannual review of data received from health and
  human services agencies regarding all children who reside in
  institutions in this state.
         (b)  The executive commissioner, the executive
  commissioner's designee, or a person with whom the commission
  contracts shall also review the recommendations of the chief
  executive officer of each appropriate health and human services
  agency or the officer's designee if the officer or the officer's
  designee repeatedly recommends that children continue residing in
  an institution. (Gov. Code, Sec. 531.159(e).)
         Sec. 546.0217.  PROCEDURES FOR PLACEMENT REVIEWS. The
  executive commissioner by rule shall develop procedures for
  conducting the reviews required by Sections 546.0215(c) and (d) and
  546.0216. (Gov. Code, Sec. 531.159(f) (part).)
         Sec. 546.0218.  ANNUAL REAUTHORIZATION OF PLANS OF CARE FOR
  CERTAIN CHILDREN. (a)  The executive commissioner shall adopt
  rules under which the commission requires a nursing facility in
  which a child resides to request from the child's parent or guardian
  a written reauthorization of the child's plan of care.
         (b)  The rules must require that the written reauthorization
  be requested annually. (Gov. Code, Sec. 531.1591.)
         Sec. 546.0219.  TRANSFER OF CHILD BETWEEN INSTITUTIONS. (a)
  This section applies only to an institution described by Section
  546.0201(4)(A), (B), or (D) in which a child resides.
         (b)  Before transferring a child who is 17 years of age or
  younger, or a child who is at least 18 years of age and for whom a
  guardian has been appointed, from one institution to another
  institution, the institution in which the child resides must
  attempt to obtain consent for the transfer from the child's parent
  or guardian unless the transfer is in response to an emergency
  situation, as defined by rules the executive commissioner adopts.
  (Gov. Code, Sec. 531.166.)
         Sec. 546.0220.  COMPLIANCE WITH PERMANENCY PLAN
  REQUIREMENTS AS PART OF INSPECTION, SURVEY, OR INVESTIGATION. As
  part of each inspection, survey, or investigation of an
  institution, including a nursing facility, a general residential
  operation for children with an intellectual disability that the
  commission licenses, or an ICF-IID, in which a child resides, the
  agency or the agency's designee shall determine the extent to which
  the nursing facility, general residential operation, or ICF-IID is
  complying with the permanency planning requirements under this
  subchapter. (Gov. Code, Sec. 531.160.)
         Sec. 546.0221.  SEARCH FOR CHILD'S PARENT OR GUARDIAN. (a)  
  The commission shall develop and implement a process by which the
  commission, on receipt of notification under Section 546.0210(h)
  that a child's parent or guardian cannot be located, conducts a
  search for the parent or guardian. If, on the first anniversary of
  the date the commission receives the notification under that
  subsection, the commission has been unsuccessful in locating the
  parent or guardian, the commission shall refer the case to:
               (1)  the department's child protective services
  division if the child is 17 years of age or younger; or
               (2)  the department's adult protective services
  division if the child is 18 years of age or older.
         (b)  On receipt of a referral under Subsection (a)(1), the
  department's child protective services division shall exercise
  intense due diligence in attempting to locate the child's parent or
  guardian. If the division is unable to locate the child's parent or
  guardian, the department shall file a suit affecting the
  parent-child relationship requesting an order appointing the
  department as the child's temporary managing conservator.
         (c)  A child is considered abandoned for purposes of the
  Family Code if the child's parent or guardian cannot be located
  following the department's exercise of intense due diligence in
  attempting to locate the parent or guardian.
         (d)  On receipt of a referral under Subsection (a)(2), the
  department's adult protective services division shall notify the
  court that appointed the child's guardian that the guardian cannot
  be located. (Gov. Code, Sec. 531.165.)
         Sec. 546.0222.  DOCUMENTATION OF ONGOING PERMANENCY
  PLANNING EFFORTS. The commission and each appropriate health and
  human services agency shall require a person who develops a
  permanency plan for a child residing in an institution to identify
  and document in the child's permanency plan all ongoing permanency
  planning efforts at least semiannually to ensure that, as soon as
  possible, the child will benefit from a permanent living
  arrangement with an enduring and nurturing parental relationship.
  (Gov. Code, Sec. 531.159(a).)
         Sec. 546.0223.  ACCESS TO RECORDS. Each institution in
  which a child resides shall allow the following to have access to
  the child's records to assist in complying with the requirements of
  this subchapter:
               (1)  the commission;
               (2)  appropriate health and human services agencies;
  and
               (3)  to the extent not otherwise prohibited by state or
  federal confidentiality laws, a local intellectual and
  developmental disability authority or private entity that enters
  into a contract or memorandum of understanding under Section
  546.0203(d) to develop a permanency plan for the child. (Gov. Code,
  Sec. 531.161.)
         Sec. 546.0224.  COLLECTION OF INFORMATION REGARDING
  INVOLVEMENT OF CERTAIN PARENTS AND GUARDIANS. (a) The commission
  shall collect and maintain aggregate information regarding the
  involvement of parents and guardians of children residing in
  institutions described by Sections 546.0201(4)(A), (B), and (D) in
  the lives of and planning activities relating to those children.
  The commission shall obtain input from stakeholders concerning the
  types of information most useful in assessing the involvement of
  those parents and guardians.
         (b)  The commission shall make the aggregate information
  available to the public on request. (Gov. Code, Sec. 531.167.)
         Sec. 546.0225.  REPORTING SYSTEMS: SEMIANNUAL REPORTING.
  (a) For each of the local permanency planning sites, the commission
  shall develop a reporting system under which each appropriate
  health and human services agency responsible for permanency
  planning under this subchapter is required to semiannually provide
  to the commission:
               (1)  the number of permanency plans the agency develops
  for children residing in institutions or children at risk of being
  placed in institutions;
               (2)  progress achieved in implementing permanency
  plans;
               (3)  the number of children the agency serves residing
  in institutions;
               (4)  the number of children the agency serves at risk of
  being placed in an institution served by the local permanency
  planning sites;
               (5)  the number of children the agency serves reunited
  with their families or placed with alternate permanent families;
  and
               (6)  cost data related to developing and implementing
  permanency plans.
         (b)  The executive commissioner shall submit to the governor
  and the committees of the senate and the house of representatives
  having primary jurisdiction over health and human services agencies
  a semiannual report on:
               (1)  the number of children residing in institutions in
  this state and the number of those children for whom a
  recommendation has been made for a transition to a community-based
  residence but who have not yet made that transition;
               (2)  the circumstances of each child described by
  Subdivision (1), including the type of institution and name of the
  institution in which the child resides, the child's age, the
  residence of the child's parents or guardians, and the length of
  time during which the child has resided in the institution;
               (3)  the number of permanency plans developed for
  children residing in institutions in this state, progress achieved
  in implementing those plans, and barriers to implementing those
  plans;
               (4)  the number of children who previously resided in
  an institution in this state and have made the transition to a
  community-based residence;
               (5)  the number of children who previously resided in
  an institution in this state and have been reunited with their
  families or placed with alternate families;
               (6)  the community supports that resulted in the
  successful placement of children described by Subdivision (5) with
  alternate families; and
               (7)  the community supports that are unavailable but
  necessary to address the needs of children who continue to reside in
  an institution in this state after being recommended to make a
  transition from the institution to an alternate family or
  community-based residence. (Gov. Code, Sec. 531.162.)
         Sec. 546.0226.  EFFECT ON OTHER LAW. This subchapter does
  not affect responsibilities imposed by federal or other state law
  on a physician or other professional. (Gov. Code, Sec. 531.163.)
  SUBCHAPTER F. FAMILY-BASED ALTERNATIVES FOR CHILDREN
         Sec. 546.0251.  DEFINITIONS. In this subchapter:
               (1)  "Child" means an individual younger than 22 years
  of age who:
                     (A)  has a physical or developmental disability;
  or
                     (B)  is medically fragile.
               (2)  "Family-based alternative" means a family setting
  in which the family provider or providers are specially trained to
  provide support and in-home care to children with disabilities or
  children who are medically fragile.
               (3)  "Family-based alternatives system" means the
  system of family-based alternatives required under this
  subchapter.
               (4)  "Institution" means any congregate care facility,
  including:
                     (A)  a nursing facility;
                     (B)  an ICF-IID;
                     (C)  a group home operated by the commission; and
                     (D)  a general residential operation for children
  with an intellectual disability that the commission licenses.
               (5)  "Waiver services" means services provided under:
                     (A)  the medically dependent children (MDCP)
  waiver program;
                     (B)  the community living assistance and support
  services (CLASS) waiver program;
                     (C)  the home and community-based services (HCS)
  waiver program;
                     (D)  the deaf-blind with multiple disabilities
  (DBMD) waiver program; and
                     (E)  any other Section 1915(c) waiver program that
  provides long-term care services to children. (Gov. Code, Sec.
  531.060(c); New.)
         Sec. 546.0252.  FAMILY-BASED ALTERNATIVES SYSTEM: PURPOSE,
  IMPLEMENTATION, AND ADMINISTRATION. (a) The purpose of the
  family-based alternatives system is to further this state's policy
  of providing for a child's basic needs for safety, security, and
  stability by ensuring that a child becomes a part of a successful
  permanent family as soon as possible.
         (b)  In achieving the purpose described by Subsection (a),
  the family-based alternatives system is intended to operate in a
  manner that recognizes that parents are a valued and integral part
  of the process established under the system. The system must:
               (1)  encourage parents to participate in all decisions
  affecting their children; and
               (2)  respect the authority of parents, other than
  parents whose parental rights have been terminated, to make
  decisions regarding their children.
         (c)  The commission shall begin implementing the
  family-based alternatives system in areas of this state with high
  numbers of children who reside in institutions.
         (d)  The family-based alternatives system may be
  administered in cooperation with public and private entities. (Gov.
  Code, Secs. 531.060(a), (b), (f), (h).)
         Sec. 546.0253.  FAMILY-BASED ALTERNATIVES SYSTEM DESIGN
  REQUIREMENTS. (a)  The family-based alternatives system must
  provide for:
               (1)  recruiting and training alternative families to
  provide services for children;
               (2)  comprehensively assessing each child in need of
  services and each alternative family available to provide services,
  as necessary to identify the most appropriate alternative family
  for the child's placement;
               (3)  providing to a child's parents or guardian
  information regarding the availability of a family-based
  alternative;
               (4)  identifying each child residing in an institution
  and offering support services, including waiver services, that
  would enable the child to return to the child's birth family or be
  placed in a family-based alternative; and
               (5)  determining through a child's permanency plan
  other circumstances in which the child must be offered waiver
  services, including circumstances in which changes in an
  institution's status affect the child's placement or the quality of
  services the child receives.
         (b)  In complying with the requirement imposed by Subsection
  (a)(3), the commission shall ensure that the procedures for
  providing information to parents or a guardian permit and encourage
  the participation of an individual who is not affiliated with the
  institution in which the child resides or with an institution in
  which the child could be placed.
         (c)  In designing the family-based alternatives system, the
  commission shall consider and, when appropriate, incorporate
  current research and recommendations developed by other public and
  private entities involved in analyzing public policy relating to
  children residing in institutions. (Gov. Code, Secs. 531.060(i),
  (j), (m).)
         Sec. 546.0254.  MEDICAID WAIVER PROGRAM ALIGNMENT. As
  necessary to implement this subchapter, the commission shall:
               (1)  ensure that an appropriate number of openings for
  waiver services that become available as a result of funding for
  transferring individuals with disabilities into community-based
  services are made available to both children and adults;
               (2)  ensure that service definitions applicable to
  waiver services are modified as necessary to permit the provision
  of waiver services through family-based alternatives;
               (3)  ensure that procedures are implemented for making
  a level of care determination for each child and identifying the
  most appropriate waiver service for the child, including procedures
  under which the commission's director of long-term care, after
  considering any preference of the child's birth family or
  alternative family, resolves disputes among agencies about the most
  appropriate waiver service; and
               (4)  require that the health and human services agency
  responsible for providing a specific waiver service to a child also
  assume responsibility for identifying any necessary transition
  activities or services. (Gov. Code, Sec. 531.060(n).)
         Sec. 546.0255.  COMMUNITY ORGANIZATION ELIGIBILITY;
  CONTRACT AND REQUIREMENTS. (a)  The commission shall contract with
  a community organization, including a faith-based community
  organization, or a nonprofit organization to develop and implement
  a family-based alternatives system under which a child who cannot
  reside with the child's birth family may receive necessary services
  in a family-based alternative instead of an institution. For
  purposes of this subsection, a community organization, including a
  faith-based community organization, or a nonprofit organization
  does not include:
               (1)  a governmental entity; or
               (2)  a quasi-governmental entity to which a state
  agency delegates authority and responsibility for planning,
  supervising, providing, or ensuring the provision of state
  services.
         (b)  To be eligible for the contract under Subsection (a), an
  organization must possess knowledge regarding the support needs of
  children with disabilities and their families.
         (c)  The contracted organization may subcontract for one or
  more components of implementing the family-based alternatives
  system with:
               (1)  community organizations, including faith-based
  community organizations;
               (2)  nonprofit organizations;
               (3)  governmental entities; or
               (4)  quasi-governmental entities described by
  Subsection (a)(2). (Gov. Code, Secs. 531.060(d), (e).)
         Sec. 546.0256.  PLACEMENT OPTIONS.  (a)  In placing a child
  in a family-based alternative, the family-based alternatives
  system may use a variety of placement options, including a shared
  parenting arrangement between the alternative family and the
  child's birth family.  Regardless of the option used, a
  family-based alternative placement must be designed as a long-term
  arrangement, except in cases in which the child's birth family
  chooses to return the child to their home.
         (b)  Adoption of the child by the child's alternative family
  is an available option in cases in which the child's birth family's
  parental rights have been terminated. (Gov. Code, Sec. 531.060(k).)
         Sec. 546.0257.  AGENCY COOPERATION.  Each affected health
  and human services agency shall:
               (1)  cooperate with the contracted organization and any
  subcontractors; and
               (2)  take all action necessary to implement the
  family-based alternatives system and comply with the requirements
  of this subchapter.  (Gov. Code, Sec. 531.060(g) (part).)
         Sec. 546.0258.  DISPUTE RESOLUTION. The commission has
  final authority to make any decisions and resolve any disputes
  regarding the family-based alternatives system. (Gov. Code, Sec.
  531.060(g) (part).)
         Sec. 546.0259.  GIFTS, GRANTS, AND DONATIONS.  The
  commission or the contracted organization may solicit and accept
  gifts, grants, and donations to support the family-based
  alternatives system's functions under this subchapter. (Gov. Code,
  Sec. 531.060(l).)
         Sec. 546.0260.  ANNUAL REPORT. Not later than January 1 of
  each year, the commission shall report to the legislature on the
  implementation of the family-based alternatives system.  The report
  must include a statement of:
               (1)  the number of children currently receiving care in
  an institution;
               (2)  the number of children placed in a family-based
  alternative under the system during the preceding year;
               (3)  the number of children who left an institution
  during the preceding year under an arrangement other than a
  family-based alternative under the system or for another reason
  unrelated to the availability of a family-based alternative under
  the system;
               (4)  the number of children waiting for an available
  placement in a family-based alternative under the system; and
               (5)  the number of alternative families trained and
  available to accept placement of a child under the system. (Gov.
  Code, Sec. 531.060(o).)
  SUBCHAPTER G. LONG-TERM CARE INSTITUTIONS AND FACILITIES
         Sec. 546.0301.  PROCEDURES TO REVIEW CONDUCT RELATED TO
  CERTAIN INSTITUTIONS AND FACILITIES. The commission shall adopt
  procedures to review:
               (1)  citations or penalties assessed for a violation of
  a rule or law against an institution or facility licensed under
  Chapter 242, 247, or 252, Health and Safety Code, or certified to
  participate in Medicaid administered in accordance with Chapter 32,
  Human Resources Code, considering:
                     (A)  the number of violations by geographic
  region;
                     (B)  the patterns of violations in each region;
  and
                     (C)  the outcomes following the assessment of a
  citation or penalty; and
               (2)  the performance of duties by employees and agents
  of a state agency responsible for licensing, inspecting, surveying,
  or investigating institutions and facilities licensed under
  Chapter 242, 247, or 252, Health and Safety Code, or certified to
  participate in Medicaid administered in accordance with Chapter 32,
  Human Resources Code, related to:
                     (A)  complaints the commission receives; or
                     (B)  any standards or rules violated by an
  employee or agent of a state agency. (Gov. Code, Sec. 531.056.)
         Sec. 546.0302.  ISSUANCE OF MATERIALS TO CERTAIN LONG-TERM
  CARE FACILITIES.  The executive commissioner shall:
               (1)  review the commission's methods for issuing
  informational letters, policy updates, policy clarifications, and
  other related materials to an entity licensed under Chapter 103,
  Human Resources Code, or Chapter 242, 247, 248A, or 252, Health and
  Safety Code; and
               (2)  develop and implement more efficient methods to
  issue those materials, as appropriate. (Gov. Code, Sec. 531.0585.)
  SUBCHAPTER H. INCENTIVE PAYMENT PROGRAM FOR CERTAIN NURSING
  FACILITIES
         Sec. 546.0351.  DEFINITIONS.  In this subchapter:
               (1)  "Incentive payment program" means the program
  established under this subchapter.
               (2)  "Nursing facility" means a convalescent or nursing
  home or related institution licensed under Chapter 242, Health and
  Safety Code, that provides long-term care services, as defined by
  Section 22.0011, Human Resources Code, to recipients. (Gov. Code,
  Sec. 531.912(a); New.)
         Sec. 546.0352.  INCENTIVE PAYMENT PROGRAM.  (a)  If
  feasible, the executive commissioner by rule may establish an
  incentive payment program for nursing facilities that choose to
  participate. The program must be designed to improve the quality of
  care and services provided to recipients.
         (b)  Subject to Section 546.0354, the incentive payment
  program may provide incentive payments in accordance with this
  section to encourage facilities to participate in the program.
         (c)  The executive commissioner may:
               (1)  determine the amount of any incentive payment
  under the incentive payment program; and
               (2)  enter into a contract with a qualified person, as
  the executive commissioner determines, for the following services
  related to the program:
                     (A)  data collection;
                     (B)  data analysis; and
                     (C)  technical support. (Gov. Code, Secs.
  531.912(b), (e).)
         Sec. 546.0353.  COMMON PERFORMANCE MEASURES.  (a)  In
  establishing an incentive payment program, the executive
  commissioner shall adopt common performance measures to be used in
  evaluating nursing facilities that are related to structure,
  process, and outcomes that positively correlate to nursing facility
  quality and improvement. The common performance measures:
               (1)  must be:
                     (A)  recognized by the executive commissioner as
  valid indicators of the overall quality of care recipients receive;
  and
                     (B)  designed to encourage and reward
  evidence-based practices among nursing facilities; and
               (2)  may include measures of:
                     (A)  quality of care, as determined by clinical
  performance ratings published by the Centers for Medicare and
  Medicaid Services, the Agency for Healthcare Research and Quality,
  or another federal agency;
                     (B)  direct-care staff retention and turnover;
                     (C)  recipient satisfaction, including the
  satisfaction of recipients who are short-term and long-term
  facility residents, and family satisfaction, as determined by the
  Consumer Assessment of Healthcare Providers and Systems Nursing
  Home Surveys relied on by the Centers for Medicare and Medicaid
  Services;
                     (D)  employee satisfaction and engagement;
                     (E)  the incidence of preventable acute care
  emergency room services use;
                     (F)  regulatory compliance;
                     (G)  level of person-centered care; and
                     (H)  direct-care staff training, including a
  facility's use of independent distance learning programs for
  continuously training direct-care staff.
         (b)  The executive commissioner shall maximize the use of
  available information technology and limit the number of
  performance measures adopted under this section to achieve
  administrative cost efficiency and avoid an unreasonable
  administrative burden on participating nursing facilities. (Gov.
  Code, Secs. 531.912(c), (d).)
         Sec. 546.0354.  SUBJECT TO APPROPRIATIONS.  The commission
  may make incentive payments under an incentive payment program only
  if money is appropriated for that purpose. (Gov. Code, Sec.
  531.912(f).)
  SUBCHAPTER I. MEDICAID GENERALLY
         Sec. 546.0401.  MEDICAID LONG-TERM CARE SYSTEM.  (a)  The
  commission shall ensure that the Medicaid long-term care system
  provides the broadest array of choices possible for recipients
  while ensuring that the services are delivered in a manner that is
  cost-effective and makes the best use of available funds.
         (b)  The commission shall also make every effort to improve
  the quality of care for recipients of Medicaid long-term care
  services by:
               (1)  evaluating the need for expanding the provider
  base for consumer-directed services and, if the commission
  identifies a demand for that expansion, encouraging area agencies
  on aging, independent living centers, and other potential long-term
  care providers to become providers through contracts with the
  commission;
               (2)  ensuring that all recipients who reside in a
  nursing facility are provided information about end-of-life care
  options and the importance of planning for end-of-life care; and
               (3)  developing policies to encourage a recipient who
  resides in a nursing facility to receive treatment at that facility
  whenever possible, while ensuring that the recipient receives an
  appropriate continuum of care. (Gov. Code, Sec. 531.083.)
         Sec. 546.0402.  ADMINISTRATION AND DELIVERY OF CERTAIN
  WAIVER PROGRAMS; PUBLIC INPUT.  (a)  To the extent authorized by
  law, the commission shall make uniform the functions relating to
  the administration and delivery of Section 1915(c) waiver programs,
  including:
               (1)  rate-setting;
               (2)  the applicability and use of service definitions;
               (3)  quality assurance; and
               (4)  intake data elements.
         (b)  Subsection (a) does not apply to functions of a Section
  1915(c) waiver program that is operated in conjunction with a
  federally funded state Medicaid program that is authorized under
  Section 1915(b) of the Social Security Act (42 U.S.C. Section
  1396n(b)).
         (c)  The commission shall ensure that information on
  individuals seeking to obtain services from Section 1915(c) waiver
  programs is maintained in a single computerized database that is
  accessible to staff of each of the state agencies administering
  those programs.
         (d)  In complying with the requirements of this section, the
  commission shall regularly consult with and obtain input from:
               (1)  consumers and family members;
               (2)  providers;
               (3)  advocacy groups;
               (4)  state agencies that administer a Section 1915(c)
  waiver program; and
               (5)  other interested persons. (Gov. Code, Secs.
  531.0218, 531.02191.)
         Sec. 546.0403.  RECOVERY OF CERTAIN ASSISTANCE; MEDICAID
  ACCOUNT. (a)  The executive commissioner shall ensure that Section
  1917(b)(1) of the Social Security Act (42 U.S.C. Section
  1396p(b)(1)) is implemented under Medicaid.
         (b)  The Medicaid account is an account in the general
  revenue fund.  Any funds recovered by implementing the provisions
  of Section 1917(b)(1) of the Social Security Act (42 U.S.C. Section
  1396p(b)(1)) must be deposited in the Medicaid account. Money in
  the account may be appropriated only to fund long-term care,
  including community-based care and facility-based care. (Gov.
  Code, Sec. 531.077.)
  SUBCHAPTER J. MEDICAID WAIVER PROGRAMS
         Sec. 546.0451.  COMPETITIVE AND INTEGRATED EMPLOYMENT
  INITIATIVE FOR CERTAIN RECIPIENTS; BIENNIAL REPORT. (a) This
  section applies to an individual receiving services under:
               (1)  any of the following Section 1915(c) waiver
  programs:
                     (A)  the home and community-based services (HCS)
  waiver program;
                     (B)  the Texas home living (TxHmL) waiver program;
                     (C)  the deaf-blind with multiple disabilities
  (DBMD) waiver program; and
                     (D)  the community living assistance and support
  services (CLASS) waiver program; and
               (2)  the STAR+PLUS home and community-based services
  (HCBS) waiver program established under Section 1115, Social
  Security Act (42 U.S.C. Section 1315).
         (b)  The executive commissioner by rule shall develop a
  uniform process that complies with the policy adopted under Section
  546.0003 to:
               (1)  assess the goals of and competitive and integrated
  employment opportunities and related employment services available
  to an individual to whom this section applies; and
               (2)  use the identified goals and available
  opportunities and services to direct the individual's plan of care
  at the time the plan is developed or renewed.
         (c)  The entity responsible for developing and renewing the
  plan of care for an individual to whom this section applies shall
  use the uniform process developed under Subsection (b) to assess
  the individual's goals, opportunities, and services described by
  that subsection and incorporate those goals, opportunities, and
  services into the individual's plan of care.
         (d)  The executive commissioner by rule shall:
               (1)  identify strategies to increase the number of
  individuals receiving employment services from the Texas Workforce
  Commission or through the waiver program in which an individual is
  enrolled;
               (2)  determine a reasonable number of individuals who
  indicate a desire to work to receive employment services and ensure
  those individuals:
                     (A)  have received employment services during the
  state fiscal biennium ending August 31, 2023, or during the period
  beginning September 1, 2023, and ending December 31, 2023, from the
  Texas Workforce Commission or through the waiver program in which
  an individual is enrolled; or
                     (B)  are receiving employment services on
  December 31, 2023, from the Texas Workforce Commission or through
  the waiver program in which an individual is enrolled; and
               (3)  ensure each individual who indicates a desire to
  work is referred to receive employment services from the Texas
  Workforce Commission or through the waiver program in which the
  individual is enrolled.
         (e)  Not later than December 31 of each even-numbered year,
  the executive commissioner shall prepare and submit to the
  governor, lieutenant governor, speaker of the house of
  representatives, and legislature a written report that outlines:
               (1)  the number of individuals to whom this section
  applies who are receiving employment services in accordance with
  rules adopted under this section;
               (2)  whether the employment services described by
  Subdivision (1) are provided by the Texas Workforce Commission,
  through the waiver program in which an individual is enrolled, or
  both; and
               (3)  the number of individuals to whom this section
  applies who have obtained competitive and integrated employment,
  categorized by waiver program and, if applicable, an individual's
  level of care. (Gov. Code, Sec. 531.02448.)
         Sec. 546.0452.  RISK MANAGEMENT CRITERIA FOR CERTAIN WAIVER
  PROGRAMS. (a) In this section, "legally authorized
  representative" has the meaning assigned by Section 546.0101.
         (b)  The commission shall consider developing risk
  management criteria under home and community-based services waiver
  programs designed to allow individuals eligible to receive services
  under the programs to assume greater choice and responsibility over
  the services and supports the individuals receive.
         (c)  The commission shall ensure that any risk management
  criteria developed include:
               (1)  a requirement that if an individual who will be
  provided services and supports has a legally authorized
  representative, the representative is involved in determining
  which services and supports the individual will receive; and
               (2)  a requirement that if services or supports are
  declined, the decision to decline is clearly documented. (Gov.
  Code, Sec. 531.0515.)
         Sec. 546.0453.  PROTOCOL FOR MAINTAINING CONTACT
  INFORMATION OF INDIVIDUALS INTERESTED IN MEDICAID WAIVER PROGRAMS.
  The commission shall develop a protocol in the office of the
  ombudsman to improve the capture and updating of contact
  information for an individual who contacts the office of the
  ombudsman regarding Medicaid waiver programs or services. (Gov.
  Code, Sec. 531.0501(d).)
         Sec. 546.0454.  INTEREST LIST MANAGEMENT FOR CERTAIN
  MEDICAID WAIVER PROGRAMS. (a) This section applies only to the
  following waiver programs:
               (1)  the community living assistance and support
  services (CLASS) waiver program;
               (2)  the home and community-based services (HCS) waiver
  program;
               (3)  the deaf-blind with multiple disabilities (DBMD)
  waiver program;
               (4)  the Texas home living (TxHmL) waiver program;
               (5)  the medically dependent children (MDCP) waiver
  program; and
               (6)  the STAR+PLUS home and community-based services
  (HCBS) program.
         (b)  The commission, in consultation with the Intellectual
  and Developmental Disability System Redesign Advisory Committee
  established under Section 542.0052, the state Medicaid managed care
  advisory committee, and interested stakeholders, shall develop a
  questionnaire to be completed by or on behalf of an individual who
  requests to be placed on or is currently on an interest list for a
  waiver program.
         (c)  The questionnaire developed under Subsection (b) must,
  at a minimum, request the following information about an individual
  seeking or receiving services under a waiver program:
               (1)  contact information for the individual or the
  individual's parent or other legally authorized representative;
               (2)  the individual's general demographic information;
               (3)  the individual's living arrangement;
               (4)  the types of assistance the individual requires;
               (5)  the individual's current caregiver supports and
  circumstances that may cause the individual to lose those supports;
  and
               (6)  when the delivery of services under a waiver
  program should begin to ensure the individual's health and welfare
  and that the individual receives services and supports in the least
  restrictive setting possible.
         (d)  If an individual is on a waiver program's interest list
  and the individual or the individual's parent or other legally
  authorized representative does not respond to a written or verbal
  request made by the commission to update information concerning the
  individual or otherwise fails to maintain contact with the
  commission, the commission:
               (1)  shall designate the individual's status on the
  interest list as inactive until the individual or the individual's
  parent or other legally authorized representative notifies the
  commission that the individual is still interested in receiving
  services under the waiver program; and
               (2)  at the time the individual or the individual's
  parent or other legally authorized representative provides notice
  to the commission under Subdivision (1), shall designate the
  individual's status on the interest list as active and restore the
  individual to the position on the list that corresponds with the
  date the individual was initially placed on the list.
         (e)  The commission's designation of an individual's status
  on an interest list as inactive under Subsection (d) may not result
  in the removal of the individual from that list or any other waiver
  program interest list.
         (f)  Not later than September 1 of each year, the commission
  shall provide to the Intellectual and Developmental Disability
  System Redesign Advisory Committee established under Section
  542.0052, or, if that advisory committee is abolished, an
  appropriate stakeholder advisory committee, as determined by the
  executive commissioner, the number of individuals, including
  individuals whose status is designated as inactive by the
  commission, who are on an interest list to receive services under a
  waiver program. (Gov. Code, Sec. 531.06011.)
         Sec. 546.0455.  INTEREST LIST MANAGEMENT FOR CERTAIN
  CHILDREN ENROLLED IN MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER
  PROGRAM. (a) This section applies only to a child who is enrolled
  in the medically dependent children (MDCP) waiver program but
  becomes ineligible for services under the program because the child
  no longer meets:
               (1)  the level of care criteria for medical necessity
  for nursing facility care; or
               (2)  the age requirement for the program.
         (b)  A legally authorized representative of a child who is
  notified by the commission that the child is no longer eligible for
  the medically dependent children (MDCP) waiver program following a
  Medicaid fair hearing, or without a Medicaid fair hearing if the
  representative opted in writing to forgo the hearing, may request
  that the commission:
               (1)  return the child to the interest list for the
  program unless the child is ineligible due to the child's age; or
               (2)  place the child on the interest list for another
  Section 1915(c) waiver program.
         (c)  At the time a child's legally authorized representative
  makes a request under Subsection (b), the commission shall:
               (1)  for a child who becomes ineligible for the reason
  described by Subsection (a)(1), place the child:
                     (A)  on the interest list for the medically
  dependent children (MDCP) waiver program in the first position on
  the list; or
                     (B)  except as provided by Subdivision (3), on the
  interest list for another Section 1915(c) waiver program in a
  position relative to other individuals on the list that is based on
  the date the child was initially placed on the interest list for the
  medically dependent children (MDCP) waiver program;
               (2)  except as provided by Subdivision (3), for a child
  who becomes ineligible for the reason described by Subsection
  (a)(2), place the child on the interest list for another Section
  1915(c) waiver program in a position relative to other individuals
  on the list that is based on the date the child was initially placed
  on the interest list for the medically dependent children (MDCP)
  waiver program; or
               (3)  for a child who becomes ineligible for a reason
  described by Subsection (a) and who is already on an interest list
  for another Section 1915(c) waiver program, move the child to a
  position on the interest list relative to other individuals on the
  list that is based on the date the child was initially placed on the
  interest list for the medically dependent children (MDCP) waiver
  program, if that date is earlier than the date the child was
  initially placed on the interest list for the other waiver program.
         (d)  Notwithstanding Subsection (c)(1)(B) or (c)(2), a child
  may be placed on an interest list for a Section 1915(c) waiver
  program in the position described by those subsections only if the
  child has previously been placed on the interest list for that
  waiver program.
         (e)  At the time the commission provides notice to a legally
  authorized representative that a child is no longer eligible for
  the medically dependent children (MDCP) waiver program following a
  Medicaid fair hearing, or without a Medicaid fair hearing if the
  representative opted in writing to forgo the hearing, the
  commission shall inform the representative in writing about:
               (1)  the options under this section for placing the
  child on an interest list; and
               (2)  the process for applying for the Medicaid buy-in
  program for children with disabilities implemented under Section
  532.0353. (Gov. Code, Sec. 531.0601.)
         Sec. 546.0456.  ELIGIBILITY OF CERTAIN CHILDREN FOR
  MEDICALLY DEPENDENT CHILDREN (MDCP) OR DEAF-BLIND WITH MULTIPLE
  DISABILITIES (DBMD) WAIVER PROGRAM; INTEREST LIST PLACEMENT. (a)
  Notwithstanding any other law and to the extent allowed by federal
  law, in determining a child's eligibility for the medically
  dependent children (MDCP) waiver program, the deaf-blind with
  multiple disabilities (DBMD) waiver program, or a "Money Follows
  the Person" demonstration project, the commission shall consider
  whether the child:
               (1)  is diagnosed as having a condition included in the
  list of compassionate allowances conditions published by the United
  States Social Security Administration; or
               (2)  receives Medicaid hospice or palliative care
  services.
         (b)  If the commission determines a child is eligible for a
  waiver program under Subsection (a), the child's enrollment in the
  applicable program is contingent on the availability of a slot in
  the program. If a slot is not immediately available, the commission
  shall place the child in the first position on the interest list for
  the medically dependent children (MDCP) waiver program or
  deaf-blind with multiple disabilities (DBMD) waiver program, as
  applicable. (Gov. Code, Sec. 531.0603.)
  SUBCHAPTER K. MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER PROGRAM
         Sec. 546.0501.  LIMITATION ON NURSING FACILITY LEVEL OF CARE
  REQUIREMENT. To the extent allowed by federal law, the commission
  may not require that a child reside in a nursing facility for an
  extended period of time to meet the nursing facility level of care
  required for the child to be determined eligible for the medically
  dependent children (MDCP) waiver program. (Gov. Code, Sec.
  531.0604.)
         Sec. 546.0502.  CONSUMER DIRECTION OF SERVICES.
  Notwithstanding Sections 546.0102(b) and 546.0103(1), a consumer
  direction model implemented under Subchapter C, including the
  consumer-directed service option, for the delivery of services
  under the medically dependent children (MDCP) waiver program must
  allow for the delivery of all services and supports available under
  that program through consumer direction. (Gov. Code, Sec.
  531.0511.)
         Sec. 546.0503.  ASSESSMENTS AND REASSESSMENTS. (a) The
  commission shall ensure that the care coordinator for a Medicaid
  managed care organization under the STAR Kids managed care program
  provides for review the results of the initial assessment or annual
  reassessment of medical necessity to the parent or legally
  authorized representative of a recipient receiving benefits under
  the medically dependent children (MDCP) waiver program.  The
  commission shall ensure that providing the results does not delay
  the determination of the services to be provided to the recipient or
  the ability to authorize and initiate services.
         (b)  The commission shall require the signature of a parent
  or legally authorized representative to verify the parent's or
  representative's receipt of the results of the initial assessment
  or reassessment from the care coordinator.  A Medicaid managed care
  organization may not delay the delivery of care pending the
  signature.
         (c)  The commission shall provide to a parent or legally
  authorized representative who disagrees with the results of the
  initial assessment or reassessment an opportunity to request to
  dispute the results with the Medicaid managed care organization
  through a peer-to-peer review with the treating physician of
  choice.
         (d)  This section does not affect any rights of a recipient
  to appeal an initial assessment or reassessment determination
  through the Medicaid managed care organization's internal appeal
  process, the Medicaid fair hearing process, or the external medical
  review process. (Gov. Code, Sec. 531.0602.)
         Sec. 546.0504.  QUALITY MONITORING BY EXTERNAL QUALITY
  REVIEW ORGANIZATION. The commission, based on the state's external
  quality review organization's initial report on the STAR Kids
  managed care program, shall determine whether the findings of the
  report necessitate additional data and research to improve the
  program. If the commission determines additional data and research
  are needed, the commission, through the external quality review
  organization, may:
               (1)  conduct annual surveys of recipients receiving
  benefits under the medically dependent children (MDCP) waiver
  program, or their representatives, using the Consumer Assessment of
  Healthcare Providers and Systems;
               (2)  conduct annual focus groups with recipients
  described by Subdivision (1) or their representatives on issues
  identified through:
                     (A)  the Consumer Assessment of Healthcare
  Providers and Systems;
                     (B)  other external quality review organization
  activities; or
                     (C)  stakeholders; and
               (3)  in consultation with the STAR Kids Managed Care
  Advisory Committee and as frequently as feasible, calculate
  Medicaid managed care organizations' performance on performance
  measures using available data sources such as the collaborative
  innovation improvement network. (Gov. Code, Sec. 531.06021(a).)
         Sec. 546.0505.  QUARTERLY REPORT. Not later than the 30th
  day after the last day of each state fiscal quarter, the commission
  shall submit to the governor, the lieutenant governor, the speaker
  of the house of representatives, the Legislative Budget Board, and
  each standing legislative committee with primary jurisdiction over
  Medicaid a report containing, for the most recent state fiscal
  quarter, the following information and data related to access to
  care for recipients receiving benefits under the medically
  dependent children (MDCP) waiver program:
               (1)  enrollment in the Medicaid buy-in for children
  program implemented under Section 532.0353;
               (2)  requests relating to interest list placements
  under Section 546.0455;
               (3)  use of the Medicaid escalation help line
  established under Subchapter R, Chapter 540, if the help line was
  operational during the applicable state fiscal quarter;
               (4)  use of, requests for, and outcomes of the external
  medical review procedure established under Section 532.0404; and
               (5)  complaints relating to the medically dependent
  children (MDCP) waiver program, categorized by disposition. (Gov.
  Code, Sec. 531.06021(b).)
  SUBCHAPTER L. QUALITY ASSURANCE FEE PROGRAM
         Sec. 546.0551.  QUALITY ASSURANCE FEE FOR CERTAIN MEDICAID
  WAIVER PROGRAM SERVICES. (a) In this section, "gross receipts"
  means money received as compensation for services under an
  intermediate care facility for individuals with an intellectual
  disability waiver program, such as a home and community services
  waiver or a community living assistance and support services
  waiver. The term does not include:
               (1)  a charitable contribution;
               (2)  revenues received for services or goods other than
  waivers; or
               (3)  any money received from consumers or their
  families as reimbursement for services or goods not normally
  covered under a waiver program.
         (b)  The executive commissioner by rule shall modify the
  quality assurance fee program under Subchapter H, Chapter 252,
  Health and Safety Code, by providing for a quality assurance fee
  program that imposes a quality assurance fee on persons providing
  services under a home and community services waiver or a community
  living assistance and support services waiver.
         (c)  The executive commissioner shall establish the fee at an
  amount that will produce annual revenues of not more than six
  percent of the total annual gross receipts in this state.
         (d)  The executive commissioner shall adopt rules governing:
               (1)  the reporting required to compute and collect the
  fee and the manner and times of collecting the fee; and
               (2)  the administration of the fee, including the
  imposition of penalties for a violation of the rules.
         (e)  Fees collected under this section must be deposited in
  the waiver program quality assurance fee account. (Gov. Code, Sec.
  531.078.)
         Sec. 546.0552.  WAIVER PROGRAM QUALITY ASSURANCE FEE
  ACCOUNT. (a) The waiver program quality assurance fee account is a
  dedicated account in the general revenue fund. The account is
  exempt from the application of Section 403.095.
         (b)  The account consists of fees collected under Section
  546.0551.
         (c)  Subject to legislative appropriation and state and
  federal law, money in the account may be appropriated only to the
  commission to:
               (1)  increase reimbursement rates paid under:
                     (A)  the home and community services waiver
  program; or
                     (B)  the community living assistance and support
  services (CLASS) waiver program; or
               (2)  offset allowable expenses under Medicaid. (Gov.
  Code, Sec. 531.079.)
         Sec. 546.0553.  REIMBURSEMENT UNDER CERTAIN MEDICAID WAIVER
  PROGRAMS. Subject to legislative appropriation and state and
  federal law, the commission shall use money from the waiver program
  quality assurance fee account, together with any federal money
  available to match money from the account, to increase
  reimbursement rates paid under:
               (1)  the home and community services waiver program; or
               (2)  the community living assistance and support
  services (CLASS) waiver program. (Gov. Code, Sec. 531.080.)
         Sec. 546.0554.  INVALIDITY; FEDERAL MONEY. If any portion
  of Section 546.0551, 546.0552, or 546.0553 is held invalid by a
  final order of a court that is not subject to appeal, or if the
  commission determines that the imposition of the quality assurance
  fee and the expenditure of the money collected as provided by those
  sections will not entitle this state to receive additional federal
  money under Medicaid, the commission shall:
               (1)  stop collecting the quality assurance fee; and
               (2)  not later than the 30th day after the date the
  commission stops collecting the quality assurance fee, return any
  money collected under Section 546.0551, but not spent under Section
  546.0553, to the persons who paid the fees in proportion to the
  total amount paid by those persons. (Gov. Code, Sec. 531.081.)
         Sec. 546.0555.  EXPIRATION OF QUALITY ASSURANCE FEE PROGRAM.
  If Subchapter H, Chapter 252, Health and Safety Code, expires, this
  subchapter expires on the same date. (Gov. Code, Sec. 531.082.)
  SUBCHAPTER M. VOLUNTEER ADVOCATE PROGRAM FOR CERTAIN ELDERLY
  INDIVIDUALS
         Sec. 546.0601.  DEFINITIONS. In this subchapter:
               (1)  "Designated caregiver" means:
                     (A)  a person designated as a caregiver by an
  elderly individual receiving services from or under the direction
  of the commission or a health and human services agency; or
                     (B)  a court-appointed guardian of an elderly
  individual receiving services from or under the direction of the
  commission or a health and human services agency.
               (2)  "Elderly individual" means an individual who is at
  least 60 years of age.
               (3)  "Program" means the volunteer advocate program
  created under this subchapter for elderly individuals receiving
  services from or under the direction of the commission or a health
  and human services agency.
               (4)  "Volunteer advocate" means a person who
  successfully completes the volunteer advocate curriculum described
  by Section 546.0602(2). (Gov. Code, Sec. 531.057(a).)
         Sec. 546.0602.  PROGRAM PRINCIPLES. The program must adhere
  to the following principles:
               (1)  the intent of the program is to evaluate, through
  the operation of pilot projects, whether providing the services of
  a trained volunteer advocate selected by an elderly individual or
  the individual's designated caregiver is effective in achieving the
  following goals:
                     (A)  extend the time the elderly individual can
  remain in an appropriate home setting;
                     (B)  maximize the efficiency of services
  delivered to the elderly individual by focusing on services needed
  to sustain family caregiving;
                     (C)  protect the elderly individual by providing a
  knowledgeable third party to review the quality of care and
  services delivered to the individual and the care options available
  to the individual and the individual's family; and
                     (D)  facilitate communication between the elderly
  individual or the individual's designated caregiver and providers
  of health care and other services;
               (2)  a volunteer advocate curriculum must be maintained
  that incorporates best practices as determined and recognized by a
  professional organization recognized in the elder health care
  field;
               (3)  the use of pro bono assistance from qualified
  professionals must be maximized in modifying the volunteer advocate
  curriculum and the program;
               (4)  trainers must be certified on the ability to
  deliver training;
               (5)  training shall be offered through multiple
  community-based organizations; and
               (6)  participation in the program is voluntary and must
  be initiated by an elderly individual or the individual's
  designated caregiver. (Gov. Code, Sec. 531.057(c).)
         Sec. 546.0603.  AGREEMENTS WITH NONPROFIT ORGANIZATIONS;
  ORGANIZATION ELIGIBILITY. The executive commissioner may enter
  into agreements with appropriate nonprofit organizations to
  provide services under the program. A nonprofit organization is
  eligible to provide services under the program if the organization:
               (1)  has significant experience in providing services
  to elderly individuals;
               (2)  has the capacity to provide training and
  supervision for individuals interested in serving as volunteer
  advocates; and
               (3)  meets any other criteria prescribed by the
  executive commissioner. (Gov. Code, Sec. 531.057(d).)
         Sec. 546.0604.  FUNDING. (a) The commission shall fund the
  program, including the design and evaluation of pilot projects,
  modification of the volunteer advocate curriculum, and training of
  volunteers, through existing appropriations to the commission.
         (b)  Notwithstanding Subsection (a), the commission may
  accept gifts, grants, or donations for the program from any source
  to:
               (1)  carry out the design of the program;
               (2)  develop criteria for evaluating any proposed pilot
  projects operated under the program;
               (3)  modify a volunteer advocate training curriculum;
               (4)  conduct training for volunteer advocates; and
               (5)  develop a request for offers to conduct any
  proposed pilot projects under the program. (Gov. Code, Secs.
  531.057(e), (f).)
         Sec. 546.0605.  RULES. The executive commissioner may adopt
  rules as necessary to implement the program. (Gov. Code, Sec.
  531.057(g).)
  SUBCHAPTER N. ADVANCING CARE FOR EXCEPTIONAL KIDS PILOT PROGRAM
         Sec. 546.0651.  DEFINITION. In this subchapter, "pilot
  program" means the pilot program established under this subchapter.
  (New.)
         Sec. 546.0652.  PILOT PROGRAM. The commission shall
  collaborate with the STAR Kids Managed Care Advisory Committee,
  recipients, family members of children with complex medical
  conditions, children's health care advocates, Medicaid managed
  care organizations, and other stakeholders to develop and implement
  a pilot program that is substantially similar to the program
  described by Section 3, Medicaid Services Investment and
  Accountability Act of 2019 (Pub. L. No. 116-16), to provide
  coordinated care through a health home to children with complex
  medical conditions. (Gov. Code, Sec. 531.0605(a).)
         Sec. 546.0653.  FEDERAL GUIDANCE AND FUNDING. The
  commission shall seek guidance from the Centers for Medicare and
  Medicaid Services and the United States Department of Health and
  Human Services regarding the design of the program and, based on the
  guidance, may actively seek and apply for federal funding to
  implement the program. (Gov. Code, Sec. 531.0605(b).)
         Sec. 546.0654.  REPORT. Not later than December 31, 2024,
  the commission shall prepare and submit to the legislature a report
  that includes:
               (1)  a summary of the commission's implementation of
  the pilot program; and
               (2)  if the pilot program has been operating for a
  period sufficient to obtain necessary data:
                     (A)  a summary of the commission's evaluation of
  the effect of the pilot program on the coordination of care for
  children with complex medical conditions; and
                     (B)  a recommendation as to whether the pilot
  program should be continued, expanded, or terminated. (Gov. Code,
  Sec. 531.0605(c).)
         Sec. 546.0655.  EXPIRATION. The pilot program terminates
  and this subchapter expires September 1, 2025. (Gov. Code, Sec.
  531.0605(d).)
  SUBCHAPTER O. MORTALITY REVIEW FOR CERTAIN INDIVIDUALS WITH
  INTELLECTUAL OR DEVELOPMENTAL DISABILITY
         Sec. 546.0701.  DEFINITION. In this subchapter, "contracted
  organization" means an entity that contracts with the commission to
  provide the services described by Section 546.0702(b). (Gov. Code,
  Sec. 531.8501.)
         Sec. 546.0702.  MORTALITY REVIEW SYSTEM. (a)  The executive
  commissioner shall establish an independent mortality review
  system to review the death of an individual with an intellectual or
  developmental disability who, at the time of the individual's death
  or at any time during the 24-hour period preceding the individual's
  death:
               (1)  resided in or received services from:
                     (A)  an ICF-IID operated or licensed by the
  commission or a community center; or
                     (B)  the ICF-IID component of the Rio Grande State
  Center; or
               (2)  received services through a Section 1915(c) waiver
  program for individuals who are eligible for ICF-IID services.
         (b)  The executive commissioner shall contract with an
  institution of higher education or a health care organization or
  association with experience in conducting research-based mortality
  studies to conduct independent mortality reviews of individuals
  with an intellectual or developmental disability.  The contract
  must require the contracted organization to form a review team
  consisting of:
               (1)  a physician with expertise regarding the medical
  treatment of individuals with an intellectual or developmental
  disability;
               (2)  a registered nurse with expertise regarding the
  medical treatment of individuals with an intellectual or
  developmental disability;
               (3)  a clinician or other professional with expertise
  in the delivery of services and supports for individuals with an
  intellectual or developmental disability; and
               (4)  any other appropriate individual as the executive
  commissioner provides.
         (c)  A review under this subchapter must be conducted:
               (1)  in addition to any review conducted by the
  facility in which the individual resided or the facility, agency,
  or provider from which the individual received services; and
               (2)  after any investigation of alleged or suspected
  abuse, neglect, or exploitation is completed.
         (d)  To ensure consistency across mortality review systems,
  a review under this subchapter must collect information consistent
  with the information required to be collected by another
  independent mortality review process established specifically for
  individuals with an intellectual or developmental disability.
         (e)  The executive commissioner shall adopt rules regarding
  the manner in which the death of an individual described by
  Subsection (a) must be reported to the contracted organization by a
  facility or waiver program provider described by that subsection.
  (Gov. Code, Sec. 531.851.)
         Sec. 546.0703.  ACCESS TO INFORMATION AND RECORDS. (a) A
  contracted organization may request information and records
  regarding a deceased individual as necessary to carry out the
  organization's duties.  The requested information and records may
  include:
               (1)  medical, dental, and mental health care
  information; and
               (2)  information and records maintained by any state or
  local government agency, including:
                     (A)  a birth certificate;
                     (B)  law enforcement investigative data;
                     (C)  medical examiner investigative data;
                     (D)  juvenile court records;
                     (E)  parole and probation information and
  records; and
                     (F)  adult or child protective services
  information and records.
         (b)  On request of the contracted organization, the
  custodian of the relevant information and records relating to a
  deceased individual shall provide those records to the organization
  at no charge. (Gov. Code, Sec. 531.852.)
         Sec. 546.0704.  MORTALITY REVIEW REPORTS. Subject to
  Section 546.0705, a contracted organization shall submit:
               (1)  to the commission, the Department of Family and
  Protective Services, the office of independent ombudsman for state
  supported living centers, and the commission's office of inspector
  general a report of the findings of the mortality review; and
               (2)  semiannually to the governor, the lieutenant
  governor, the speaker of the house of representatives, and the
  standing committees of the senate and house of representatives with
  primary jurisdiction over the commission, the department, the
  office of independent ombudsman for state supported living centers,
  and the commission's office of inspector general a report that
  contains:
                     (A)  aggregate information regarding the deaths
  for which the organization performed an independent mortality
  review;
                     (B)  trends in the causes of death the
  organization identifies; and
                     (C)  any suggestions for system-wide improvements
  to address conditions that contributed to deaths reviewed by the
  organization. (Gov. Code, Sec. 531.853.)
         Sec. 546.0705.  USE AND PUBLICATION RESTRICTIONS;
  CONFIDENTIALITY. (a) The commission may use or publish
  information under this subchapter only to advance statewide
  practices regarding the treatment and care of individuals with an
  intellectual or developmental disability. A summary of the data in
  the contracted organization's reports or a statistical compilation
  of data reports may be released by the commission for general
  publication if the summary or statistical compilation does not
  contain any information that would permit the identification of an
  individual or that is confidential or privileged under this
  subchapter or other state or federal law.
         (b)  Information and records acquired by the contracted
  organization in the exercise of the organization's duties under
  this subchapter:
               (1)  are confidential and exempt from disclosure under
  Chapter 552; and
               (2)  may be disclosed only as necessary to carry out the
  organization's duties.
         (c)  The identity of:
               (1)  an individual whose death was reviewed in
  accordance with this subchapter is confidential and may not be
  revealed; and
               (2)  a health care provider or the name of a facility or
  agency that provided services to or was the residence of an
  individual whose death was reviewed in accordance with this
  subchapter is confidential and may not be revealed.
         (d)  Reports, information, statements, memoranda, and other
  information furnished under this subchapter to the contracted
  organization and any findings or conclusions resulting from a
  review by the organization are privileged.
         (e)  A contracted organization's report of the findings of
  the independent mortality review conducted under this subchapter
  and any records the organization develops relating to the review:
               (1)  are confidential and privileged;
               (2)  are not subject to discovery or subpoena; and
               (3)  may not be introduced into evidence in any civil,
  criminal, or administrative proceeding.
         (f)  A member of the contracted organization's review team
  may not testify or be required to testify in a civil, criminal, or
  administrative proceeding as to observations, factual findings, or
  conclusions that were made in conducting a review under this
  subchapter. (Gov. Code, Sec. 531.854.)
         Sec. 546.0706.  LIMITATION ON LIABILITY. A health care
  provider or other person is not civilly or criminally liable for
  furnishing information to the contracted organization or to the
  commission for use by the organization in accordance with this
  subchapter unless the person acted in bad faith or knowingly
  provided false information to the organization or the commission. (Gov. Code, Sec. 531.855.)
 
  CHAPTER 547. MENTAL HEALTH AND SUBSTANCE USE SERVICES
  SUBCHAPTER A. DELIVERY OF MENTAL HEALTH AND SUBSTANCE USE SERVICES
  Sec. 547.0001.  EVALUATION OF CERTAIN CONTRACTORS AND
                   SUBCONTRACTORS
  Sec. 547.0002.  OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS
                   TO CARE
  Sec. 547.0003.  RULES GOVERNING PEER SPECIALISTS
  Sec. 547.0004.  VETERAN SUICIDE PREVENTION ACTION PLAN
  Sec. 547.0005.  LOCAL MENTAL HEALTH AUTHORITY GROUP
                   REGIONAL STRATEGIES; ANNUAL REPORT
  SUBCHAPTER B. TEXAS SYSTEM OF CARE FRAMEWORK
  Sec. 547.0051.  DEFINITIONS
  Sec. 547.0052.  TEXAS SYSTEM OF CARE FRAMEWORK
  Sec. 547.0053.  IMPLEMENTATION
  Sec. 547.0054.  TECHNICAL ASSISTANCE FOR LOCAL SYSTEMS
                   OF CARE
  SUBCHAPTER C. SERVICES FOR CHILDREN WITH SEVERE EMOTIONAL
  DISTURBANCES
  Sec. 547.0101.  DEFINITIONS
  Sec. 547.0102.  EVALUATIONS BY COMMUNITY RESOURCE
                   COORDINATION GROUPS
  Sec. 547.0103.  SUMMARY REPORT BY COMMISSION
  Sec. 547.0104.  AGENCY IMPLEMENTATION OF
                   RECOMMENDATIONS
  SUBCHAPTER D. STATEWIDE BEHAVIORAL HEALTH COORDINATING COUNCIL
  Sec. 547.0151.  DEFINITION
  Sec. 547.0152.  PURPOSE
  Sec. 547.0153.  COMPOSITION OF COUNCIL
  Sec. 547.0154.  PRESIDING OFFICER
  Sec. 547.0155.  MEETINGS
  Sec. 547.0156.  POWERS AND DUTIES
  Sec. 547.0157.  SUICIDE PREVENTION SUBCOMMITTEE;
                   SUICIDE DATA REPORTS
  SUBCHAPTER E. BEHAVIORAL HEALTH GRANT PROGRAMS GENERALLY
  Sec. 547.0201.  STREAMLINING PROCESS FOR AWARDING
                   BEHAVIORAL HEALTH GRANTS
  SUBCHAPTER F. MATCHING GRANT PROGRAM FOR CERTAIN COMMUNITY MENTAL
  HEALTH PROGRAMS ASSISTING INDIVIDUALS EXPERIENCING MENTAL ILLNESS
  Sec. 547.0251.  DEFINITION
  Sec. 547.0252.  MATCHING GRANT PROGRAM
  Sec. 547.0253.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
                   CONDITIONS
  Sec. 547.0254.  SELECTION OF RECIPIENTS; APPLICATIONS
                   AND PROPOSALS
  Sec. 547.0255.  LOCAL MENTAL HEALTH AUTHORITY
                   INVOLVEMENT
  Sec. 547.0256.  USE OF GRANTS AND MATCHING AMOUNTS
  Sec. 547.0257.  DISTRIBUTING AND ALLOCATING
                   APPROPRIATED MONEY
  Sec. 547.0258.  RULES
  Sec. 547.0259.  BIENNIAL REPORT
  SUBCHAPTER G. MATCHING GRANT PROGRAM FOR COMMUNITY MENTAL HEALTH
  PROGRAMS ASSISTING VETERANS AND THEIR FAMILIES
  Sec. 547.0301.  DEFINITION
  Sec. 547.0302.  MATCHING GRANT PROGRAM
  Sec. 547.0303.  MATCHING CONTRIBUTIONS REQUIRED
  Sec. 547.0304.  MATCHING GRANT CONDITIONS: SINGLE
                   COUNTIES
  Sec. 547.0305.  MATCHING GRANT CONDITIONS: MULTIPLE
                   COUNTIES
  Sec. 547.0306.  SELECTION OF RECIPIENTS; APPLICATIONS
                   AND PROPOSALS
  Sec. 547.0307.  USE OF GRANTS AND MATCHING AMOUNTS
  Sec. 547.0308.  DISTRIBUTING AND ALLOCATING
                   APPROPRIATED MONEY
  Sec. 547.0309.  RULES
  SUBCHAPTER H. MATCHING GRANT PROGRAM FOR CERTAIN COMMUNITY
  COLLABORATIVES TO REDUCE INVOLVEMENT OF INDIVIDUALS WITH MENTAL
  ILLNESS IN CRIMINAL JUSTICE SYSTEM
  Sec. 547.0351.  DEFINITION
  Sec. 547.0352.  MATCHING GRANT PROGRAM
  Sec. 547.0353.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
                   CONDITIONS
  Sec. 547.0354.  COMMUNITY COLLABORATIVE ELIGIBILITY;
                   CERTAIN GRANTS PROHIBITED
  Sec. 547.0355.  PETITION REQUIRED; CONTENTS
  Sec. 547.0356.  REVIEW OF PETITION BY COMMISSION
  Sec. 547.0357.  USE OF GRANT MONEY AND MATCHING FUNDS
  Sec. 547.0358.  REPORT BY COMMUNITY COLLABORATIVE
  Sec. 547.0359.  INSPECTIONS
  Sec. 547.0360.  ALLOCATING APPROPRIATED MONEY
  SUBCHAPTER I. MATCHING GRANT PROGRAM FOR COMMUNITY COLLABORATIVE
  IN MOST POPULOUS COUNTY TO REDUCE INVOLVEMENT OF INDIVIDUALS WITH
  MENTAL ILLNESS IN CRIMINAL JUSTICE SYSTEM
  Sec. 547.0401.  DEFINITION
  Sec. 547.0402.  MATCHING GRANT PROGRAM
  Sec. 547.0403.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
                   CONDITIONS
  Sec. 547.0404.  COMMUNITY COLLABORATIVE ELIGIBILITY
  Sec. 547.0405.  DISTRIBUTION OF GRANT
  Sec. 547.0406.  USE OF GRANT MONEY AND MATCHING FUNDS
  Sec. 547.0407.  REPORT BY COMMUNITY COLLABORATIVE
  Sec. 547.0408.  INSPECTIONS
  CHAPTER 547. MENTAL HEALTH AND SUBSTANCE USE SERVICES
  SUBCHAPTER A. DELIVERY OF MENTAL HEALTH AND SUBSTANCE USE SERVICES
         Sec. 547.0001.  EVALUATION OF CERTAIN CONTRACTORS AND
  SUBCONTRACTORS. (a) To ensure the appropriate delivery of mental
  health and substance use services, the commission shall regularly
  evaluate program contractors and subcontractors that provide or
  arrange services for individuals enrolled in:
               (1)  the Medicaid managed care program; and
               (2)  the child health plan program.
         (b)  The commission shall monitor:
               (1)  penetration rates as those rates relate to mental
  health and substance use services provided by or through
  contractors and subcontractors;
               (2)  utilization rates as those rates relate to mental
  health and substance use services provided by or through
  contractors and subcontractors; and
               (3)  provider networks used by contractors and
  subcontractors to provide mental health or substance use services.
  (Gov. Code, Sec. 531.0225.)
         Sec. 547.0002.  OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO
  CARE. (a) In this section, "ombudsman" means the individual
  designated under this section by the executive commissioner as the
  ombudsman for behavioral health access to care unless the context
  requires otherwise.
         (b)  The executive commissioner shall designate an ombudsman
  for behavioral health access to care.
         (c)  The ombudsman is administratively attached to the
  commission's office of the ombudsman established under Section
  523.0255.
         (d)  The commission may use an alternate title for the
  ombudsman in consumer-facing materials if the commission
  determines that an alternate title would benefit consumer
  understanding or access.
         (e)  The ombudsman serves as a neutral party to help
  consumers, including consumers who are uninsured or have public or
  private health benefit coverage, and behavioral health care
  providers navigate and resolve issues related to consumer access to
  behavioral health care, including care for mental health conditions
  and substance use disorders.
         (f)  The ombudsman shall:
               (1)  interact with consumers and behavioral health care
  providers regarding concerns or complaints to help the consumers
  and providers resolve behavioral health care access issues;
               (2)  identify, track, and help report potential
  violations of state or federal rules, regulations, or statutes
  concerning the availability of, and terms and conditions of,
  benefits for mental health conditions or substance use disorders,
  including potential violations related to quantitative and
  nonquantitative treatment limitations;
               (3)  report concerns, complaints, and potential
  violations described by Subdivision (2) to the appropriate
  regulatory or oversight agency;
               (4)  receive and report concerns and complaints
  relating to inappropriate care or mental health commitment;
               (5)  provide appropriate information to help consumers
  obtain behavioral health care;
               (6)  develop appropriate points of contact for
  referrals to other state and federal agencies; and
               (7)  provide appropriate information to help consumers
  or providers file appeals or complaints with the appropriate
  entities, including insurers and other state and federal agencies.
         (g)  The Texas Department of Insurance shall appoint a
  liaison to the ombudsman to receive the reports of concerns,
  complaints, and potential violations described by Subsection
  (f)(2) from the ombudsman, consumers, or behavioral health care
  providers. (Gov. Code, Sec. 531.02251.)
         Sec. 547.0003.  RULES GOVERNING PEER SPECIALISTS. (a) With
  input from mental health and substance use peer specialists, the
  commission shall develop and the executive commissioner shall
  adopt:
               (1)  rules establishing training requirements for peer
  specialists to provide services to individuals with mental illness
  or individuals with substance use conditions;
               (2)  rules establishing certification and supervision
  requirements for peer specialists;
               (3)  rules defining the scope of services that peer
  specialists may provide;
               (4)  rules distinguishing peer services from other
  services that a person must hold a license to provide; and
               (5)  any other rules necessary to protect the health
  and safety of individuals receiving peer services.
         (b)  The executive commissioner may not adopt rules under
  this section that preclude the provision of mental health
  rehabilitative services under 25 T.A.C. Chapter 416, Subchapter A,
  as that subchapter existed on January 1, 2017. (Gov. Code, Secs.
  531.0999(a), (f).)
         Sec. 547.0004.  VETERAN SUICIDE PREVENTION ACTION PLAN. (a)
  The commission, in collaboration with the Texas Coordinating
  Council for Veterans Services, the United States Department of
  Veterans Affairs, the Service Members, Veterans, and their Families
  Technical Assistance Center Implementation Academy of the
  Substance Abuse and Mental Health Services Administration of the
  United States Department of Health and Human Services, veteran
  advocacy groups, health care providers, and any other organization
  or interested party the commission considers appropriate, shall
  develop a comprehensive action plan to increase access to and
  availability of professional veteran health services to prevent
  veteran suicides.
         (b)  The action plan must:
               (1)  identify opportunities for raising awareness of
  and providing resources for veteran suicide prevention;
               (2)  identify opportunities to increase access to
  veteran mental health services;
               (3)  identify funding resources to provide accessible,
  affordable veteran mental health services;
               (4)  provide measures to expand public-private
  partnerships to ensure access to quality, timely mental health
  services;
               (5)  provide for proactive outreach measures to reach
  veterans needing care;
               (6)  provide for peer-to-peer service coordination,
  including training, certification, recertification, and continuing
  education for peer coordinators; and
               (7)  address suicide prevention awareness, measures,
  and training regarding veterans involved in the justice system.
         (c)  The commission shall make specific long-term statutory,
  administrative, and budget-related recommendations to the
  legislature and the governor regarding the policy initiatives and
  reforms necessary to implement the action plan developed under this
  section.  The initiatives and reforms in the long-term plan must be
  fully implemented by September 1, 2027.
         (d)  The commission shall include in the commission's
  strategic plan under Chapter 2056 the plans for implementing the
  long-term recommendations under Subsection (c).
         (e)  This section expires September 1, 2027. (Gov. Code,
  Secs. 531.0925(a), (b), (c) (part), (d), (e).)
         Sec. 547.0005.  LOCAL MENTAL HEALTH AUTHORITY GROUP REGIONAL
  STRATEGIES; ANNUAL REPORT. (a)  In this section, "local mental
  health authority group" means a group of local mental health
  authorities established by the commission under Chapter 963 (S.B.
  633), Acts of the 86th Legislature, Regular Session, 2019.
         (b)  The commission shall require each local mental health
  authority group to meet at least quarterly to collaborate on
  planning and implementing regional strategies to reduce:
               (1)  costs to local governments of providing services
  to individuals experiencing a mental health crisis;
               (2)  transportation to mental health facilities of
  individuals served by an authority that is a member of the group;
               (3)  incarceration of individuals with mental illness
  in county jails located in an area served by an authority that is a
  member of the group; and
               (4)  visits by individuals with mental illness at
  hospital emergency rooms located in an area served by an authority
  that is a member of the group.
         (c)  The commission shall use federal funds in accordance
  with state and federal guidelines to implement this section.
         (d)  The commission, in coordination with each local mental
  health authority group, shall annually update the mental health
  services development plan that was initially developed by the
  commission and each local mental health authority group under
  Chapter 963 (S.B. 633), Acts of the 86th Legislature, Regular
  Session, 2019. The commission and each group's updated plan must
  include a description of:
               (1)  actions taken by the group to implement regional
  strategies in the plan; and
               (2)  new regional strategies identified by the group to
  reduce the circumstances described by Subsection (b), including the
  estimated number of outpatient and inpatient beds necessary to meet
  the goals of each group's regional strategy.
         (e)  Not later than December 1 of each year, the commission
  shall produce and publish on the commission's Internet website a
  report containing the most recent version of each mental health
  services development plan developed by the commission and a local
  mental health authority group.  (Gov. Code, Sec. 531.0222.)
  SUBCHAPTER B. TEXAS SYSTEM OF CARE FRAMEWORK
         Sec. 547.0051.  DEFINITIONS. In this subchapter:
               (1)  "Minor" means an individual younger than 18 years
  of age.
               (2)  "Serious emotional disturbance" means a mental,
  behavioral, or emotional disorder of sufficient duration to result
  in functional impairment that substantially interferes with or
  limits an individual's role or ability to function in family,
  school, or community activities.
               (3)  "System of care framework" means a framework for
  collaboration among state agencies, minors who have a serious
  emotional disturbance or are at risk of developing a serious
  emotional disturbance, and the families of those minors that
  improves access to services and delivers effective community-based
  services that are family-driven, youth- or young adult-guided, and
  culturally and linguistically competent. (Gov. Code, Sec.
  531.251(a).)
         Sec. 547.0052.  TEXAS SYSTEM OF CARE FRAMEWORK. (a) The
  commission shall implement a system of care framework to develop
  local mental health systems of care in communities for minors who:
               (1)  have or are at risk of developing a serious
  emotional disturbance;
               (2)  are receiving residential mental health services
  and supports or inpatient mental health hospitalization; or
               (3)  are at risk of being removed from the minor's home
  and placed in a more restrictive environment to receive mental
  health services and supports, including:
                     (A)  an inpatient mental health hospital;
                     (B)  a residential treatment facility; or
                     (C)  a facility or program operated by the
  Department of Family and Protective Services or an agency that is
  part of the juvenile justice system.
         (b)  The commission shall:
               (1)  maintain a comprehensive plan for the delivery of
  mental health services and supports to a minor and a minor's family
  using a system of care framework, including best practices in the
  financing, administration, governance, and delivery of those
  services;
               (2)  enter into memoranda of understanding with the
  Department of State Health Services, the Department of Family and
  Protective Services, the Texas Education Agency, the Texas Juvenile
  Justice Department, and the Texas Correctional Office on Offenders
  with Medical or Mental Impairments that specify the roles and
  responsibilities of each agency in implementing the comprehensive
  plan;
               (3)  identify appropriate local, state, and federal
  funding sources to finance infrastructure and mental health
  services and supports necessary to support state and local system
  of care framework efforts; and
               (4)  develop an evaluation system to measure
  cross-system performance and outcomes of state and local system of
  care framework efforts.
         (c)  In implementing this section, the commission shall
  consult with stakeholders, including:
               (1)  minors who have or are at risk of developing a
  serious emotional disturbance or young adults who received mental
  health services and supports as a minor with or at risk of
  developing a serious emotional disturbance; and
               (2)  family members of those minors or young adults.
  (Gov. Code, Secs. 531.251(b), (c).)
         Sec. 547.0053.  IMPLEMENTATION. The commission shall:
               (1)  monitor the implementation of a system of care
  framework under Section 547.0052; and
               (2)  adopt rules necessary to facilitate or adjust that
  implementation. (Gov. Code, Sec. 531.255.)
         Sec. 547.0054.  TECHNICAL ASSISTANCE FOR LOCAL SYSTEMS OF
  CARE. The commission may provide technical assistance to a
  community that implements a local system of care. (Gov. Code, Sec.
  531.257.)
  SUBCHAPTER C. SERVICES FOR CHILDREN WITH SEVERE EMOTIONAL
  DISTURBANCES
         Sec. 547.0101.  DEFINITIONS. In this subchapter:
               (1)  "Children with severe emotional disturbances"
  includes children:
                     (A)  who are at risk of incarceration or placement
  in a residential mental health facility;
                     (B)  who are students in a special education
  program under Subchapter A, Chapter 29, Education Code;
                     (C)  with a substance use disorder or a
  developmental disability; and
                     (D)  for whom a court may appoint the Department
  of Family and Protective Services as managing conservator.
               (2)  "Community resource coordination group" means a
  coordination group established under a memorandum of understanding
  adopted under Subchapter D, Chapter 522.
               (3)  "Systems of care services" means a comprehensive
  state system of mental health services and other necessary and
  related services that is organized as a coordinated network to meet
  the multiple and changing needs of children with severe emotional
  disturbances and their families. (Gov. Code, Sec. 531.421.)
         Sec. 547.0102.  EVALUATIONS BY COMMUNITY RESOURCE
  COORDINATION GROUPS. (a) Each community resource coordination
  group shall evaluate the provision of systems of care services in
  the community that the group serves. The evaluation must:
               (1)  describe and prioritize services needed by
  children with severe emotional disturbances in the community;
               (2)  review and assess the available systems of care
  services in the community to meet those needs;
               (3)  assess the integration of the provision of those
  services; and
               (4)  identify barriers to the effective provision of
  those services.
         (b)  Each community resource coordination group shall create
  a report that includes the evaluation described by Subsection (a)
  and related recommendations, including:
               (1)  suggested policy and statutory changes for
  agencies providing systems of care services; and
               (2)  recommendations for overcoming barriers to the
  provision of systems of care services and improving the integration
  of those services.
         (c)  Each community resource coordination group shall submit
  the report described by Subsection (b) to the commission. The
  commission shall provide to each group a deadline for submitting
  the report that is coordinated with any regional reviews by the
  commission of the delivery of related services. (Gov. Code, Sec.
  531.422.)
         Sec. 547.0103.  SUMMARY REPORT BY COMMISSION. (a) The
  commission shall create a summary report based on the evaluations
  in the reports submitted to the commission by community resource
  coordination groups under Section 547.0102. The commission's
  report must include:
               (1)  recommendations for policy and statutory changes
  at each agency involved in providing systems of care services; and
               (2)  the outcome expected from implementing each
  recommendation.
         (b)  The commission may include in the report created under
  this section recommendations for:
               (1)  the statewide expansion of sites participating in
  the Texas System of Care; and
               (2)  the integration of services provided at those
  sites with services provided by community resource coordination
  groups.
         (c)  The commission shall coordinate, where appropriate, the
  recommendations in the report created under this section with:
               (1)  recommendations in the assessment developed under
  Chapter 23 (S.B. 491), Acts of the 78th Legislature, Regular
  Session, 2003; and
               (2)  the continuum of care developed under Section
  533.040(d), Health and Safety Code.
         (d)  The commission shall provide a copy of the report
  created under this section to each agency for which the report makes
  a recommendation and to other agencies as appropriate. (Gov. Code,
  Sec. 531.423.)
         Sec. 547.0104.  AGENCY IMPLEMENTATION OF RECOMMENDATIONS.
  As appropriate, the person responsible for adopting rules for an
  agency described by Section 547.0103(a) shall implement the
  recommendations in the report created under Section 547.0103 by:
               (1)  adopting rules;
               (2)  implementing policy changes; and
               (3)  entering into memoranda of understanding with
  other agencies. (Gov. Code, Sec. 531.424.)
  SUBCHAPTER D. STATEWIDE BEHAVIORAL HEALTH COORDINATING COUNCIL
         Sec. 547.0151.  DEFINITION. In this subchapter, "council"
  means the statewide behavioral health coordinating council. (Gov.
  Code, Sec. 531.471.)
         Sec. 547.0152.  PURPOSE. The council is established to
  ensure a strategic statewide approach to behavioral health
  services. (Gov. Code, Sec. 531.472.)
         Sec. 547.0153.  COMPOSITION OF COUNCIL. (a) The council is
  composed of at least one representative designated by each of the
  following entities:
               (1)  the governor's office;
               (2)  the Texas Veterans Commission;
               (3)  the commission;
               (4)  the Department of State Health Services;
               (5)  the Department of Family and Protective Services;
               (6)  the Texas Civil Commitment Office;
               (7)  The University of Texas Health Science Center at
  Houston;
               (8)  The University of Texas Health Science Center at
  Tyler;
               (9)  the Texas Tech University Health Sciences Center;
               (10)  the Texas Department of Criminal Justice;
               (11)  the Texas Correctional Office on Offenders with
  Medical or Mental Impairments;
               (12)  the Commission on Jail Standards;
               (13)  the Texas Indigent Defense Commission;
               (14)  the court of criminal appeals;
               (15)  the Texas Juvenile Justice Department;
               (16)  the Texas Military Department;
               (17)  the Texas Education Agency;
               (18)  the Texas Workforce Commission;
               (19)  the Health Professions Council, representing:
                     (A)  the State Board of Dental Examiners;
                     (B)  the Texas State Board of Pharmacy;
                     (C)  the State Board of Veterinary Medical
  Examiners;
                     (D)  the Texas Optometry Board;
                     (E)  the Texas Board of Nursing; and
                     (F)  the Texas Medical Board; and
               (20)  the Texas Department of Housing and Community
  Affairs.
         (b)  The executive commissioner shall determine the number
  of representatives that each entity may designate to serve on the
  council.
         (c)  The council may authorize another state agency or
  institution that provides specific behavioral health services with
  the use of appropriated money to designate a representative to the
  council.
         (d)  A council member serves at the pleasure of the
  designating entity. (Gov. Code, Sec. 531.473.)
         Sec. 547.0154.  PRESIDING OFFICER. The mental health
  statewide coordinator shall serve as the presiding officer of the
  council. (Gov. Code, Sec. 531.474.)
         Sec. 547.0155.  MEETINGS. The council shall meet at least
  once quarterly or more frequently at the call of the presiding
  officer. (Gov. Code, Sec. 531.475.)
         Sec. 547.0156.  POWERS AND DUTIES. (a)  The council:
               (1)  shall develop and monitor the implementation of a
  five-year statewide behavioral health strategic plan;
               (2)  shall develop a biennial coordinated statewide
  behavioral health expenditure proposal;
               (3)  shall annually publish an updated inventory of
  behavioral health programs and services that this state funds that
  includes a description of how those programs and services further
  the purpose of the statewide behavioral health strategic plan;
               (4)  may create subcommittees to carry out the
  council's duties under this subchapter; and
               (5)  may facilitate opportunities to increase
  collaboration for the effective expenditure of available federal
  and state funds for behavioral and mental health services in this
  state.
         (b)  The council shall include statewide suicide prevention
  efforts in the five-year statewide behavioral health strategic plan
  the council develops under Subsection (a). (Gov. Code, Sec.
  531.476.)
         Sec. 547.0157.  SUICIDE PREVENTION SUBCOMMITTEE; SUICIDE
  DATA REPORTS. (a) The council shall create a suicide prevention
  subcommittee to focus on statewide suicide prevention efforts using
  information collected by the council from available sources of
  suicide data reports. The suicide prevention subcommittee shall
  establish guidelines for the frequent use of those reports in
  carrying out the council's purpose under this subchapter.
         (b)  The suicide prevention subcommittee shall establish a
  method for identifying how suicide data reports are used to make
  policy.
         (c)  Public or private entities that collect information
  regarding suicide and suicide prevention may provide suicide data
  reports to commission staff the executive commissioner designates
  to receive those reports. (Gov. Code, Sec. 531.477.)
  SUBCHAPTER E. BEHAVIORAL HEALTH GRANT PROGRAMS GENERALLY
         Sec. 547.0201.  STREAMLINING PROCESS FOR AWARDING
  BEHAVIORAL HEALTH GRANTS. (a) The commission shall implement a
  process to better coordinate behavioral health grants the
  commission administers. The process must:
               (1)  streamline the administrative processes at the
  commission; and
               (2)  decrease the administrative burden on applicants
  applying for multiple grants.
         (b)  The process may include developing a standard
  application for multiple behavioral health grants. (Gov. Code, Sec.
  531.0991(m).)
  SUBCHAPTER F. MATCHING GRANT PROGRAM FOR CERTAIN COMMUNITY MENTAL
  HEALTH PROGRAMS ASSISTING INDIVIDUALS EXPERIENCING MENTAL ILLNESS
         Sec. 547.0251.  DEFINITION. In this subchapter, "matching
  grant program" means the matching grant program established under
  this subchapter. (New.)
         Sec. 547.0252.  MATCHING GRANT PROGRAM. To the extent money
  is appropriated to the commission for that purpose, the commission
  shall establish a matching grant program to support community
  mental health programs providing services and treatment to
  individuals experiencing mental illness. (Gov. Code, Sec.
  531.0991(a).)
         Sec. 547.0253.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
  CONDITIONS.  (a)  The commission shall:
               (1)  condition each grant awarded under this subchapter
  on the grant recipient obtaining and securing funds to match the
  grant from non-state sources in amounts of money or other
  consideration as required by Subsection (c); and
               (2)  ensure that each grant recipient obtains or
  secures contributions to match a grant awarded to the recipient in
  an amount of money or other consideration as required by Subsection
  (c).
         (b)  The matching contributions obtained or secured by the
  grant recipient, as the executive commissioner determines, may
  include cash or in-kind contributions from any person but may not
  include money from state or federal funds.
         (c)  A grant recipient must leverage funds in an amount equal
  to:
               (1)  25 percent of the grant amount if the community
  mental health program is located in a county with a population of
  less than 100,000;
               (2)  50 percent of the grant amount if the community
  mental health program is located in a county with a population of
  100,000 or more but less than 250,000;
               (3)  100 percent of the grant amount if the community
  mental health program is located in a county with a population of at
  least 250,000; and
               (4)  the percentage of the grant amount otherwise
  required by this subsection for the largest county in which a
  community mental health program is located if the community mental
  health program is located in more than one county. (Gov. Code, Secs.
  531.0991(b), (g), (h).)
         Sec. 547.0254.  SELECTION OF RECIPIENTS; APPLICATIONS AND
  PROPOSALS.  The commission shall select grant recipients based on
  the submission of applications or proposals by nonprofit and
  governmental entities. The executive commissioner shall develop
  criteria for evaluating those applications or proposals and the
  selection of grant recipients. The selection criteria must:
               (1)  evaluate and score:
                     (A)  fiscal controls for the project;
                     (B)  project effectiveness;
                     (C)  project cost; and
                     (D)  an applicant's previous experience with
  grants and contracts;
               (2)  address whether the services proposed in the
  application or proposal would duplicate services already available
  in the applicant's service area;
               (3)  address the possibility of and method for making
  multiple awards; and
               (4)  include other factors that the executive
  commissioner considers relevant. (Gov. Code, Sec. 531.0991(e).)
         Sec. 547.0255.  LOCAL MENTAL HEALTH AUTHORITY INVOLVEMENT.  
  (a)  A nonprofit or governmental entity that applies for a grant
  under this subchapter must:
               (1)  notify each local mental health authority with a
  local service area covered wholly or partly by the entity's
  proposed community mental health program; and
               (2)  provide in the entity's application a letter of
  support from each of those local mental health authorities.
         (b)  The commission shall consider a local mental health
  authority's written input before awarding a grant under this
  subchapter and may take any recommendations made by the authority.
  (Gov. Code, Sec. 531.0991(f).)
         Sec. 547.0256.  USE OF GRANTS AND MATCHING AMOUNTS.  A grant
  awarded under the matching grant program and matching amounts must
  be used for the sole purpose of supporting community mental health
  programs that:
               (1)  provide mental health services and treatment to
  individuals with a mental illness; and
               (2)  coordinate mental health services for individuals
  with a mental illness with other transition support services. (Gov.
  Code, Sec. 531.0991(d).)
         Sec. 547.0257.  DISTRIBUTING AND ALLOCATING APPROPRIATED
  MONEY.  (a)  The commission shall disburse money appropriated to or
  obtained by the commission for the matching grant program directly
  to a grant recipient, as the executive commissioner authorizes.
         (b)  Except as provided by Subsection (c), from money
  appropriated to the commission for each fiscal year to implement
  this subchapter, the commission shall reserve 50 percent of that
  total to be awarded only as grants to a community mental health
  program located in a county with a population not greater than
  250,000.
         (c)  Without regard to the limitation provided by Subsection
  (b) and to the extent money appropriated to the commission to
  implement this subchapter for a fiscal year remains available to
  the commission after the commission selects grant recipients for
  the fiscal year, the commission shall make grants available through
  a competitive request for proposal process using the remaining
  money for the fiscal year.
         (d)  The commission may use a reasonable amount not to exceed
  five percent of the money appropriated by the legislature for the
  purposes of this subchapter to pay the administrative costs of
  implementing this subchapter.  (Gov. Code, Secs. 531.0991(c), (i),
  (j), (n).)
         Sec. 547.0258.  RULES.  The executive commissioner shall
  adopt rules necessary to implement the matching grant program under
  this subchapter. (Gov. Code, Sec. 531.0991(l).)
         Sec. 547.0259.  BIENNIAL REPORT.  Not later than December 1
  of each even-numbered year, the executive commissioner shall submit
  to the governor, the lieutenant governor, and each member of the
  legislature a report evaluating the success of the matching grant
  program. (Gov. Code, Sec. 531.0991(k).)
  SUBCHAPTER G. MATCHING GRANT PROGRAM FOR COMMUNITY MENTAL HEALTH
  PROGRAMS ASSISTING VETERANS AND THEIR FAMILIES
         Sec. 547.0301.  DEFINITION. In this subchapter, "matching
  grant program" means the matching grant program established under
  this subchapter. (New.)
         Sec. 547.0302.  MATCHING GRANT PROGRAM. To the extent funds
  are appropriated to the commission for that purpose, the commission
  shall establish a matching grant program to support community
  mental health programs that provide services and treatment to
  veterans and their families. (Gov. Code, Sec. 531.0992(a).)
         Sec. 547.0303.  MATCHING CONTRIBUTIONS REQUIRED.  (a)  The
  commission shall ensure that each grant recipient obtains or
  secures contributions to match a grant awarded to the recipient in
  amounts of money or other consideration as required by Section
  547.0304 or 547.0305.
         (b)  The money or other consideration obtained or secured by
  the commission may, as the executive commissioner determines,
  include cash or in-kind contributions from private contributors or
  local governments but may not include state or federal funds.  (Gov.
  Code, Sec. 531.0992(c).)
         Sec. 547.0304.  MATCHING GRANT CONDITIONS: SINGLE COUNTIES.  
  For services and treatment provided in a single county, the
  commission shall condition each grant provided under this
  subchapter on a potential grant recipient providing funds from
  non-state sources in a total amount at least equal to:
               (1)  25 percent of the grant amount if the community
  mental health program to be supported by the grant provides
  services and treatment in a county with a population of less than
  100,000;
               (2)  50 percent of the grant amount if the community
  mental health program to be supported by the grant provides
  services and treatment in a county with a population of 100,000 or
  more but less than 250,000; or
               (3)  100 percent of the grant amount if the community
  mental health program to be supported by the grant provides
  services and treatment in a county with a population of 250,000 or
  more.  (Gov. Code, Sec. 531.0992(d-1).)
         Sec. 547.0305.  MATCHING GRANT CONDITIONS: MULTIPLE
  COUNTIES.  For a community mental health program that provides
  services and treatment in more than one county, the commission
  shall condition each grant provided under this subchapter on a
  potential grant recipient providing funds from non-state sources in
  a total amount at least equal to:
               (1)  25 percent of the grant amount if the county with
  the largest population in which the community mental health program
  to be supported by the grant provides services and treatment has a
  population of less than 100,000;
               (2)  50 percent of the grant amount if the county with
  the largest population in which the community mental health program
  to be supported by the grant provides services and treatment has a
  population of 100,000 or more but less than 250,000; or
               (3)  100 percent of the grant amount if the county with
  the largest population in which the community mental health program
  to be supported by the grant provides services and treatment has a
  population of 250,000 or more.  (Gov. Code, Sec. 531.0992(d-2).)
         Sec. 547.0306.  SELECTION OF RECIPIENTS; APPLICATIONS AND
  PROPOSALS. (a) The commission shall select grant recipients based
  on the submission of applications or proposals by nonprofit and
  governmental entities.
         (b)  The executive commissioner shall develop criteria for
  evaluating the applications or proposals and the selection of grant
  recipients. The selection criteria must:
               (1)  evaluate and score:
                     (A)  fiscal controls for the project;
                     (B)  project effectiveness;
                     (C)  project cost; and
                     (D)  an applicant's previous experience with
  grants and contracts;
               (2)  address the possibility of and method for making
  multiple awards; and
               (3)  include other factors that the executive
  commissioner considers relevant.  (Gov. Code, Sec. 531.0992(f).)
         Sec. 547.0307.  USE OF GRANTS AND MATCHING AMOUNTS. A grant
  awarded under the matching grant program must be used for the sole
  purpose of supporting community mental health programs that:
               (1)  provide mental health services and treatment to
  veterans and their families; and
               (2)  coordinate mental health services for veterans and
  their families with other transition support services.  (Gov. Code,
  Sec. 531.0992(e).)
         Sec. 547.0308.  DISTRIBUTING AND ALLOCATING APPROPRIATED
  MONEY. (a) As the executive commissioner authorizes, the
  commission shall disburse money appropriated to or obtained by the
  commission for the matching grant program directly to grant
  recipients.
         (b)  The commission may use a reasonable amount not to exceed
  five percent of the money appropriated by the legislature for the
  purposes of this subchapter to pay the administrative costs of
  implementing this subchapter.  (Gov. Code, Secs. 531.0992(d), (g).)
         Sec. 547.0309.  RULES. The executive commissioner shall
  adopt rules necessary to implement the matching grant program.  
  (Gov. Code, Sec. 531.0992(h).)
  SUBCHAPTER H. MATCHING GRANT PROGRAM FOR CERTAIN COMMUNITY
  COLLABORATIVES TO REDUCE INVOLVEMENT OF INDIVIDUALS WITH MENTAL
  ILLNESS IN CRIMINAL JUSTICE SYSTEM
         Sec. 547.0351.  DEFINITION. In this subchapter, "matching
  grant program" means the matching grant program established under
  this subchapter. (New.)
         Sec. 547.0352.  MATCHING GRANT PROGRAM. The commission
  shall establish a matching grant program to provide grants to
  county-based community collaboratives to reduce:
               (1)  recidivism by, the frequency of arrests of, and
  incarceration of individuals with mental illness; and
               (2)  the total wait time for forensic commitment of
  individuals with mental illness to a state hospital.  (Gov. Code,
  Sec. 531.0993(a).)
         Sec. 547.0353.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
  CONDITIONS. (a) The commission shall condition each grant
  provided to a community collaborative under this subchapter on the
  collaborative providing funds from non-state sources in a total
  amount at least equal to:
               (1)  25 percent of the grant amount if the
  collaborative includes a county with a population of less than
  100,000;
               (2)  50 percent of the grant amount if the
  collaborative includes a county with a population of 100,000 or
  more but less than 250,000;
               (3)  100 percent of the grant amount if the
  collaborative includes a county with a population of 250,000 or
  more; and
               (4)  the percentage of the grant amount otherwise
  required by this subsection for the largest county included in the
  collaborative, if the collaborative includes more than one county.
         (b)  A community collaborative may seek and receive gifts,
  grants, or donations from any person to raise the required funds
  from non-state sources. (Gov. Code, Secs. 531.0993(c), (c-1).)
         Sec. 547.0354.  COMMUNITY COLLABORATIVE ELIGIBILITY;
  CERTAIN GRANTS PROHIBITED. (a)  A community collaborative may
  petition the commission to receive a grant under the matching grant
  program only if the collaborative includes:
               (1)  a county;
               (2)  a local mental health authority that operates in
  the county; and
               (3)  each hospital district, if any, located in the
  county.
         (b)  A collaborative may include other local entities
  designated by the collaborative's members.
         (c)  The commission may not award a grant under this
  subchapter for a fiscal year to a community collaborative that
  includes a county with a population greater than four million if the
  legislature appropriates money for a mental health jail diversion
  program in the county for that fiscal year. (Gov. Code, Secs.
  531.0993(b), (i).)
         Sec. 547.0355.  PETITION REQUIRED; CONTENTS.  In each state
  fiscal year for which a community collaborative seeks a grant, the
  collaborative must submit a petition to the commission not later
  than the 30th day of that fiscal year. The collaborative must
  include with a petition:
               (1)  a statement indicating the amount of funds from
  non-state sources that the collaborative is able to provide; and
               (2)  a plan that:
                     (A)  is endorsed by each of the collaborative's
  member entities;
                     (B)  identifies a target population;
                     (C)  describes how the grant money and the funds
  from non-state sources will be used;
                     (D)  includes outcome measures to evaluate the
  success of the plan; and
                     (E)  describes how the success of the plan, in
  accordance with the outcome measures, would further the state's
  interest in the grant program's purposes.  (Gov. Code, Sec.
  531.0993(d).)
         Sec. 547.0356.  REVIEW OF PETITION BY COMMISSION.  The
  commission must review plans submitted with a petition under
  Section 547.0355 before the commission provides a grant under this
  subchapter. The commission must fulfill this requirement not later
  than the 60th day of each fiscal year.  (Gov. Code, Sec.
  531.0993(e).)
         Sec. 547.0357.  USE OF GRANT MONEY AND MATCHING FUNDS.  
  Acceptable uses of the grant money and matching funds include:
               (1)  continuing a mental health jail diversion program;
               (2)  establishing or expanding a mental health jail
  diversion program;
               (3)  establishing alternatives to competency
  restoration in a state hospital, including outpatient competency
  restoration, inpatient competency restoration in a setting other
  than a state hospital, or jail-based competency restoration;
               (4)  providing assertive community treatment or
  forensic assertive community treatment with an outreach component;
               (5)  providing intensive mental health services and
  substance use treatment not readily available in the county;
               (6)  providing continuity of care services for an
  individual being released from a state hospital;
               (7)  establishing interdisciplinary rapid response
  teams to reduce law enforcement's involvement with mental health
  emergencies; and
               (8)  providing local community hospital, crisis,
  respite, or residential beds.  (Gov. Code, Sec. 531.0993(f).)
         Sec. 547.0358.  REPORT BY COMMUNITY COLLABORATIVE.  Not
  later than the 90th day after the last day of the state fiscal year
  for which the commission distributes a grant under this subchapter,
  each grant recipient shall prepare and submit a report to the
  commission describing the effect of the grant money and matching
  funds in achieving the standard defined by the outcome measures in
  the plan submitted with a petition under Section 547.0355. (Gov.
  Code, Sec. 531.0993(g).)
         Sec. 547.0359.  INSPECTIONS.  The commission may inspect the
  operation and provision of mental health services provided by a
  community collaborative to ensure state money appropriated for the
  matching grant program is used effectively.  (Gov. Code, Sec.
  531.0993(h).)
         Sec. 547.0360.  ALLOCATING APPROPRIATED MONEY.  (a)  Except
  as provided by Subsection (b), the commission shall reserve at
  least 20 percent of money appropriated to the commission for each
  fiscal year to implement the matching grant program to be awarded
  only as grants to a community collaborative that includes a county
  with a population of less than 250,000.
         (b)  Without regard to the limitation provided by Subsection
  (a) and to the extent money appropriated to the commission for a
  fiscal year to implement this subchapter remains available to the
  commission after the commission has selected grant recipients for
  the fiscal year, the commission shall make grants available through
  a competitive request for proposal process using the remaining
  money for the fiscal year.
         (c)  The commission may use a reasonable amount not to exceed
  five percent of the money appropriated by the legislature for the
  purposes of this subchapter to pay the administrative costs of
  implementing this subchapter.  (Gov. Code, Secs. 531.0993(c-2),
  (f-1), (j).)
  SUBCHAPTER I. MATCHING GRANT PROGRAM FOR COMMUNITY COLLABORATIVE
  IN MOST POPULOUS COUNTY TO REDUCE INVOLVEMENT OF INDIVIDUALS WITH
  MENTAL ILLNESS IN CRIMINAL JUSTICE SYSTEM
         Sec. 547.0401.  DEFINITION. In this subchapter, "matching
  grant program" means the matching grant program established under
  this subchapter. (New.)
         Sec. 547.0402.  MATCHING GRANT PROGRAM. The commission
  shall establish a matching grant program to provide a grant to a
  county-based community collaborative in the most populous county in
  this state to reduce:
               (1)  recidivism by, the frequency of arrests of, and
  incarceration of individuals with mental illness; and
               (2)  the total wait time for forensic commitment of
  individuals with mental illness to a state hospital. (Gov. Code,
  Sec. 531.09935(a).)
         Sec. 547.0403.  MATCHING CONTRIBUTIONS REQUIRED; GRANT
  CONDITIONS. (a) The commission shall condition a grant provided to
  the community collaborative under this subchapter on the
  collaborative providing funds from non-state sources in a total
  amount at least equal to the grant amount.
         (b)  A community collaborative may seek and receive gifts,
  grants, or donations from any person to raise the required funds
  from non-state sources. (Gov. Code, Secs. 531.09935(d), (e).)
         Sec. 547.0404.  COMMUNITY COLLABORATIVE ELIGIBILITY. (a) A
  community collaborative may receive a grant under the matching
  grant program only if the collaborative includes:
               (1)  the county;
               (2)  a local mental health authority operating in the
  county; and
               (3)  each hospital district located in the county.
         (b)  A collaborative may include other local entities
  designated by the collaborative's members. (Gov. Code, Sec.
  531.09935(b).)
         Sec. 547.0405.  DISTRIBUTION OF GRANT. Not later than the
  30th day of each fiscal year, the commission shall make available to
  the community collaborative established in the county described by
  Section 547.0402 a grant in an amount equal to the lesser of:
               (1)  the amount appropriated to the commission for that
  fiscal year for a mental health jail diversion pilot program in that
  county; or
               (2)  the collaborative's available matching funds.
  (Gov. Code, Sec. 531.09935(c).)
         Sec. 547.0406.  USE OF GRANT MONEY AND MATCHING FUNDS.
  Acceptable uses of the grant money and matching funds include:
               (1)  continuing a mental health jail diversion program;
               (2)  establishing or expanding a mental health jail
  diversion program;
               (3)  establishing alternatives to competency
  restoration in a state hospital, including outpatient competency
  restoration, inpatient competency restoration in a setting other
  than a state hospital, or jail-based competency restoration;
               (4)  providing assertive community treatment or
  forensic assertive community treatment with an outreach component;
               (5)  providing intensive mental health services and
  substance use treatment not readily available in the county;
               (6)  providing continuity of care services for an
  individual being released from a state hospital;
               (7)  establishing interdisciplinary rapid response
  teams to reduce law enforcement's involvement with mental health
  emergencies; and
               (8)  providing local community hospital, crisis,
  respite, or residential beds. (Gov. Code, Sec. 531.09935(f).)
         Sec. 547.0407.  REPORT BY COMMUNITY COLLABORATIVE. Not
  later than the 90th day after the last day of the state fiscal year
  for which the commission distributes a grant under this subchapter,
  the grant recipient shall prepare and submit a report to the
  commission describing the effect of the grant money and matching
  funds in fulfilling the purpose described by Section 547.0402.
  (Gov. Code, Sec. 531.09935(g).)
         Sec. 547.0408.  INSPECTIONS. The commission may inspect the
  operation and provision of mental health services provided by the
  community collaborative to ensure state money appropriated for the
  matching grant program is used effectively. (Gov. Code, Sec. 531.09935(h).)
 
  CHAPTER 547A.  COMMUNITY COLLABORATIVES
  Sec. 547A.0001.  GRANTS FOR ESTABLISHING AND EXPANDING
                    COMMUNITY COLLABORATIVES
  Sec. 547A.0002.  ACCEPTABLE USES OF GRANT MONEY
  Sec. 547A.0003.  ELEMENTS OF COMMUNITY COLLABORATIVES
  Sec. 547A.0004.  OUTCOME MEASURES FOR COMMUNITY
                    COLLABORATIVES
  Sec. 547A.0005.  PLAN REQUIRED FOR CERTAIN COMMUNITY
                    COLLABORATIVES
  Sec. 547A.0006.  ANNUAL REVIEW OF OUTCOME MEASURES
  Sec. 547A.0007.  REDUCTION AND CESSATION OF FUNDING
  Sec. 547A.0008.  RULES
  Sec. 547A.0009.  ADMINISTRATIVE COSTS
  CHAPTER 547A.  COMMUNITY COLLABORATIVES
         Sec. 547A.0001.  GRANTS FOR ESTABLISHING AND EXPANDING
  COMMUNITY COLLABORATIVES. (a) To the extent funds are
  appropriated to the commission for that purpose, the commission
  shall make grants to entities, including local governmental
  entities, nonprofit community organizations, and faith-based
  community organizations, to establish or expand community
  collaboratives that bring the public and private sectors together
  to provide services to individuals experiencing homelessness,
  substance use issues, or mental illness. In awarding grants, the
  commission shall give special consideration to entities:
               (1)  establishing new collaboratives; or
               (2)  establishing or expanding collaboratives that
  serve two or more counties, each with a population of less than
  100,000.
         (b)  Except as provided by Subsection (c), the commission
  shall require each entity awarded a grant under this section to:
               (1)  leverage additional funding or in-kind
  contributions from private contributors or local governments,
  excluding state or federal funds, in an amount that is at least
  equal to the amount of the grant awarded under this section;
               (2)  provide evidence of significant coordination and
  collaboration between the entity, local mental health authorities,
  municipalities, local law enforcement agencies, and other
  community stakeholders in establishing or expanding a community
  collaborative funded by a grant awarded under this section; and
               (3)  provide evidence of a local law enforcement policy
  to divert appropriate individuals from jails or other detention
  facilities to an entity affiliated with a community collaborative
  for the purpose of providing services to those individuals.
         (c)  The commission may award a grant under this section to
  an entity for the purpose of establishing a community mental health
  program in a county with a population of less than 250,000, if the
  entity leverages additional funding or in-kind contributions from
  private contributors or local governments, excluding state or
  federal funds, in an amount equal to one-quarter of the grant amount
  to be awarded under this section, and the entity otherwise meets the
  requirements of Subsections (b)(2) and (3).  (Gov. Code, Sec.
  539.002.)
         Sec. 547A.0002.  ACCEPTABLE USES OF GRANT MONEY.  An entity
  shall use money received from a grant made by the commission and
  private funding sources to establish or expand a community
  collaborative. Acceptable uses for the money include:
               (1)  developing the infrastructure of the
  collaborative and the start-up costs of the collaborative;
               (2)  establishing, operating, or maintaining other
  community service providers in the community the collaborative
  serves, including intake centers, detoxification units, sheltering
  centers for food, workforce training centers, microbusinesses, and
  educational centers;
               (3)  providing clothing, hygiene products, and medical
  services to and arranging transitional and permanent residential
  housing for individuals the collaborative serves;
               (4)  providing mental health services and substance use
  treatment not readily available in the community the collaborative
  serves;
               (5)  providing information, tools, and resource
  referrals to assist individuals the collaborative serves in
  addressing the needs of their children; and
               (6)  establishing and operating coordinated intake
  processes, including triage procedures, to protect public safety in
  the community the collaborative serves. (Gov. Code, Sec. 539.003.)
         Sec. 547A.0003.  ELEMENTS OF COMMUNITY COLLABORATIVES. (a)
  If appropriate, an entity may incorporate into the community
  collaborative the entity operates the use of the homeless
  management information system, transportation plans, and case
  managers. An entity may also consider incorporating into a
  collaborative mentoring and volunteering opportunities, strategies
  to assist homeless youth and homeless families with children,
  strategies to reintegrate individuals who were recently
  incarcerated into the community, services for veterans, and
  strategies for individuals the collaborative serves to participate
  in the planning, governance, and oversight of the collaborative.
         (b)  The focus of a community collaborative shall be the
  eventual successful transition of individuals from receiving
  services from the collaborative to becoming integrated into the
  community the collaborative serves through community relationships
  and family supports. (Gov. Code, Sec. 539.004.)
         Sec. 547A.0004.  OUTCOME MEASURES FOR COMMUNITY
  COLLABORATIVES.  Each entity that receives a grant from the
  commission to establish or expand a community collaborative shall
  select at least four of the following outcome measures that the
  entity will focus on meeting through implementing and operating the
  collaborative:
               (1)  individuals the collaborative serves finding
  employment that results in those individuals having incomes that
  are at or above 100 percent of the federal poverty level;
               (2)  individuals the collaborative serves finding
  permanent housing;
               (3)  individuals the collaborative serves completing
  alcohol or substance use programs;
               (4)  the collaborative helping to start social
  businesses in the community or engaging in job creation, job
  training, or other workforce development activities;
               (5)  a decrease in the use of jail beds by individuals
  the collaborative serves;
               (6)  a decrease in the need for emergency care by
  individuals the collaborative serves;
               (7)  a decrease in the number of children whose
  families lack adequate housing referred to the Department of Family
  and Protective Services or a local entity responsible for child
  welfare; and
               (8)  any other appropriate outcome measure the
  commission approves that measures whether a collaborative is
  meeting a specific need of the community the collaborative serves.  
  (Gov. Code, Sec. 539.005.)
         Sec. 547A.0005.  PLAN REQUIRED FOR CERTAIN COMMUNITY
  COLLABORATIVES. (a) The governing body of a county shall develop
  and make public a plan detailing the method by which:
               (1)  local mental health authorities, municipalities,
  local law enforcement agencies, and other community stakeholders in
  the county may coordinate to establish or expand a community
  collaborative to accomplish the goals of Section 547A.0001;
               (2)  entities in the county may leverage funding from
  private sources to accomplish the goals of Section 547A.0001
  through the formation or expansion of a community collaborative;
  and
               (3)  the formation or expansion of a community
  collaborative may establish or support resources or services to
  help local law enforcement agencies to divert individuals who have
  been arrested to appropriate mental health care or substance use
  treatment.
         (b)  The governing body of a county in which an entity that
  received a grant under former Section 539.002 before September 1,
  2017, is located is not required to develop a plan under Subsection
  (a).
         (c)  Two or more counties, each with a population of less
  than 100,000, may form a joint plan under Subsection (a). (Gov.
  Code, Sec. 539.0051.)
         Sec. 547A.0006.  ANNUAL REVIEW OF OUTCOME MEASURES.  The
  commission shall contract with an independent third party to verify
  annually whether a community collaborative is meeting the outcome
  measures the entity that operates the collaborative selects under
  Section 547A.0004.  (Gov. Code, Sec. 539.006.)
         Sec. 547A.0007.  REDUCTION AND CESSATION OF FUNDING.  The
  commission shall establish processes by which the commission may
  reduce or cease providing funding to an entity if the community
  collaborative the entity operates does not meet the outcome
  measures the entity for the collaborative selects under Section
  547A.0004. The commission shall redistribute on a competitive
  basis any funds withheld from an entity under this section to other
  entities operating high-performing collaboratives.  (Gov. Code,
  Sec. 539.007.)
         Sec. 547A.0008.  RULES.  The executive commissioner shall
  adopt any rules necessary to implement the community collaborative
  grant program established under this chapter, including rules
  establishing:
               (1)  the requirements for an entity to be eligible to
  receive a grant;
               (2)  the required elements of a community collaborative
  an entity operates; and
               (3)  permissible and prohibited uses of money an entity
  receives from a grant the commission makes.  (Gov. Code, Sec.
  539.008.)
         Sec. 547A.0009.  ADMINISTRATIVE COSTS.  The commission may
  use a reasonable amount not to exceed five percent of the money the
  legislature appropriates for the purposes of this chapter to pay
  administrative costs of implementing this chapter.  (Gov. Code, Sec. 539.009.)
 
  CHAPTER 548. HEALTH CARE SERVICES PROVIDED THROUGH TELE-CONNECTIVE
  MEANS
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 548.0001.  PROVISION OF SERVICES THROUGH
                   TELECOMMUNICATIONS AND INFORMATION
                   TECHNOLOGY UNDER MEDICAID AND OTHER
                   PUBLIC BENEFITS PROGRAMS
  Sec. 548.0002.  RULES AND PROCEDURES REGARDING
                   REIMBURSING CERTAIN TELEMEDICINE
                   MEDICAL SERVICES
  SUBCHAPTER B. TELEMEDICINE MEDICAL, TELEDENTISTRY DENTAL,
  TELEHEALTH, AND HOME TELEMONITORING SERVICES PROVIDED UNDER
  MEDICAID IN GENERAL
  Sec. 548.0051.  MEDICAID REIMBURSEMENT SYSTEM FOR
                   TELEMEDICINE MEDICAL, TELEDENTISTRY
                   DENTAL, AND TELEHEALTH SERVICES
  Sec. 548.0052.  REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
                   TELEDENTISTRY DENTAL, OR TELEHEALTH
                   SERVICE BY MEDICAID MANAGED CARE
                   ORGANIZATION
  Sec. 548.0053.  REIMBURSEMENT OF FEDERALLY QUALIFIED
                   HEALTH CENTERS FOR TELEMEDICINE
                   MEDICAL, TELEDENTISTRY DENTAL, OR
                   TELEHEALTH SERVICE
  Sec. 548.0054.  PROVIDER AND FACILITY PARTICIPATION
  Sec. 548.0055.  PROMOTION AND SUPPORT OF MEDICAL HOME
                   AND CARE COORDINATION
  Sec. 548.0056.  BIENNIAL REPORT
  Sec. 548.0057.  RULES
  SUBCHAPTER C. PROVISION OF AND REIMBURSEMENT FOR TELEMEDICINE
  MEDICAL AND TELEHEALTH SERVICES IN GENERAL
  Sec. 548.0101.  DEFINITIONS
  Sec. 548.0102.  MEDICAID REIMBURSEMENT REQUIREMENTS:
                   TELEMEDICINE MEDICAL SERVICES
  Sec. 548.0103.  PHYSICIAN'S CHOICE OF PLATFORM
  Sec. 548.0104.  CERTAIN TELEMEDICINE MEDICAL SERVICE
                   REIMBURSEMENT DENIALS PROHIBITED
  Sec. 548.0105.  PROTOCOLS AND GUIDELINES
  Sec. 548.0106.  PROVIDER COORDINATION
  Sec. 548.0107.  COMPLIANCE
  Sec. 548.0108.  TEXAS MEDICAL BOARD RULES
  Sec. 548.0109.  EFFECT ON OTHER REQUIREMENTS
  SUBCHAPTER D. PROVISION OF AND REIMBURSEMENT FOR TELEDENTISTRY
  DENTAL SERVICES IN GENERAL
  Sec. 548.0151.  MEDICAID REIMBURSEMENT REQUIREMENTS
  Sec. 548.0152.  DENTIST'S CHOICE OF PLATFORM
  Sec. 548.0153.  CERTAIN TELEDENTISTRY DENTAL SERVICES
                   REIMBURSEMENT DENIALS PROHIBITED
  Sec. 548.0154.  STATE BOARD OF DENTAL EXAMINERS RULES
  SUBCHAPTER E. REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
  TELEDENTISTRY DENTAL, AND TELEHEALTH SERVICES PROVIDED TO CERTAIN
  CHILDREN
  Sec. 548.0201.  REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
                   TELEDENTISTRY DENTAL, AND TELEHEALTH
                   SERVICES PROVIDED TO CHILDREN WITH
                   SPECIAL HEALTH CARE NEEDS
  Sec. 548.0202.  MEDICAID REIMBURSEMENT FOR TELEMEDICINE
                   MEDICAL SERVICES PROVIDED IN
                   SCHOOL-BASED SETTING
  Sec. 548.0203.  MEDICAID REIMBURSEMENT FOR TELEHEALTH
                   SERVICES PROVIDED THROUGH SCHOOL
                   DISTRICT OR CHARTER SCHOOL
  SUBCHAPTER F. MEDICAID REIMBURSEMENT FOR HOME TELEMONITORING
  SERVICES
  Sec. 548.0251.  DEFINITIONS
  Sec. 548.0252.  MEDICAID REIMBURSEMENT PROGRAM FOR HOME
                   TELEMONITORING SERVICES AUTHORIZED
  Sec. 548.0253.  REIMBURSEMENT PROGRAM REQUIREMENTS
  Sec. 548.0254.  DISCONTINUATION OF REIMBURSEMENT
                   PROGRAM UNDER CERTAIN CIRCUMSTANCES
  Sec. 548.0255.  DETERMINATION OF COST SAVINGS FOR
                   MEDICARE PROGRAM
  Sec. 548.0256.  REIMBURSEMENT FOR OTHER CONDITIONS AND
                   RISK FACTORS
  SUBCHAPTER G. MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL
  CONSULTATIONS
  Sec. 548.0301.  DEFINITION
  Sec. 548.0302.  MEDICAID REIMBURSEMENT FOR INTERNET
                   MEDICAL CONSULTATION AUTHORIZED
  Sec. 548.0303.  PILOT PROGRAM FOR MEDICAID
                   REIMBURSEMENT FOR INTERNET MEDICAL
                   CONSULTATION
  SUBCHAPTER H. PEDIATRIC TELE-CONNECTIVITY RESOURCE PROGRAM FOR
  RURAL TEXAS
  Sec. 548.0351.  DEFINITIONS
  Sec. 548.0352.  ESTABLISHMENT OF PEDIATRIC
                   TELE-CONNECTIVITY RESOURCE PROGRAM
                   FOR RURAL TEXAS
  Sec. 548.0353.  USE OF PROGRAM GRANT
  Sec. 548.0354.  SELECTION OF PROGRAM GRANT RECIPIENTS
  Sec. 548.0355.  GIFTS, GRANTS, AND DONATIONS
  Sec. 548.0356.  WORK GROUP
  Sec. 548.0357.  BIENNIAL REPORT
  Sec. 548.0358.  RULES
  Sec. 548.0359.  APPROPRIATION REQUIRED
  SUBCHAPTER I. TELEHEALTH TREATMENT PROGRAM FOR SUBSTANCE USE
  DISORDERS
  Sec. 548.0401.  TELEHEALTH TREATMENT PROGRAM FOR
                   SUBSTANCE USE DISORDERS
  CHAPTER 548. HEALTH CARE SERVICES PROVIDED THROUGH TELE-CONNECTIVE
  MEANS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 548.0001.  PROVISION OF SERVICES THROUGH
  TELECOMMUNICATIONS AND INFORMATION TECHNOLOGY UNDER MEDICAID AND
  OTHER PUBLIC BENEFITS PROGRAMS. (a) In this section:
               (1)  "Behavioral health services" has the meaning
  assigned by Section 540.0703.
               (2)  "Case management services" includes service
  coordination, service management, and care coordination.
         (b)  To the extent permitted by federal law and to the extent
  it is cost-effective and clinically effective, as the commission
  determines, the commission shall ensure that Medicaid recipients,
  child health plan program enrollees, and other individuals
  receiving benefits under a public benefits program the commission
  or a health and human services agency administers, regardless of
  whether receiving benefits through a managed care delivery model or
  another delivery model, have the option to receive services as
  telemedicine medical services, telehealth services, or otherwise
  using telecommunications or information technology, including the
  following services:
               (1)  preventive health and wellness services;
               (2)  case management services, including targeted case
  management services;
               (3)  subject to Subsection (c), behavioral health
  services;
               (4)  occupational, physical, and speech therapy
  services;
               (5)  nutritional counseling services; and
               (6)  assessment services, including nursing
  assessments under the following Section 1915(c) waiver programs:
                     (A)  the community living assistance and support
  services (CLASS) waiver program;
                     (B)  the deaf-blind with multiple disabilities
  (DBMD) waiver program;
                     (C)  the home and community-based services (HCS)
  waiver program; and
                     (D)  the Texas home living (TxHmL) waiver program.
         (c)  To the extent permitted by state and federal law and to
  the extent it is cost-effective and clinically effective, as the
  commission determines, the executive commissioner by rule shall
  develop and implement a system that ensures behavioral health
  services may be provided using an audio-only platform consistent
  with Section 111.008, Occupations Code, to a Medicaid recipient, a
  child health plan program enrollee, or another individual receiving
  those services under another public benefits program the commission
  or a health and human services agency administers.
         (d)  If the executive commissioner determines that providing
  services other than behavioral health services is appropriate using
  an audio-only platform under a public benefits program the
  commission or a health and human services agency administers, in
  accordance with applicable federal and state law, the executive
  commissioner may by rule authorize the provision of those services
  under the applicable program using the audio-only platform. In
  determining whether the use of an audio-only platform in a program
  is appropriate under this subsection, the executive commissioner
  shall consider whether using the platform would be cost-effective
  and clinically effective. (Gov. Code, Sec. 531.02161.)
         Sec. 548.0002.  RULES AND PROCEDURES REGARDING REIMBURSING
  CERTAIN TELEMEDICINE MEDICAL SERVICES. (a) In addition to the
  authority granted by other law regarding telemedicine medical
  services, the executive commissioner may review rules and
  procedures applicable to reimbursement of a telemedicine medical
  service provided through any government-funded health program
  subject to the commission's oversight. The executive commissioner
  may modify the rules and procedures as necessary to ensure that
  reimbursement for a telemedicine medical service is provided:
               (1)  in a cost-effective manner; and
               (2)  only in circumstances in which providing the
  service is clinically effective.
         (b)  This section does not affect the commission's authority
  or duties under other law regarding reimbursing a telemedicine
  medical service under Medicaid. (Gov. Code, Sec. 531.02174.)
  SUBCHAPTER B. TELEMEDICINE MEDICAL, TELEDENTISTRY DENTAL,
  TELEHEALTH, AND HOME TELEMONITORING SERVICES PROVIDED UNDER
  MEDICAID IN GENERAL
         Sec. 548.0051.  MEDICAID REIMBURSEMENT SYSTEM FOR
  TELEMEDICINE MEDICAL, TELEDENTISTRY DENTAL, AND TELEHEALTH
  SERVICES. The executive commissioner by rule shall develop and
  implement a system to reimburse Medicaid providers for telemedicine
  medical services, teledentistry dental services, or telehealth
  services performed. (Gov. Code, Sec. 531.0216(a).)
         Sec. 548.0052.  REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
  TELEDENTISTRY DENTAL, OR TELEHEALTH SERVICE BY MEDICAID MANAGED
  CARE ORGANIZATION. (a) The commission shall ensure that a Medicaid
  managed care organization does not:
               (1)  deny reimbursement for a covered health care
  service or procedure delivered by a health care provider with whom
  the organization contracts to a Medicaid recipient as a
  telemedicine medical service, teledentistry dental service, or
  telehealth service solely because the covered service or procedure
  is not provided through an in-person consultation; or
               (2)  limit, deny, or reduce reimbursement for a covered
  health care service or procedure delivered by a health care
  provider with whom the organization contracts to a Medicaid
  recipient as a telemedicine medical service, teledentistry dental
  service, or telehealth service based on the provider's choice of
  platform for providing the health care service or procedure.
         (b)  In complying with state and federal requirements to
  provide access to medically necessary services under the Medicaid
  managed care program, a Medicaid managed care organization
  determining whether reimbursement for a telemedicine medical
  service, teledentistry dental service, or telehealth service is
  appropriate shall continue to consider other factors, including
  whether:
               (1)  reimbursement is cost-effective; and
               (2)  providing the service is clinically effective.
  (Gov. Code, Secs. 531.0216(g) (part), (j).)
         Sec. 548.0053.  REIMBURSEMENT OF FEDERALLY QUALIFIED HEALTH
  CENTERS FOR TELEMEDICINE MEDICAL, TELEDENTISTRY DENTAL, OR
  TELEHEALTH SERVICE. (a) Subject to Subsection (b), the executive
  commissioner by rule shall ensure that a rural health clinic as
  defined by 42 U.S.C. Section 1396d(l)(1) and a federally qualified
  health center as defined by 42 U.S.C. Section 1396d(l)(2)(B) may be
  reimbursed for the originating site facility fee or the distant
  site practitioner fee or both, as appropriate, for a covered
  telemedicine medical service, teledentistry dental service, or
  telehealth service delivered by a health care provider to a
  Medicaid recipient.
         (b)  The commission is required to implement this section
  only if the legislature appropriates money specifically for that
  purpose. If the legislature does not appropriate money specifically
  for that purpose, the commission may, but is not required to,
  implement this section using other money available to the
  commission for that purpose. (Gov. Code, Sec. 531.0216(i).)
         Sec. 548.0054.  PROVIDER AND FACILITY PARTICIPATION. (a)
  The commission shall encourage health care providers and health
  care facilities to provide telemedicine medical services,
  teledentistry dental services, and telehealth services in the
  health care delivery system.  The commission may not require that a
  service be provided to a patient through telemedicine medical
  services, teledentistry dental services, or telehealth services.
         (b)  The commission shall explore opportunities to increase
  STAR Health program providers' use of telemedicine medical services
  in medically underserved areas of this state. (Gov. Code, Secs.
  531.0216(c), (c-1).)
         Sec. 548.0055.  PROMOTION AND SUPPORT OF MEDICAL HOME AND
  CARE COORDINATION. (a) The commission shall ensure that a Medicaid
  managed care organization ensures that using telemedicine medical
  services, teledentistry dental services, or telehealth services
  promotes and supports patient-centered medical homes by allowing a
  Medicaid recipient to receive a telemedicine medical service,
  teledentistry dental service, or telehealth service from a provider
  other than the recipient's primary care physician or provider,
  except as provided by Section 548.0202(b), only if:
               (1)  the service is provided in accordance with the law
  and contract requirements applicable to providing the same health
  care service in an in-person setting, including requirements
  regarding care coordination; and
               (2)  subject to Subsection (b), the provider of the
  service gives notice to the Medicaid recipient's primary care
  physician or provider regarding the service, including a summary of
  the service, exam findings, a list of prescribed or administered
  medications, and patient instructions, for the purpose of sharing
  medical information.
         (b)  A provider of a telemedicine medical service,
  teledentistry dental service, or telehealth service is required to
  provide notice under Subsection (a)(2) only if:
               (1)  the recipient has a primary care physician or
  provider; and
               (2)  the recipient or, if appropriate, the recipient's
  parent or legal guardian, consents to the notice.
         (c)  The commission shall develop, document, and implement a
  monitoring process to ensure that a Medicaid managed care
  organization ensures that using telemedicine medical services,
  teledentistry dental services, or telehealth services promotes and
  supports patient-centered medical homes and care coordination in
  accordance with Subsection (a). The process must include
  monitoring of the rate at which a telemedicine medical service,
  teledentistry dental service, or telehealth service provider gives
  notice in accordance with Subsection (a)(2). (Gov. Code, Secs.
  531.0216(g) (part), (h).)
         Sec. 548.0056.  BIENNIAL REPORT. Not later than December 1
  of each even-numbered year, the commission shall report to the
  speaker of the house of representatives and the lieutenant governor
  on the effects of telemedicine medical services, teledentistry
  dental services, telehealth services, and home telemonitoring
  services on Medicaid in this state, including:
               (1)  the number of physicians, dentists, health
  professionals, and licensed health care facilities using the
  services;
               (2)  the geographic and demographic disposition of the
  physicians, dentists, and health professionals;
               (3)  the number of patients receiving the services;
               (4)  the types of services being provided;
               (5)  the utilization cost; and
               (6)  the cost savings to Medicaid from using the
  services. (Gov. Code, Sec. 531.0216(f).)
         Sec. 548.0057.  RULES. Subject to Sections 111.004 and
  153.004, Occupations Code, the executive commissioner may adopt
  rules as necessary to implement this subchapter. In the rules
  adopted under this subchapter, the executive commissioner shall
  refer to:
               (1)  the site where the patient is physically located
  as the patient site; and
               (2)  the site where the physician, dentist, or health
  professional providing the telemedicine medical service,
  teledentistry dental service, or telehealth service is physically
  located as the distant site. (Gov. Code, Sec. 531.0216(d).)
  SUBCHAPTER C. PROVISION OF AND REIMBURSEMENT FOR TELEMEDICINE
  MEDICAL AND TELEHEALTH SERVICES IN GENERAL
         Sec. 548.0101.  DEFINITIONS. In this subchapter:
               (1)  "Health professional" means:
                     (A)  a physician;
                     (B)  an individual who is:
                           (i)  licensed or certified in this state to
  perform health care services; and
                           (ii)  authorized to assist a physician in
  providing telemedicine medical services that are delegated and
  supervised by the physician; or
                     (C)  a licensed or certified health professional
  acting within the scope of the license or certification who does not
  perform a telemedicine medical service.
               (2)  "Physician" means an individual licensed to
  practice medicine in this state under Subtitle B, Title 3,
  Occupations Code. (Gov. Code, Sec. 531.0217(a).)
         Sec. 548.0102.  MEDICAID REIMBURSEMENT REQUIREMENTS:
  TELEMEDICINE MEDICAL SERVICES. (a) The executive commissioner by
  rule shall require each health and human services agency that
  administers a part of Medicaid to provide Medicaid reimbursement
  for a telemedicine medical service initiated or provided by a
  physician.
         (b)  The commission shall ensure that reimbursement is
  provided only for a telemedicine medical service a physician
  initiates or provides.
         (c)  The commission shall require reimbursement for a
  telemedicine medical service at the same rate Medicaid reimburses
  for the same in-person medical service. (Gov. Code, Secs.
  531.0217(b), (c), (d) (part).)
         Sec. 548.0103.  PHYSICIAN'S CHOICE OF PLATFORM. The
  commission may not limit a physician's choice of platform for
  providing a telemedicine medical service or telehealth service by
  requiring that the physician use a particular platform to receive
  Medicaid reimbursement for the service. (Gov. Code, Sec.
  531.0217(d) (part).)
         Sec. 548.0104.  CERTAIN TELEMEDICINE MEDICAL SERVICE
  REIMBURSEMENT DENIALS PROHIBITED.  A request for Medicaid
  reimbursement for a telemedicine medical service may not be denied
  solely because an in-person medical service between a physician and
  a patient did not occur. (Gov. Code, Sec. 531.0217(d) (part).)
         Sec. 548.0105.  PROTOCOLS AND GUIDELINES. A health care
  facility that receives reimbursement under this subchapter for a
  telemedicine medical service provided by a physician who practices
  in that facility or a health professional who participates in a
  telemedicine medical service under this subchapter shall establish
  quality of care protocols and patient confidentiality guidelines to
  ensure that the telemedicine medical service meets legal
  requirements and acceptable patient care standards. (Gov. Code,
  Sec. 531.0217(e).)
         Sec. 548.0106.  PROVIDER COORDINATION. If a patient
  receiving a telemedicine medical service has a primary care
  physician or provider and the patient or, if appropriate, the
  patient's parent or legal guardian consents to the notification,
  the commission shall require that the primary care physician or
  provider be notified of the telemedicine medical service for the
  purpose of sharing medical information. (Gov. Code, Sec.
  531.0217(g) (part).)
         Sec. 548.0107.  COMPLIANCE. The commission in consultation
  with the Texas Medical Board shall monitor and regulate the use of
  telemedicine medical services to ensure compliance with this
  subchapter. In addition to any other method of enforcement, the
  commission may use a corrective action plan to ensure compliance
  with this subchapter. (Gov. Code, Sec. 531.0217(h).)
         Sec. 548.0108.  TEXAS MEDICAL BOARD RULES. The Texas
  Medical Board, in consultation with the commission, as appropriate,
  may adopt rules as necessary to:
               (1)  ensure that appropriate care, including quality of
  care, is provided to patients who receive telemedicine medical
  services; and
               (2)  prevent abuse and fraud through the use of
  telemedicine medical services, including rules relating to filing
  claims and records required to be maintained in connection with
  telemedicine. (Gov. Code, Sec. 531.0217(i).)
         Sec. 548.0109.  EFFECT ON OTHER REQUIREMENTS. This
  subchapter does not affect any requirement relating to:
               (1)  a rural health clinic; or
               (2)  physician delegation to an advanced practice nurse
  or physician assistant of the authority to carry out or sign
  prescription drug orders. (Gov. Code, Sec. 531.0217(k).)
  SUBCHAPTER D. PROVISION OF AND REIMBURSEMENT FOR TELEDENTISTRY
  DENTAL SERVICES IN GENERAL
         Sec. 548.0151.  MEDICAID REIMBURSEMENT REQUIREMENTS. (a)
  The executive commissioner by rule shall require each health and
  human services agency that administers a part of Medicaid to
  provide Medicaid reimbursement for teledentistry dental services
  provided by a dentist licensed to practice dentistry in this state.
         (b)  The commission shall require reimbursement for a
  teledentistry dental service at the same rate as the Medicaid
  program reimburses for the same in-person dental service.  (Gov.
  Code, Secs. 531.02172(a), (b) (part).)
         Sec. 548.0152.  DENTIST'S CHOICE OF PLATFORM. The
  commission may not limit a dentist's choice of platform for
  providing a teledentistry dental service by requiring that the
  dentist use a particular platform to receive reimbursement for the
  service.  (Gov. Code, Sec. 531.02172(b) (part).)
         Sec. 548.0153.  CERTAIN TELEDENTISTRY DENTAL SERVICES
  REIMBURSEMENT DENIALS PROHIBITED. A request for reimbursement may
  not be denied solely because an in-person dental service between a
  dentist and a patient did not occur. (Gov. Code, Sec. 531.02172(b)
  (part).)
         Sec. 548.0154.  STATE BOARD OF DENTAL EXAMINERS RULES. The
  State Board of Dental Examiners, in consultation with the
  commission and the commission's office of inspector general, as
  appropriate, may adopt rules as necessary to:
               (1)  ensure that appropriate care, including quality of
  care, is provided to patients who receive teledentistry dental
  services; and
               (2)  prevent abuse and fraud through the use of
  teledentistry dental services, including rules relating to filing
  claims and the records required to be maintained in connection with
  teledentistry dental services. (Gov. Code, Sec. 531.02172(c).)
  SUBCHAPTER E. REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
  TELEDENTISTRY DENTAL, AND TELEHEALTH SERVICES PROVIDED TO CERTAIN
  CHILDREN
         Sec. 548.0201.  REIMBURSEMENT FOR TELEMEDICINE MEDICAL,
  TELEDENTISTRY DENTAL, AND TELEHEALTH SERVICES PROVIDED TO CHILDREN
  WITH SPECIAL HEALTH CARE NEEDS. (a) In this section, "child with
  special health care needs" has the meaning assigned by Section
  35.0022, Health and Safety Code.
         (b)  The executive commissioner by rule shall establish
  policies that permit reimbursement under Medicaid and the child
  health plan program for services provided through telemedicine
  medical services, teledentistry dental services, and telehealth
  services to children with special health care needs.
         (c)  The policies required under this section must:
               (1)  be designed to:
                     (A)  prevent unnecessary travel and encourage
  efficient use of telemedicine medical services, teledentistry
  dental services, and telehealth services for children with special
  health care needs in all suitable circumstances; and
                     (B)  ensure in a cost-effective manner the
  availability to a child with special health care needs of services
  appropriately performed using telemedicine medical services,
  teledentistry dental services, and telehealth services that are
  comparable to the same types of services available to that child
  without using telemedicine medical services, teledentistry dental
  services, and telehealth services; and
               (2)  provide for reimbursement of multiple providers of
  different services who participate in a single session of
  telemedicine medical services, teledentistry dental services,
  telehealth services, or any combination of those services for a
  child with special health care needs, if the commission determines
  that reimbursing each provider for the session is cost-effective in
  comparison to the costs that would be involved in obtaining the
  services from providers without using telemedicine medical
  services, teledentistry dental services, and telehealth services,
  including the costs of transportation and lodging and other direct
  costs. (Gov. Code, Sec. 531.02162.)
         Sec. 548.0202.  MEDICAID REIMBURSEMENT FOR TELEMEDICINE
  MEDICAL SERVICES PROVIDED IN SCHOOL-BASED SETTING. (a) In this
  section, "physician" means an individual licensed to practice
  medicine in this state under Subtitle B, Title 3, Occupations Code.
         (b)  The commission shall ensure that Medicaid reimbursement
  is provided to a physician for a telemedicine medical service
  provided by the physician, even if the physician is not the
  patient's primary care physician or provider, if:
               (1)  the physician is an authorized Medicaid health
  care provider;
               (2)  the patient is a child who receives the service in
  a primary or secondary school-based setting; and
               (3)  the parent or legal guardian of the patient
  provides consent before the service is provided.
         (c)  In the case of a telemedicine medical service provided
  to a child in a school-based setting as described by Subsection (b),
  the notification under Section 548.0106, if any, must include a
  summary of the service, including exam findings, prescribed or
  administered medications, and patient instructions.
         (d)  If a patient receiving a telemedicine medical service in
  a school-based setting as described by Subsection (b) does not have
  a primary care physician or provider, the commission shall require
  that the patient's parent or legal guardian receive:
               (1)  the notification required under Section 548.0106;
  and
               (2)  a list of primary care physicians or providers
  from which the patient may select the patient's primary care
  physician or provider.
         (e)  The commission in consultation with the Texas Medical
  Board shall monitor and regulate the use of telemedicine medical
  services to ensure compliance with this section. In addition to any
  other method of enforcement, the commission may use a corrective
  action plan to ensure compliance with this section.
         (f)  The Texas Medical Board, in consultation with the
  commission, as appropriate, may adopt rules as necessary to:
               (1)  ensure that appropriate care, including quality of
  care, is provided to patients who receive telemedicine medical
  services; and
               (2)  prevent abuse and fraud through the use of
  telemedicine medical services, including rules relating to filing
  of claims and records required to be maintained in connection with
  telemedicine.
         (g)  This section does not affect any requirement relating
  to:
               (1)  a rural health clinic; or
               (2)  physician delegation to an advanced practice nurse
  or physician assistant of the authority to carry out or sign
  prescription drug orders. (Gov. Code, Secs. 531.0217(a)(2), (c-4),
  (g) (part), (g-1), (h), (i), (k).)
         Sec. 548.0203.  MEDICAID REIMBURSEMENT FOR TELEHEALTH
  SERVICES PROVIDED THROUGH SCHOOL DISTRICT OR CHARTER SCHOOL. (a)
  In this section, "health professional" means an individual who is:
               (1)  licensed, registered, certified, or otherwise
  authorized by this state to practice as a social worker,
  occupational therapist, or speech-language pathologist;
               (2)  a licensed professional counselor;
               (3)  a licensed marriage and family therapist; or
               (4)  a licensed specialist in school psychology.
         (b)  The commission shall ensure that Medicaid reimbursement
  is provided to a school district or open-enrollment charter school
  for telehealth services provided through the school district or
  charter school by a health professional, even if the health
  professional is not the patient's primary care provider, if:
               (1)  the school district or charter school is an
  authorized Medicaid health care provider; and
               (2)  the parent or legal guardian of the patient
  provides consent before the service is provided. (Gov. Code, Sec.
  531.02171.)
  SUBCHAPTER F. MEDICAID REIMBURSEMENT FOR HOME TELEMONITORING
  SERVICES
         Sec. 548.0251.  DEFINITIONS. In this subchapter:
               (1)  "Home and community support services agency" means
  a person licensed under Chapter 142, Health and Safety Code, to
  provide home health, hospice, or personal assistance services as
  those terms are defined by Section 142.001, Health and Safety Code.
               (2)  "Hospital" means a hospital licensed under Chapter
  241, Health and Safety Code. (Gov. Code, Sec. 531.02164(a).)
         Sec. 548.0252.  MEDICAID REIMBURSEMENT PROGRAM FOR HOME
  TELEMONITORING SERVICES AUTHORIZED. If the commission determines
  that establishing a statewide program that permits Medicaid
  reimbursement for home telemonitoring services would be
  cost-effective and feasible, the executive commissioner by rule
  shall establish the program as provided by this subchapter.  (Gov.
  Code, Sec. 531.02164(b).)
         Sec. 548.0253.  REIMBURSEMENT PROGRAM REQUIREMENTS. (a) A
  program established under this subchapter must:
               (1)  provide that home telemonitoring services are
  available only to an individual who:
                     (A)  is diagnosed with one or more of the
  following conditions:
                           (i)  pregnancy;
                           (ii)  diabetes;
                           (iii)  heart disease;
                           (iv)  cancer;
                           (v)  chronic obstructive pulmonary disease;
                           (vi)  hypertension;
                           (vii)  congestive heart failure;
                           (viii)  mental illness or serious emotional
  disturbance;
                           (ix)  asthma;
                           (x)  myocardial infarction; or
                           (xi)  stroke; and
                     (B)  exhibits two or more of the following risk
  factors:
                           (i)  two or more hospitalizations in the
  prior 12-month period;
                           (ii)  frequent or recurrent emergency room
  admissions;
                           (iii)  a documented history of poor
  adherence to ordered medication regimens;
                           (iv)  a documented history of falls in the
  prior six-month period;
                           (v)  limited or absent informal support
  systems;
                           (vi)  living alone or being home alone for
  extended periods; and
                           (vii)  a documented history of care access
  challenges;
               (2)  ensure that clinical information gathered by a
  home and community support services agency or hospital while
  providing home telemonitoring services is shared with the patient's
  physician; and
               (3)  ensure that the program does not duplicate disease
  management program services provided under Section 32.057, Human
  Resources Code.
         (b)  Notwithstanding Subsection (a)(1), a program
  established under this subchapter must also provide that home
  telemonitoring services are available to pediatric individuals
  who:
               (1)  are diagnosed with end-stage solid organ disease;
               (2)  have received an organ transplant; or
               (3)  require mechanical ventilation.  (Gov. Code, Secs.
  531.02164(c), (c-1).)
         Sec. 548.0254.  DISCONTINUATION OF REIMBURSEMENT PROGRAM
  UNDER CERTAIN CIRCUMSTANCES. If, after implementation, the
  commission determines that the program established under this
  subchapter is not cost-effective, the commission may discontinue
  the program and stop providing Medicaid reimbursement for home
  telemonitoring services, notwithstanding Subchapter B or any other
  law. (Gov. Code, Sec. 531.02164(d).)
         Sec. 548.0255.  DETERMINATION OF COST SAVINGS FOR MEDICARE
  PROGRAM. The commission shall determine whether providing home
  telemonitoring services to individuals who are eligible to receive
  benefits under both Medicaid and the Medicare program achieves cost
  savings for the Medicare program. (Gov. Code, Sec. 531.02164(e).)
         Sec. 548.0256.  REIMBURSEMENT FOR OTHER CONDITIONS AND RISK
  FACTORS. (a) To comply with state and federal requirements to
  provide access to medically necessary services under the Medicaid
  managed care program, a Medicaid managed care organization may
  reimburse providers for home telemonitoring services provided to
  individuals who have conditions and exhibit risk factors other than
  those expressly authorized by this subchapter.
         (b)  In determining whether the Medicaid managed care
  organization should provide reimbursement for services under this
  section, the organization shall consider whether reimbursement for
  the service is cost-effective and providing the service is
  clinically effective. (Gov. Code, Sec. 531.02164(f).)
  SUBCHAPTER G. MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL
  CONSULTATIONS
         Sec. 548.0301.  DEFINITION. In this subchapter, "physician"
  means an individual licensed to practice medicine in this state
  under Subtitle B, Title 3, Occupations Code. (Gov. Code, Sec.
  531.02175(a).)
         Sec. 548.0302.  MEDICAID REIMBURSEMENT FOR INTERNET MEDICAL
  CONSULTATION AUTHORIZED. (a)  The executive commissioner by rule
  may require the commission and each health and human services
  agency that administers a part of Medicaid to provide Medicaid
  reimbursement for a medical consultation that a physician or other
  health care professional provides using the Internet as a
  cost-effective alternative to an in-person consultation.
         (b)  The executive commissioner may require the commission
  or a health and human services agency to provide the reimbursement
  described by this section only if the Centers for Medicare and
  Medicaid Services develops an appropriate Current Procedural
  Terminology code for medical services provided using the Internet.
  (Gov. Code, Sec. 531.02175(b).)
         Sec. 548.0303.  PILOT PROGRAM FOR MEDICAID REIMBURSEMENT FOR
  INTERNET MEDICAL CONSULTATION. (a)  The executive commissioner may
  develop and implement a pilot program in one or more sites the
  executive commissioner chooses under which Medicaid reimbursements
  are paid for medical consultations provided by physicians or other
  health care professionals using the Internet. The pilot program
  must be designed to test whether an Internet medical consultation
  is a cost-effective alternative to an in-person consultation under
  Medicaid.
         (b)  The executive commissioner may modify the pilot program
  as necessary throughout the program's implementation to maximize
  the potential cost-effectiveness of Internet medical
  consultations.
         (c)  If the executive commissioner determines from the pilot
  program that Internet medical consultations are cost-effective,
  the executive commissioner may expand the pilot program to
  additional sites or implement Medicaid reimbursements for Internet
  medical consultations statewide.
         (d)  The executive commissioner is not required to implement
  the pilot program authorized under Subsection (a) as a prerequisite
  to providing Medicaid reimbursement authorized by Section 548.0302
  on a statewide basis. (Gov. Code, Secs. 531.02175(c), (d).)
  SUBCHAPTER H. PEDIATRIC TELE-CONNECTIVITY RESOURCE PROGRAM FOR
  RURAL TEXAS
         Sec. 548.0351.  DEFINITIONS.  In this subchapter:
               (1)  "Nonurban health care facility" means a hospital
  licensed under Chapter 241, Health and Safety Code, or other
  licensed health care facility in this state that is located in a
  rural area as defined by Section 845.002, Insurance Code.
               (2)  "Pediatric specialist" means a physician who is
  certified in general pediatrics by the American Board of Pediatrics
  or American Osteopathic Board of Pediatrics.
               (3)  "Pediatric subspecialist" means a physician who is
  certified in a pediatric subspecialty by a member board of the
  American Board of Medical Specialties or American Osteopathic Board
  of Pediatrics.
               (4)  "Pediatric tele-specialty provider" means a
  pediatric health care facility in this state that offers continuous
  access to telemedicine medical services provided by pediatric
  subspecialists.
               (5)  "Physician" means an individual licensed to
  practice medicine in this state.
               (6)  "Program" means the pediatric tele-connectivity
  resource program for rural Texas established under this subchapter.
               (7)  Notwithstanding Section 521.0001, "telemedicine
  medical service" means a health care service delivered to a
  patient:
                     (A)  by a physician acting within the scope of the
  physician's license or a health professional acting under the
  delegation and supervision of a physician and within the scope of
  the health professional's license;
                     (B)  from a physical location that is different
  from the patient's location; and
                     (C)  using telecommunications or information
  technology. (Gov. Code, Sec. 541.001.)
         Sec. 548.0352.  ESTABLISHMENT OF PEDIATRIC
  TELE-CONNECTIVITY RESOURCE PROGRAM FOR RURAL TEXAS.  The
  commission with any necessary assistance of pediatric
  tele-specialty providers shall establish a pediatric
  tele-connectivity resource program for rural Texas to award grants
  to nonurban health care facilities to connect the facilities with
  pediatric specialists and pediatric subspecialists who provide
  telemedicine medical services. (Gov. Code, Sec. 541.002.)
         Sec. 548.0353.  USE OF PROGRAM GRANT.  A nonurban health
  care facility awarded a grant under this subchapter may use grant
  money to:
               (1)  purchase equipment necessary for implementing a
  telemedicine medical service;
               (2)  modernize the facility's information technology
  infrastructure and secure information technology support to ensure
  an uninterrupted two-way video signal that is compliant with the
  Health Insurance Portability and Accountability Act of 1996 (Pub.
  L. No. 104-191);
               (3)  pay a service fee to a pediatric tele-specialty
  provider under an annual contract with the provider; or
               (4)  pay for other activities, services, supplies,
  facilities, resources, and equipment the commission determines
  necessary for the facility to use a telemedicine medical service.
  (Gov. Code, Sec. 541.003.)
         Sec. 548.0354.  SELECTION OF PROGRAM GRANT RECIPIENTS.
  (a)  The commission with any necessary assistance of pediatric
  tele-specialty providers may select an eligible nonurban health
  care facility to receive a grant under this subchapter.
         (b)  To be eligible for a grant, a nonurban health care
  facility must have:
               (1)  a quality assurance program that measures the
  compliance of the facility's health care providers with the
  facility's medical protocols;
               (2)  on staff at least one full-time equivalent
  physician who has training and experience in pediatrics and one
  individual who is responsible for ongoing nursery and neonatal
  support and care;
               (3)  a designated neonatal intensive care unit or an
  emergency department;
               (4)  a commitment to obtaining neonatal or pediatric
  education from a tertiary facility to expand the facility's depth
  and breadth of telemedicine medical service capabilities; and
               (5)  the capability of maintaining records and
  producing reports that measure the effectiveness of the grant the
  facility would receive. (Gov. Code, Sec. 541.004.)
         Sec. 548.0355.  GIFTS, GRANTS, AND DONATIONS. (a)  The
  commission may solicit and accept gifts, grants, and donations from
  any public or private source for the purposes of this subchapter.
         (b)  A political subdivision that participates in the
  program may pay part of the costs of the program. (Gov. Code, Sec.
  541.005.)
         Sec. 548.0356.  WORK GROUP. (a)  The commission may
  establish a program work group to:
               (1)  assist the commission with developing,
  implementing, or evaluating the program; and
               (2)  prepare a report on the results and outcomes of the
  grants awarded under this subchapter.
         (b)  A program work group member is not entitled to
  compensation for serving on the program work group and may not be
  reimbursed for travel or other expenses incurred while conducting
  the business of the program work group.
         (c)  A program work group is not subject to Chapter 2110.
  (Gov. Code, Sec. 541.006.)
         Sec. 548.0357.  BIENNIAL REPORT.  Not later than December 1
  of each even-numbered year, the commission shall submit a report to
  the governor and members of the legislature regarding the
  activities of the program and grant recipients under the program,
  including the results and outcomes of grants awarded under this
  subchapter. (Gov. Code, Sec. 541.007.)
         Sec. 548.0358.  RULES.  The executive commissioner may
  adopt rules necessary to implement this subchapter. (Gov. Code,
  Sec. 541.008.)
         Sec. 548.0359.  APPROPRIATION REQUIRED.  The commission may
  not spend state funds to accomplish the purposes of this subchapter
  and is not required to award a grant under this subchapter unless
  money is appropriated for the purposes of this subchapter. (Gov.
  Code, Sec. 541.009.)
  SUBCHAPTER I. TELEHEALTH TREATMENT PROGRAM FOR SUBSTANCE USE
  DISORDERS
         Sec. 548.0401.  TELEHEALTH TREATMENT PROGRAM FOR SUBSTANCE
  USE DISORDERS. The executive commissioner by rule shall establish
  a program to increase opportunities and expand access to telehealth
  treatment for substance use disorders in this state. (Gov. Code, Sec. 531.02253.)
 
  CHAPTER 549. PROVISION OF DRUGS AND DRUG INFORMATION
  SUBCHAPTER A. GENERAL PROVISIONS APPLICABLE TO PROVISION OF DRUGS
  UNDER VENDOR DRUG PROGRAM AND CERTAIN OTHER PROGRAMS
  Sec. 549.0001.  BULK PURCHASING WITH ANOTHER STATE OF
                   PRESCRIPTION DRUGS AND OTHER
                   MEDICATIONS
  Sec. 549.0002.  VALUE-BASED ARRANGEMENT IN MEDICAID
                   VENDOR DRUG PROGRAM
  Sec. 549.0003.  PERIOD OF VALIDITY OF PRESCRIPTIONS
                   UNDER MEDICAID
  Sec. 549.0004.  CERTAIN MEDICATIONS FOR SEX OFFENDERS
                   PROHIBITED
  Sec. 549.0005.  PRIOR APPROVAL OF AND PHARMACY PROVIDER
                   ACCESS TO CERTAIN COMMUNICATIONS WITH
                   CERTAIN RECIPIENTS AND ENROLLEES
  SUBCHAPTER B. REVIEW AND ANALYSIS OF CERTAIN PRESCRIPTION DRUG
  PURCHASES AND PATTERNS
  Sec. 549.0051.  PERIODIC REVIEW OF VENDOR DRUG PROGRAM
                   PURCHASES
  Sec. 549.0052.  MEDICAID PRESCRIPTION DRUG USE AND
                   EXPENDITURE PATTERNS
  SUBCHAPTER C. SUPPLEMENTAL REBATES OR PROGRAM BENEFITS FOR
  PRESCRIPTION DRUGS
  Sec. 549.0101.  DEFINITIONS
  Sec. 549.0102.  REQUIREMENT TO NEGOTIATE FOR
                   SUPPLEMENTAL REBATES FOR CERTAIN
                   PROGRAMS
  Sec. 549.0103.  VOLUNTARY NEGOTIATION
                   FOR MANUFACTURER AND LABELER SUPPLEMENTAL
                   REBATES
  Sec. 549.0104.  CONSIDERATIONS IN SUPPLEMENTAL REBATE
                   NEGOTIATIONS
  Sec. 549.0105.  REQUIRED DISCLOSURES IN NEGOTIATIONS
                   FOR SUPPLEMENTAL REBATES
  Sec. 549.0106.  PROGRAM BENEFITS INSTEAD OF
                   SUPPLEMENTAL REBATES; MONETARY
                   CONTRIBUTION OR DONATION
  Sec. 549.0107.  LIMITATIONS ON AGREEMENT TO ACCEPT
                   PROGRAM BENEFITS INSTEAD OF
                   SUPPLEMENTAL REBATES
  Sec. 549.0108.  TREATMENT OF PROGRAM BENEFITS FOR
                   CERTAIN PURPOSES
  SUBCHAPTER D.  CONFIDENTIALITY OF INFORMATION RELATING TO
  PRESCRIPTION DRUG REBATE NEGOTIATIONS AND AGREEMENTS
  Sec. 549.0151.  CERTAIN PRESCRIPTION DRUG INFORMATION
                   CONFIDENTIAL
  Sec. 549.0152.  GENERAL PRESCRIPTION DRUG INFORMATION
                   NOT CONFIDENTIAL; EXCEPTION
  Sec. 549.0153.  EXISTENCE OR NONEXISTENCE OF
                   SUPPLEMENTAL REBATE AGREEMENT NOT
                   CONFIDENTIAL
  SUBCHAPTER E. PREFERRED DRUG LISTS
  Sec. 549.0201.  DEFINITION
  Sec. 549.0202.  PREFERRED DRUG LISTS REQUIRED FOR
                   MEDICAID VENDOR DRUG AND CHILD HEALTH
                   PLAN PROGRAMS
  Sec. 549.0203.  PREFERRED DRUG LISTS AUTHORIZED FOR
                   CERTAIN PROGRAMS
  Sec. 549.0204.  LIMITATION ON DRUGS INCLUDED ON
                   PREFERRED DRUG LISTS; EXCEPTIONS
  Sec. 549.0205.  CONSIDERATIONS FOR INCLUDING DRUG ON
                   PREFERRED DRUG LISTS
  Sec. 549.0206.  SUBMISSION OF EVIDENCE TO SUPPORT
                   INCLUDING DRUG ON PREFERRED DRUG
                   LISTS
  Sec. 549.0207.  PUBLICATION OF INFORMATION RELATING TO
                   AND DISTRIBUTION OF PREFERRED DRUG
                   LISTS
  SUBCHAPTER F. PRIOR AUTHORIZATION FOR CERTAIN DRUGS
  Sec. 549.0251.  DRUGS SUBJECT TO PRIOR AUTHORIZATION
                   REQUIREMENTS
  Sec. 549.0252.  PRIOR AUTHORIZATION AND CERTAIN
                   PROTOCOL REQUIREMENTS PROHIBITED FOR
                   CERTAIN ANTIRETROVIRAL DRUGS
  Sec. 549.0253.  PRIOR AUTHORIZATION PROHIBITED FOR
                   CERTAIN NONPREFERRED ANTIPSYCHOTIC
                   DRUGS
  Sec. 549.0254.  ADMINISTRATION OF PRIOR AUTHORIZATION
                   REQUIREMENTS
  Sec. 549.0255.  PREREQUISITE TO IMPLEMENTING PRIOR
                   AUTHORIZATION REQUIREMENT FOR CERTAIN
                   DRUGS
  Sec. 549.0256.  NOTICE OF PRIOR AUTHORIZATION
                   REQUIREMENT IMPLEMENTATION AND
                   PROCEDURES
  Sec. 549.0257.  PRIOR AUTHORIZATION PROCEDURES
  Sec. 549.0258.  PRIOR AUTHORIZATION AUTOMATION AND
                   POINT-OF-SALE REQUIREMENTS
  Sec. 549.0259.  APPLICABILITY OF PRIOR AUTHORIZATION
                   REQUIREMENTS TO PRIOR PRESCRIPTIONS
  Sec. 549.0260.  APPEAL OF PRIOR AUTHORIZATION DENIAL
                   UNDER MEDICAID VENDOR DRUG PROGRAM
  SUBCHAPTER G. DRUG UTILIZATION REVIEW BOARD
  Sec. 549.0301.  DEFINITION
  Sec. 549.0302.  BOARD COMPOSITION; APPLICATION PROCESS
  Sec. 549.0303.  CONFLICTS OF INTEREST
  Sec. 549.0304.  BOARD MEMBER TERMS
  Sec. 549.0305.  PRESIDING OFFICER
  Sec. 549.0306.  INAPPLICABILITY OF OTHER LAW TO BOARD
  Sec. 549.0307.  ADMINISTRATIVE SUPPORT FOR BOARD
  Sec. 549.0308.  RULES FOR BOARD OPERATION
  Sec. 549.0309.  GENERAL POWERS AND DUTIES OF BOARD
  Sec. 549.0310.  BOARD MEETINGS; REVIEW OF CERTAIN
                   PRODUCTS
  Sec. 549.0311.  BOARD SUMMARY OF CERTAIN INFORMATION
                   REQUIRED
  Sec. 549.0312.  PUBLIC DISCLOSURE OF CERTAIN BOARD
                   RECOMMENDATIONS REQUIRED
  SUBCHAPTER H. MEDICAID DRUG UTILIZATION REVIEW PROGRAM
  Sec. 549.0351.  DEFINITIONS
  Sec. 549.0352.  DRUG USE REVIEWS
  Sec. 549.0353.  ANNUAL REPORT
  SUBCHAPTER I. PHARMACEUTICAL PATIENT ASSISTANCE PROGRAM
  INFORMATION
  Sec. 549.0401.  DEFINITION
  Sec. 549.0402.  PROVISION OF PROGRAM INFORMATION BY
                   PHARMACEUTICAL COMPANY
  Sec. 549.0403.  PUBLIC ACCESS TO PROGRAM INFORMATION
  SUBCHAPTER J. STATE PRESCRIPTION DRUG PROGRAM
  Sec. 549.0451.  DEVELOPMENT AND IMPLEMENTATION OF STATE
                   PRESCRIPTION DRUG PROGRAM
  Sec. 549.0452.  PROGRAM ELIGIBILITY
  Sec. 549.0453.  RULES
  Sec. 549.0454.  GENERIC EQUIVALENT AUTHORIZED
  Sec. 549.0455.  PROGRAM FUNDING AND FUNDING PRIORITIES
  CHAPTER 549. PROVISION OF DRUGS AND DRUG INFORMATION
  SUBCHAPTER A. GENERAL PROVISIONS APPLICABLE TO PROVISION OF DRUGS
  UNDER VENDOR DRUG PROGRAM AND CERTAIN OTHER PROGRAMS
         Sec. 549.0001.  BULK PURCHASING WITH ANOTHER STATE OF
  PRESCRIPTION DRUGS AND OTHER MEDICATIONS. (a) Subject to
  Subsection (b), the commission and each health and human services
  agency the executive commissioner authorizes may enter into an
  agreement with one or more other states for the joint bulk
  purchasing of prescription drugs and other medications to be used
  in Medicaid, the child health plan program, or another program
  under the commission's authority.
         (b)  A joint bulk purchasing agreement may not be entered
  into until:
               (1)  the commission determines that entering into the
  agreement would be feasible and cost-effective; and
               (2)  if appropriated money would be spent under the
  proposed agreement, the governor and the Legislative Budget Board
  grant prior approval to spend appropriated money under the proposed
  agreement.
         (c)  In determining the feasibility and cost-effectiveness
  of entering into a joint bulk purchasing agreement, the commission
  shall identify:
               (1)  the most cost-effective existing joint bulk
  purchasing agreement; and
               (2)  any potential groups of states with which this
  state could enter into a new cost-effective joint bulk purchasing
  agreement.
         (d)  If a joint bulk purchasing agreement is entered into,
  the commission shall adopt procedures applicable to an agreement
  and joint purchase described by this section.  The procedures must
  ensure that this state receives:
               (1)  all prescription drugs and other medications
  purchased with money provided by this state; and
               (2)  an equitable share of any price benefits resulting
  from the joint bulk purchase. (Gov. Code, Sec. 531.090.)
         Sec. 549.0002.  VALUE-BASED ARRANGEMENT IN MEDICAID VENDOR
  DRUG PROGRAM. (a) In this section, "manufacturer" has the meaning
  assigned by Section 549.0101.
         (b)  Subject to Subchapter D, the commission may enter into a
  value-based arrangement for the Medicaid vendor drug program by
  written agreement with a manufacturer based on outcome data or
  other metrics to which this state and the manufacturer agree in
  writing. The value-based arrangement may include a rebate, a
  discount, a price reduction, a contribution, risk sharing, a
  reimbursement, payment deferral or installment payments, a
  guarantee, patient care, shared savings payments, withholds, a
  bonus, or any other thing of value. (Gov. Code, Sec. 531.0701.)
         Sec. 549.0003.  PERIOD OF VALIDITY OF PRESCRIPTIONS UNDER
  MEDICAID. (a) This section does not apply to a prescription for a
  controlled substance, as defined by Chapter 481, Health and Safety
  Code.
         (b)  In the rules and standards governing the vendor drug
  program, the executive commissioner, to the extent allowed by
  federal law and laws regulating the writing of prescriptions and
  dispensing of prescription medications, shall ensure that a
  prescription written by an authorized health care provider under
  Medicaid is valid for the lesser of:
               (1)  the period for which the prescription is written;
  or
               (2)  one year. (Gov. Code, Sec. 531.0694.)
         Sec. 549.0004.  CERTAIN MEDICATIONS FOR SEX OFFENDERS
  PROHIBITED. (a) To the maximum extent allowed under federal law,
  the commission may not provide a sexual performance enhancing
  medication under the vendor drug program or any other health and
  human services program to an individual required to register as a
  sex offender under Chapter 62, Code of Criminal Procedure.
         (b)  The executive commissioner may adopt rules as necessary
  to implement this section. (Gov. Code, Sec. 531.089.)
         Sec. 549.0005.  PRIOR APPROVAL OF AND PHARMACY PROVIDER
  ACCESS TO CERTAIN COMMUNICATIONS WITH CERTAIN RECIPIENTS AND
  ENROLLEES. (a)  This section applies to:
               (1)  the vendor drug program for Medicaid and the child
  health plan program;
               (2)  the kidney health care program;
               (3)  the children with special health care needs
  program; and
               (4)  any other state program the commission administers
  that provides prescription drug benefits.
         (b)  A managed care organization, including a health
  maintenance organization, or a pharmacy benefit manager, that
  administers claims for prescription drug benefits under a program
  to which this section applies shall, at least 10 days before the
  date the organization or pharmacy benefit manager intends to
  deliver a communication to recipients or enrollees collectively
  under a program:
               (1)  submit a copy of the communication to the
  commission for approval; and
               (2)  if applicable, allow the pharmacy providers of the
  recipients or enrollees who are to receive the communication access
  to the communication. (Gov. Code, Sec. 531.0697.)
  SUBCHAPTER B. REVIEW AND ANALYSIS OF CERTAIN PRESCRIPTION DRUG
  PURCHASES AND PATTERNS
         Sec. 549.0051.  PERIODIC REVIEW OF VENDOR DRUG PROGRAM
  PURCHASES. (a) The commission shall periodically review all
  purchases made under the vendor drug program to determine the
  cost-effectiveness of including a component for prescription drug
  benefits in any capitation rate paid by this state under a Medicaid
  managed care program or the child health plan program.
         (b)  In making the determination required by Subsection (a),
  the commission shall consider the value of any prescription drug
  rebates this state receives.  (Gov. Code, Sec. 531.069.)
         Sec. 549.0052.  MEDICAID PRESCRIPTION DRUG USE AND
  EXPENDITURE PATTERNS. The commission shall:
               (1)  monitor and analyze Medicaid prescription drug use
  and expenditure patterns;
               (2)  identify the therapeutic prescription drug
  classes and individual prescription drugs that are most often
  prescribed to patients or that represent the greatest expenditures;
  and
               (3)  post the data the commission identifies under this
  section on the commission's Internet website and update the
  information on a quarterly basis. (Gov. Code, Sec. 531.0693.)
  SUBCHAPTER C. SUPPLEMENTAL REBATES OR PROGRAM BENEFITS FOR
  PRESCRIPTION DRUGS
         Sec. 549.0101.  DEFINITIONS. In this subchapter:
               (1)  "Labeler" means a person that:
                     (A)  has a labeler code from the United States
  Food and Drug Administration under 21 C.F.R. Section 207.33; and
                     (B)  receives prescription drugs from a
  manufacturer or wholesaler and repackages those drugs for later
  retail sale.
               (2)  "Manufacturer" means a manufacturer of
  prescription drugs as defined by 42 U.S.C. Section 1396r-8(k)(5),
  including a subsidiary or affiliate of a manufacturer.
               (3)  "Supplemental rebate" means a cash rebate a
  manufacturer pays to this state:
                     (A)  on the basis of appropriate quarterly health
  and human services program utilization data relating to the
  manufacturer's products; and
                     (B)  in accordance with a state supplemental
  rebate agreement negotiated with the manufacturer and, if
  necessary, approved by the federal government under 42 U.S.C.
  Section 1396r-8.
               (4)  "Wholesaler" means a person licensed under
  Subchapter I, Chapter 431, Health and Safety Code.  (Gov. Code,
  Secs. 531.070(a), (b).)
         Sec. 549.0102.  REQUIREMENT TO NEGOTIATE FOR SUPPLEMENTAL
  REBATES FOR CERTAIN PROGRAMS. (a) Subject to Subsection (b), the
  commission shall negotiate with manufacturers and labelers,
  including generic manufacturers and labelers, to obtain
  supplemental rebates for prescription drugs provided under:
               (1)  the Medicaid vendor drug program in excess of the
  Medicaid rebates required by 42 U.S.C. Section 1396r-8;
               (2)  the child health plan program; and
               (3)  any other state program the commission or a health
  and human services agency administers, including a community mental
  health center or state mental health hospital.
         (b)  The commission may by contract authorize a private
  entity to negotiate with manufacturers and labelers on the
  commission's behalf.  (Gov. Code, Secs. 531.070(h), (i).)
         Sec. 549.0103.  VOLUNTARY NEGOTIATION FOR MANUFACTURER AND
  LABELER SUPPLEMENTAL REBATES. A manufacturer or labeler that sells
  prescription drugs in this state may voluntarily negotiate with the
  commission and enter into an agreement to provide supplemental
  rebates for prescription drugs provided under:
               (1)  the Medicaid vendor drug program in excess of the
  Medicaid rebates required by 42 U.S.C. Section 1396r-8;
               (2)  the child health plan program; and
               (3)  any other state program the commission or a health
  and human services agency administers, including a community mental
  health center or state mental health hospital. (Gov. Code, Sec.
  531.070(j).)
         Sec. 549.0104.  CONSIDERATIONS IN SUPPLEMENTAL REBATE
  NEGOTIATIONS. (a) In negotiating terms for a supplemental rebate
  amount, the commission shall consider:
               (1)  rebates calculated under the Medicaid rebate
  program in accordance with 42 U.S.C. Section 1396r-8;
               (2)  any other available information on prescription
  drug prices or rebates; and
               (3)  other program benefits as specified in Section
  549.0106(b).
         (b)  In negotiating terms for a supplemental rebate, the
  commission shall use the average manufacturer price as defined in
  42 U.S.C. Section 1396r-8(k)(1) as the cost basis for the product.
  (Gov. Code, Secs. 531.070(k), (m).)
         Sec. 549.0105.  REQUIRED DISCLOSURES IN NEGOTIATIONS FOR
  SUPPLEMENTAL REBATES. Before or during supplemental rebate
  agreement negotiations for a prescription drug being considered for
  the preferred drug list, the commission shall disclose to
  pharmaceutical manufacturers any clinical edits or clinical
  protocols that may be imposed on drugs within a particular drug
  category that are placed on the preferred drug list during the
  contract period.  Clinical edits may not be imposed for a preferred
  drug during the contract period unless the disclosure is made.
  (Gov. Code, Sec. 531.070(n).)
         Sec. 549.0106.  PROGRAM BENEFITS INSTEAD OF SUPPLEMENTAL
  REBATES; MONETARY CONTRIBUTION OR DONATION. (a) For purposes of
  this section, a program benefit may mean a disease management
  program authorized under this title, a drug product donation
  program, a drug utilization control program, prescriber and
  beneficiary counseling and education, a fraud or abuse initiative,
  and another service or administrative investment with guaranteed
  savings to a program a health and human services agency operates.
         (b)  The commission may enter into a written agreement with a
  manufacturer to accept a program benefit instead of a supplemental
  rebate only if:
               (1)  the program benefit yields savings that are at
  least equal to the amount the manufacturer would have provided
  under a state supplemental rebate agreement during the current
  biennium as determined by the written agreement;
               (2)  the manufacturer:
                     (A)  posts a performance bond guaranteeing
  savings to this state; and
                     (B)  agrees that if the savings are not achieved
  in accordance with the written agreement, the manufacturer will
  forfeit the bond to this state, less any savings that were achieved;
  and
               (3)  the program benefit is in addition to other
  program benefits the manufacturer currently offers to recipients of
  Medicaid or related programs.
         (c)  For purposes of this subchapter, the commission may
  consider a monetary contribution or donation to the arrangements
  described in Subsection (b) for the purpose of offsetting
  expenditures to other state health care programs, but that funding
  may not be used to offset expenditures for covered outpatient drugs
  as defined by 42 U.S.C. Section 1396r-8(k)(2) under the vendor drug
  program. An arrangement under this subsection may not yield less
  than the amount this state would have benefited under a
  supplemental rebate. The commission may consider an arrangement
  under this subchapter as satisfying the requirements of Section
  549.0204(a). (Gov. Code, Secs. 531.070(c), (d), (g).)
         Sec. 549.0107.  LIMITATIONS ON AGREEMENT TO ACCEPT PROGRAM
  BENEFITS INSTEAD OF SUPPLEMENTAL REBATES. (a) A commission
  agreement to accept a program benefit described by Section
  549.0106:
               (1)  may not prohibit the commission from entering into
  a similar agreement with another entity that relates to a different
  drug class;
               (2)  must be limited to a period the commission
  expressly determines; and
               (3)  subject to Subsection (b), may cover only a
  product that has received United States Food and Drug
  Administration approval as of the date the commission enters into
  the agreement.
         (b)  A new product the United States Food and Drug
  Administration approves after the commission enters into the
  agreement may be incorporated into the agreement only under an
  amendment to the agreement.  (Gov. Code, Sec. 531.070(f).)
         Sec. 549.0108.  TREATMENT OF PROGRAM BENEFITS FOR CERTAIN
  PURPOSES. Other than as required to satisfy the provisions of this
  subchapter, a program benefit described by Section 549.0106 is
  considered an alternative to, and not the equivalent of, a
  supplemental rebate.  A program benefit must be treated in this
  state's submissions to the federal government, including, as
  appropriate, waiver requests and quarterly Medicaid claims, so as
  to maximize the availability of federal matching payments.  (Gov.
  Code, Sec. 531.070(e).)
  SUBCHAPTER D.  CONFIDENTIALITY OF INFORMATION RELATING TO
  PRESCRIPTION DRUG REBATE NEGOTIATIONS AND AGREEMENTS
         Sec. 549.0151.  CERTAIN PRESCRIPTION DRUG INFORMATION
  CONFIDENTIAL. (a) Notwithstanding any other state law other than
  Sections 549.0152 and 549.0153, information the commission obtains
  or maintains regarding prescription drug rebate negotiations or a
  supplemental Medicaid or other rebate agreement, including trade
  secrets, rebate amount, rebate percentage, and manufacturer or
  labeler pricing, is confidential and not subject to disclosure
  under Chapter 552.
         (b)  Information that is confidential under Subsection (a)
  includes information described by that subsection that the
  commission obtains or maintains in connection with:
               (1)  the vendor drug program;
               (2)  the child health plan program;
               (3)  the kidney health care program;
               (4)  the children with special health care needs
  program; or
               (5)  another state program the commission or a health
  and human services agency administers.  (Gov. Code, Secs.
  531.071(a), (b).)
         Sec. 549.0152.  GENERAL PRESCRIPTION DRUG INFORMATION NOT
  CONFIDENTIAL; EXCEPTION. General information about the aggregate
  costs of different classes of prescription drugs is not
  confidential under Section 549.0151(a), except that a drug name or
  information that could reveal a drug name is confidential. (Gov.
  Code, Sec. 531.071(c).)
         Sec. 549.0153.  EXISTENCE OR NONEXISTENCE OF SUPPLEMENTAL
  REBATE AGREEMENT NOT CONFIDENTIAL. Information about whether the
  commission and a manufacturer or labeler reached or did not reach a
  supplemental rebate agreement under Subchapter C for a particular
  prescription drug is not confidential under Section 549.0151(a).
  (Gov. Code, Sec. 531.071(d).)
  SUBCHAPTER E. PREFERRED DRUG LISTS
         Sec. 549.0201.  DEFINITION. In this subchapter, "board"
  means the Drug Utilization Review Board. (New.)
         Sec. 549.0202.  PREFERRED DRUG LISTS REQUIRED FOR MEDICAID
  VENDOR DRUG AND CHILD HEALTH PLAN PROGRAMS. In a manner that
  complies with state and federal law, the commission shall adopt
  preferred drug lists for:
               (1)  the Medicaid vendor drug program; and
               (2)  prescription drugs purchased through the child
  health plan program. (Gov. Code, Sec. 531.072(a) (part).)
         Sec. 549.0203.  PREFERRED DRUG LISTS AUTHORIZED FOR CERTAIN
  PROGRAMS. The commission may adopt preferred drug lists for:
               (1)  community mental health centers;
               (2)  state mental health hospitals; and
               (3)  any state program the commission or a state health
  and human services agency administers other than a program for
  which Section 549.0202 requires the adoption of preferred drug
  lists. (Gov. Code, Sec. 531.072(a) (part).)
         Sec. 549.0204.  LIMITATION ON DRUGS INCLUDED ON PREFERRED
  DRUG LISTS; EXCEPTIONS. (a) The preferred drug lists adopted under
  this subchapter may contain only drugs provided by a manufacturer
  or labeler that reaches an agreement with the commission on
  supplemental rebates under Subchapter C.
         (b)  Notwithstanding Subsection (a), the preferred drug
  lists may contain:
               (1)  a drug provided by a manufacturer or labeler that
  has not reached a supplemental rebate agreement with the commission
  if the commission determines that including the drug on the
  preferred drug lists will not have a negative cost impact to this
  state; or
               (2)  a drug provided by a manufacturer or labeler that
  has reached an agreement with the commission to provide program
  benefits instead of supplemental rebates as described by Subchapter
  C. (Gov. Code, Secs. 531.072(b), (b-1).)
         Sec. 549.0205.  CONSIDERATIONS FOR INCLUDING DRUG ON
  PREFERRED DRUG LISTS. (a) In making a decision regarding the
  placement of a drug on each of the preferred drug lists adopted
  under this subchapter, the commission shall consider:
               (1)  the board's recommendations under Section
  549.0309;
               (2)  the drug's clinical efficacy;
               (3)  the price of competing drugs after deducting any
  federal and state rebate amounts; and
               (4)  program benefit offerings solely or in conjunction
  with rebates and other pricing information.
         (b)  The commission shall consider including on a preferred
  drug list:
               (1)  multiple methods of delivery within each drug
  class, including liquid, capsule, and tablet, including an orally
  disintegrating tablet; and
               (2)  all strengths and dosage forms of a drug. (Gov.
  Code, Secs. 531.072(b-2), (c), (c-1).)
         Sec. 549.0206.  SUBMISSION OF EVIDENCE TO SUPPORT INCLUDING
  DRUG ON PREFERRED DRUG LISTS. (a) In this section, "labeler" and
  "manufacturer" have the meanings assigned by Section 549.0101.
         (b)  The commission shall ensure that a manufacturer or
  labeler may submit written evidence that supports including a drug
  on the preferred drug lists before a supplemental rebate agreement
  is reached with the commission. (Gov. Code, Sec. 531.072(e)
  (part).)
         Sec. 549.0207.  PUBLICATION OF INFORMATION RELATING TO AND
  DISTRIBUTION OF PREFERRED DRUG LISTS. (a) The commission shall
  publish on the commission's Internet website any decisions on
  preferred drug list placement, including:
               (1)  a list of drugs reviewed and the commission's
  decision for or against placement on a preferred drug list of each
  reviewed drug;
               (2)  for each recommendation, whether a supplemental
  rebate agreement or a program benefit agreement was reached under
  Subchapter C; and
               (3)  the rationale for any departure from a board
  recommendation under Section 549.0309.
         (b)  The commission shall:
               (1)  provide for the distribution of current copies of
  the preferred drug lists adopted under this subchapter by posting
  the lists on the Internet; and
               (2)  mail copies of the lists to a health care provider
  on the provider's request. (Gov. Code, Secs. 531.072(d),
  531.0741.)
  SUBCHAPTER F. PRIOR AUTHORIZATION FOR CERTAIN DRUGS
         Sec. 549.0251.  DRUGS SUBJECT TO PRIOR AUTHORIZATION
  REQUIREMENTS. (a) The executive commissioner, in the rules and
  standards governing the Medicaid vendor drug program and the child
  health plan program, shall require prior authorization for the
  reimbursement of a drug that is not included in the appropriate
  preferred drug list adopted under Subchapter E unless:
               (1)  the drug is exempt from prior authorization
  requirements by federal law; or
               (2)  the executive commissioner is prohibited under
  Sections 549.0252 and 549.0253(a) from requiring prior
  authorization for the drug.
         (b)  The executive commissioner may require prior
  authorization for the reimbursement of a drug provided through any
  state program, other than a program described by Subsection (a),
  that the commission or a state health and human services agency
  administers, including a community mental health center and a state
  mental health hospital if the commission adopts a preferred drug
  list under Subchapter E that applies to that facility and the drug
  is not included in the appropriate list.
         (c)  The executive commissioner shall require that the prior
  authorization be obtained by the prescribing physician or
  prescribing practitioner. (Gov. Code, Sec. 531.073(a).)
         Sec. 549.0252.  PRIOR AUTHORIZATION AND CERTAIN PROTOCOL
  REQUIREMENTS PROHIBITED FOR CERTAIN ANTIRETROVIRAL DRUGS. (a) In
  this section, "antiretroviral drug" means a drug that treats human
  immunodeficiency virus infection or prevents acquired immune
  deficiency syndrome. The term includes:
               (1)  protease inhibitors;
               (2)  non-nucleoside reverse transcriptase inhibitors;
               (3)  nucleoside reverse transcriptase inhibitors;
               (4)  integrase inhibitors;
               (5)  fusion inhibitors;
               (6)  attachment inhibitors;
               (7)  CD4 post-attachment inhibitors;
               (8)  CCR5 receptor antagonists; and
               (9)  other antiretroviral drugs used to treat human
  immunodeficiency virus infection or prevent acquired immune
  deficiency syndrome.
         (b)  The executive commissioner, in the rules and standards
  governing the Medicaid vendor drug program, may not require a
  clinical, nonpreferred, or other prior authorization for an
  antiretroviral drug, or a step therapy or other protocol, that
  could restrict or delay the dispensing of the drug except to
  minimize fraud, waste, or abuse. (Gov. Code, Sec. 531.073(j).)
         Sec. 549.0253.  PRIOR AUTHORIZATION PROHIBITED FOR CERTAIN
  NONPREFERRED ANTIPSYCHOTIC DRUGS. (a) The executive commissioner,
  in the rules and standards governing the vendor drug program, may
  not require prior authorization for a nonpreferred antipsychotic
  drug that is included on the vendor drug formulary and prescribed to
  an adult patient if:
               (1)  during the preceding year, the patient was
  prescribed and unsuccessfully treated with a 14-day treatment trial
  of an antipsychotic drug that is included on the appropriate
  preferred drug list adopted under Subchapter E and for which a
  single claim was paid;
               (2)  the patient has previously been prescribed and
  obtained prior authorization for the nonpreferred antipsychotic
  drug and the prescription is for the purpose of drug dosage
  titration; or
               (3)  subject to federal law on maximum dosage limits
  and commission rules on drug quantity limits, the patient has
  previously been prescribed and obtained prior authorization for the
  nonpreferred antipsychotic drug and the prescription modifies the
  dosage, dosage frequency, or both, of the drug as part of the same
  treatment for which the drug was previously prescribed.
         (b)  Subsection (a) does not affect:
               (1)  a pharmacist's authority to dispense the generic
  equivalent or interchangeable biological product of a prescription
  drug in accordance with Subchapter A, Chapter 562, Occupations
  Code;
               (2)  any drug utilization review requirements
  prescribed by state or federal law; or
               (3)  clinical prior authorization edits to preferred
  and nonpreferred antipsychotic drug prescriptions. (Gov. Code,
  Secs. 531.073(a-3), (a-4).)
         Sec. 549.0254.  ADMINISTRATION OF PRIOR AUTHORIZATION
  REQUIREMENTS. (a) The commission may by contract authorize a
  private entity to administer the prior authorization requirements
  imposed by Sections 549.0251 and 549.0255 through 549.0259 on the
  commission's behalf.
         (b)  The commission shall ensure that the prior
  authorization requirements are implemented in a manner that
  minimizes the cost to this state and any administrative burden
  placed on providers. (Gov. Code, Secs. 531.073(e), (f).)
         Sec. 549.0255.  PREREQUISITE TO IMPLEMENTING PRIOR
  AUTHORIZATION REQUIREMENT FOR CERTAIN DRUGS. Until the commission
  completes a study evaluating the impact of a prior authorization
  requirement on recipients of certain drugs, the executive
  commissioner shall delay requiring prior authorization for drugs
  that are used to treat patients with illnesses that:
               (1)  are life-threatening;
               (2)  are chronic; and
               (3)  require complex medical management strategies.
  (Gov. Code, Sec. 531.073(a-1).)
         Sec. 549.0256.  NOTICE OF PRIOR AUTHORIZATION REQUIREMENT
  IMPLEMENTATION AND PROCEDURES. Not later than the 30th day before
  the date a prior authorization requirement is implemented, the
  commission shall post on the Internet for consumers and providers:
               (1)  notice of the implementation date; and
               (2)  a detailed description of the procedures to be
  used in obtaining prior authorization. (Gov. Code, Sec.
  531.073(a-2).)
         Sec. 549.0257.  PRIOR AUTHORIZATION PROCEDURES. (a) The
  commission shall establish procedures for the prior authorization
  requirement under the Medicaid vendor drug program to ensure that
  the requirements of 42 U.S.C. Section 1396r-8(d)(5) are met. The
  procedures must ensure that:
               (1)  a prior authorization requirement is not imposed
  for a drug before the drug has been considered at a meeting of the
  Drug Utilization Review Board under Subchapter G;
               (2)  a response to a request for prior authorization is
  provided by telephone or other telecommunications device within 24
  hours after receipt of the request; and
               (3)  a 72-hour supply of the drug prescribed is
  provided in an emergency or if the commission does not provide a
  response within the period required by Subdivision (2).
         (b)  The commission shall implement procedures to ensure
  that a recipient or enrollee under Medicaid, the child health plan
  program, or another state program the commission administers, or an
  individual who becomes eligible under Medicaid, the child health
  plan program, or another state program the commission or a health
  and human services agency administers, receives continuity of care
  in relation to certain prescriptions the commission identifies.
         (c)  The commission shall ensure that requests for prior
  authorization may be submitted by telephone, facsimile, or
  electronic communications through the Internet.
         (d)  The commission shall provide an automated process that
  may be used to assess a Medicaid recipient's medical and drug claim
  history to determine whether the recipient's medical condition
  satisfies the applicable criteria for dispensing a drug without an
  additional prior authorization request. (Gov. Code, Secs.
  531.073(b), (d), (g), (h).)
         Sec. 549.0258.  PRIOR AUTHORIZATION AUTOMATION AND
  POINT-OF-SALE REQUIREMENTS. The executive commissioner, in the
  rules and standards governing the vendor drug program and as part of
  the requirements under a contract between the commission and a
  Medicaid managed care organization, shall:
               (1)  require, to the maximum extent possible based on a
  pharmacy benefit manager's claim system, automation of clinical
  prior authorization for each drug in the antipsychotic drug class;
  and
               (2)  ensure that, at the time a nonpreferred or
  clinical prior authorization edit is denied, a pharmacist is
  immediately provided a point-of-sale return message that:
                     (A)  clearly specifies the contact and other
  information necessary for the pharmacist to submit a prior
  authorization request for the prescription; and
                     (B)  instructs the pharmacist to dispense, only if
  clinically appropriate under federal or state law, a 72-hour supply
  of the prescription.  (Gov. Code, Sec. 531.073(a-5).)
         Sec. 549.0259.  APPLICABILITY OF PRIOR AUTHORIZATION
  REQUIREMENTS TO PRIOR PRESCRIPTIONS. The commission shall ensure
  that a prescription drug prescribed before implementation of a
  prior authorization requirement for that drug for a recipient or
  enrollee under Medicaid, the child health plan program, or another
  state program the commission or a health and human services agency
  administers, or for an individual who becomes eligible under
  Medicaid, the child health plan program, or another state program
  the commission or a health and human services agency administers,
  is not subject to any prior authorization requirement under this
  subchapter until the earlier of:
               (1)  the date the recipient or enrollee exhausts all
  the prescription, including any authorized refills; or
               (2)  the expiration of a period the commission
  prescribes. (Gov. Code, Sec. 531.073(c).)
         Sec. 549.0260.  APPEAL OF PRIOR AUTHORIZATION DENIAL UNDER
  MEDICAID VENDOR DRUG PROGRAM. A recipient of drug benefits under
  the Medicaid vendor drug program may appeal through the Medicaid
  fair hearing process a denial of prior authorization under this
  subchapter for a covered drug or covered dosage. (Gov. Code, Sec.
  531.072(f).)
  SUBCHAPTER G. DRUG UTILIZATION REVIEW BOARD
         Sec. 549.0301.  DEFINITION. In this subchapter, "board"
  means the Drug Utilization Review Board. (Gov. Code, Sec.
  531.0736(a).)
         Sec. 549.0302.  BOARD COMPOSITION; APPLICATION PROCESS. (a)
  The composition of the board must comply with federal law,
  including 42 C.F.R. Section 456.716. The executive commissioner
  shall determine the board's composition, which must include:
               (1)  two representatives of managed care
  organizations, one of whom must be a physician and one of whom must
  be a pharmacist, as nonvoting members;
               (2)  at least 17 physicians and pharmacists who:
                     (A)  provide services across the entire
  population of Medicaid recipients and represent different
  specialties, including at least one of each of the following types
  of physicians:
                           (i)  a pediatrician;
                           (ii)  a primary care physician;
                           (iii)  an obstetrician and gynecologist;
                           (iv)  a child and adolescent psychiatrist;
  and
                           (v)  an adult psychiatrist; and
                     (B)  have experience in either developing or
  practicing under a preferred drug list; and
               (3)  a consumer advocate who represents Medicaid
  recipients.
         (b)  The executive commissioner by rule shall develop and
  implement a process by which an individual may apply to become a
  board member and shall post the application and information
  regarding the application process on the commission's Internet
  website. (Gov. Code, Secs. 531.0736(c), (c-1).)
         Sec. 549.0303.  CONFLICTS OF INTEREST. (a) A voting board
  member may not have a contractual relationship with, ownership
  interest in, or other conflict of interest with:
               (1)  a pharmaceutical manufacturer or labeler; or
               (2)  an entity the commission engages to assist in
  developing preferred drug lists or administering the Medicaid Drug
  Utilization Review Program.
         (b)  The executive commissioner may implement this section
  by:
               (1)  adopting rules that identify prohibited
  relationships and conflicts; or
               (2)  requiring the board to develop a
  conflict-of-interest policy that applies to the board. (Gov. Code,
  Sec. 531.0737.)
         Sec. 549.0304.  BOARD MEMBER TERMS. Board members serve
  staggered four-year terms.  (Gov. Code, Sec. 531.0736(e).)
         Sec. 549.0305.  PRESIDING OFFICER. The voting board members
  shall elect from among the voting members a presiding officer. The
  presiding officer must be a physician.  (Gov. Code, Sec.
  531.0736(f).)
         Sec. 549.0306.  INAPPLICABILITY OF OTHER LAW TO BOARD.  
  Chapter 2110 does not apply to the board.  (Gov. Code, Sec.
  531.0736(m).)
         Sec. 549.0307.  ADMINISTRATIVE SUPPORT FOR BOARD.  The
  commission shall provide administrative support and resources as
  necessary for the board to perform the board's duties.  (Gov. Code,
  Sec. 531.0736(l).)
         Sec. 549.0308.  RULES FOR BOARD OPERATION.  (a)  The
  executive commissioner shall adopt rules governing the board's
  operation, including:
               (1)  rules governing the procedures the board uses to
  provide notice of a meeting; and
               (2)  rules prohibiting the board from discussing
  confidential information described by Subchapter D in a public
  meeting.
         (b)  The board shall comply with the rules adopted under this
  section and Section 549.0311.  (Gov. Code, Sec. 531.0736(i).)
         Sec. 549.0309.  GENERAL POWERS AND DUTIES OF BOARD. (a) In
  addition to performing any other duties required by federal law,
  the board shall:
               (1)  develop and submit to the commission
  recommendations for the preferred drug lists the commission adopts
  under Subchapter E;
               (2)  suggest to the commission restrictions or clinical
  edits on prescription drugs;
               (3)  recommend to the commission educational
  interventions for Medicaid providers;
               (4)  review drug utilization across Medicaid; and
               (5)  perform other duties that may be specified by law
  and otherwise make recommendations to the commission.
         (b)  In developing recommendations for the preferred drug
  lists, the board shall consider the clinical efficacy, safety, and
  cost-effectiveness of, and any program benefit associated with, a
  product.
         (c)  To the extent feasible, the board:
               (1)  shall review all drug classes included in the
  preferred drug lists at least once every 12 months; and
               (2)  may recommend inclusions in and exclusions from
  the lists to ensure that the lists provide for a range of clinically
  effective, safe, cost-effective, and medically appropriate drug
  therapies for the diverse segments of the Medicaid population,
  children receiving health benefits coverage under the child health
  plan program, and any other affected individuals.  (Gov. Code,
  Secs. 531.0736(b), (h), (k).)
         Sec. 549.0310.  BOARD MEETINGS; REVIEW OF CERTAIN PRODUCTS.  
  (a)  The board shall hold a public meeting quarterly at the call of
  the presiding officer and shall permit public comment before voting
  on any changes in the preferred drug lists the commission adopts
  under Subchapter E, the adoption of or changes to drug use criteria,
  or the adoption of prior authorization or drug utilization review
  proposals. The location of the quarterly public meeting may rotate
  among different geographic areas across this state, or allow for
  public input through teleconferencing centers in various
  geographic areas across this state.
         (b)  The board shall hold public meetings at other times at
  the call of the presiding officer.
         (c)  Minutes of each meeting shall be made available to the
  public not later than the 10th business day after the date the
  minutes are approved.
         (d)  The board may meet in executive session to discuss
  confidential information as described by Section 549.0308.
         (e)  Board members appointed under Section 549.0302(a)(1)
  may attend quarterly and other regularly scheduled meetings, but
  may not:
               (1)  attend executive sessions; or
               (2)  access confidential drug pricing information.
         (f)  In this subsection, "labeler" and "manufacturer" have
  the meanings assigned by Section 549.0101.  The commission shall
  ensure that a drug that has been approved or had any of the drug's
  particular uses approved by the United States Food and Drug
  Administration under a priority review classification is reviewed
  by the board at the next regularly scheduled board meeting. On
  receiving notice from a manufacturer or labeler of the availability
  of a new product, the commission, to the extent possible, shall
  schedule a review for the product at the next regularly scheduled
  board meeting.  (Gov. Code, Secs. 531.072(e) (part), 531.0736(b)
  (part), (d), (g).)
         Sec. 549.0311.  BOARD SUMMARY OF CERTAIN INFORMATION
  REQUIRED. (a) The executive commissioner by rule shall require the
  board or the board's designee to present a summary of any clinical
  efficacy and safety information or analyses regarding a drug under
  consideration for a preferred drug list the commission adopts under
  Subchapter E that is provided to the board by a private entity that
  contracted with the commission to provide the information.
  Confidential information described by Subchapter D must be omitted
  from the summary.
         (b)  The board or the board's designee shall provide the
  summary in electronic form before the public meeting at which
  consideration of the drug occurs.
         (c)  The summary must be posted on the commission's Internet
  website. (Gov. Code, Secs. 531.0736(b) (part), (j).)
         Sec. 549.0312.  PUBLIC DISCLOSURE OF CERTAIN BOARD
  RECOMMENDATIONS REQUIRED. (a) The commission or the commission's
  agent shall publicly disclose, immediately after the board's
  deliberations conclude, each specific drug recommended for or
  against preferred drug list status for each drug class included in
  the preferred drug list for the Medicaid vendor drug program. The
  disclosure must include:
               (1)  the general basis for the recommendation for each
  drug class; and
               (2)  for each recommendation, whether a supplemental
  rebate agreement or program benefit agreement was reached under
  Subchapter C.
         (b)  The disclosure must be posted on the commission's
  Internet website not later than the 10th business day after the date
  of conclusion of board deliberations that result in recommendations
  made to the executive commissioner regarding the placement of drugs
  on the preferred drug list. (Gov. Code, Sec. 531.0736(n).)
  SUBCHAPTER H. MEDICAID DRUG UTILIZATION REVIEW PROGRAM
         Sec. 549.0351.  DEFINITIONS. In this subchapter:
               (1)  "Medicaid Drug Utilization Review Program" means
  the program  the vendor drug program operates to improve the quality
  of pharmaceutical care under Medicaid.
               (2)  "Prospective drug use review" means the review of
  a patient's drug therapy and prescription drug order or medication
  order before dispensing or distributing a drug to the patient.
               (3)  "Retrospective drug use review" means the review
  of prescription drug claims data to identify patterns of
  prescribing.  (Gov. Code, Sec. 531.0735(a).)
         Sec. 549.0352.  DRUG USE REVIEWS. (a) The commission shall
  provide for an increase in the number and types of retrospective
  drug use reviews performed each year under the Medicaid Drug
  Utilization Review Program in comparison to the number and types of
  reviews performed in the state fiscal year ending August 31, 2009.
         (b)  In determining the number and types of drug use reviews
  to be performed, the commission shall:
               (1)  allow for the repeat of retrospective drug use
  reviews that address ongoing drug therapy problems and that, in
  previous years, improved client outcomes and reduced Medicaid
  spending;
               (2)  consider implementing disease-specific
  retrospective drug use reviews that:
                     (A)  address ongoing drug therapy problems in this
  state; and
                     (B)  reduced Medicaid prescription drug use
  expenditures in another state; and
               (3)  regularly examine Medicaid prescription drug
  claims data to identify occurrences of potential drug therapy
  problems that may be addressed by repeating successful
  retrospective drug use reviews performed in this state or another
  state.  (Gov. Code, Secs. 531.0735(b), (c).)
         Sec. 549.0353.  ANNUAL REPORT. (a) In addition to any other
  information required by federal law, the commission shall include
  the following information in the annual report regarding the
  Medicaid Drug Utilization Review Program:
               (1)  a detailed description of the program's
  activities; and
               (2)  estimates of cost savings anticipated to result
  from the program's performance of prospective and retrospective
  drug use reviews.
         (b)  The cost-saving estimates for prospective drug use
  reviews under Subsection (a) must include savings attributed to
  drug use reviews performed through the vendor drug program's
  electronic claims processing system and clinical edits screened
  through the prior authorization system implemented under
  Subchapter F.
         (c)  The commission shall post the annual report regarding
  the Medicaid Drug Utilization Review Program on the commission's
  Internet website. (Gov. Code, Secs. 531.0735(d), (e), (f).)
  SUBCHAPTER I. PHARMACEUTICAL PATIENT ASSISTANCE PROGRAM
  INFORMATION
         Sec. 549.0401.  DEFINITION. In this subchapter, "patient
  assistance program" means a program a pharmaceutical company offers
  under which the company provides a drug to individuals in need of
  assistance at no charge or at a substantially reduced cost. The
  term does not include the provision of a drug as part of a clinical
  trial.  (Gov. Code, Sec. 531.351.)
         Sec. 549.0402.  PROVISION OF PROGRAM INFORMATION BY
  PHARMACEUTICAL COMPANY. Each pharmaceutical company that does
  business in this state and that offers a patient assistance program
  shall inform the commission of:
               (1)  the existence of the program;
               (2)  the eligibility requirements for the program;
               (3)  the drugs covered by the program; and
               (4)  information used for applying for the program,
  such as a telephone number. (Gov. Code, Sec. 531.352.)
         Sec. 549.0403.  PUBLIC ACCESS TO PROGRAM INFORMATION. (a)
  The commission shall establish a system under which members of the
  public can call a toll-free telephone number to obtain information
  about available patient assistance programs. The commission shall
  ensure that the system is staffed at least during normal business
  hours with individuals who can:
               (1)  determine whether a patient assistance program is
  offered for a particular drug;
               (2)  determine whether an individual may be eligible to
  participate in a program; and
               (3)  assist an individual who wishes to apply for a
  program.
         (b)  The commission shall publicize the telephone number to
  pharmacies and drug prescribers. (Gov. Code, Sec. 531.353.)
  SUBCHAPTER J. STATE PRESCRIPTION DRUG PROGRAM
         Sec. 549.0451.  DEVELOPMENT AND IMPLEMENTATION OF STATE
  PRESCRIPTION DRUG PROGRAM. The commission shall develop and
  implement a state prescription drug program that operates in the
  same manner as the vendor drug program operates in providing
  prescription drug benefits to Medicaid recipients. (Gov. Code,
  Sec. 531.301(a).)
         Sec. 549.0452.  PROGRAM ELIGIBILITY. An individual is
  eligible for prescription drug benefits under the state
  prescription drug program if the individual is:
               (1)  a qualified Medicare beneficiary, as defined by 42
  U.S.C. Section 1396d(p)(1);
               (2)  a specified low-income Medicare beneficiary who is
  eligible for assistance under Medicaid for Medicare cost-sharing
  payments under 42 U.S.C. Section 1396a(a)(10)(E)(iii);
               (3)  a qualified disabled and working individual, as
  defined by 42 U.S.C. Section 1396d(s); or
               (4)  a qualifying individual who is eligible for
  assistance under Medicaid under 42 U.S.C. Section
  1396a(a)(10)(E)(iv). (Gov. Code, Sec. 531.301(b).)
         Sec. 549.0453.  RULES. (a) The executive commissioner
  shall adopt rules necessary for implementing the state prescription
  drug program.
         (b)  In adopting rules for the state prescription drug
  program, the executive commissioner:
               (1)  shall consult with an advisory panel composed of
  an equal number of physicians, pharmacists, and pharmacologists the
  executive commissioner appoints; and
               (2)  may:
                     (A)  require an individual who is eligible for
  prescription drug benefits to pay a cost-sharing payment;
                     (B)  authorize the use of a prescription drug
  formulary to specify which prescription drugs the state
  prescription drug program will cover;
                     (C)  to the extent possible, require clinically
  appropriate prior authorization for prescription drug benefits in
  the same manner as prior authorization is required under the vendor
  drug program; and
                     (D)  establish a drug utilization review program
  to ensure the appropriate use of prescription drugs under the state
  prescription drug program.  (Gov. Code, Sec. 531.302.)
         Sec. 549.0454.  GENERIC EQUIVALENT AUTHORIZED. In rules
  adopted for the state prescription drug program, the executive
  commissioner may require that, unless the practitioner's signature
  on a prescription clearly indicates that the prescription must be
  dispensed as written, a pharmacist may select a generic equivalent
  of the prescribed drug. (Gov. Code, Sec. 531.303.)
         Sec. 549.0455.  PROGRAM FUNDING AND FUNDING PRIORITIES. (a)
  Prescription drugs under the state prescription drug program may be
  funded only with state money unless funds are available under
  federal law to fund all or part of the program.
         (b)  If money available for the state prescription drug
  program is insufficient to provide prescription drug benefits to
  all individuals who are eligible under Section 549.0452, the
  commission shall:
               (1)  limit the number of enrollees based on available
  funding; and
               (2)  provide the prescription drug benefits to eligible
  individuals in the following order of priority:
                     (A)  individuals eligible under Section
  549.0452(1);
                     (B)  individuals eligible under Section
  549.0452(2); and
                     (C)  individuals eligible under Sections
  549.0452(3) and (4). (Gov. Code, Secs. 531.301(c), 531.304.)
  CHAPTER 550. HUMAN SERVICES AND OTHER SOCIAL SERVICES PROVIDED
  THROUGH FAITH- AND COMMUNITY-BASED ORGANIZATIONS
  SUBCHAPTER A. GENERAL PROVISIONS
  Sec. 550.0001.  DEFINITIONS
  Sec. 550.0002.  PURPOSE OF CHAPTER
  Sec. 550.0003.  CONSTRUCTION OF CHAPTER
  Sec. 550.0004.  CONSISTENT APPLICATION WITH FEDERAL LAW
  SUBCHAPTER B. GOVERNMENTAL LIAISONS FOR FAITH- AND COMMUNITY-BASED
  ORGANIZATIONS
  Sec. 550.0051.  DEFINITION
  Sec. 550.0052.  DESIGNATION OF FAITH- AND
                   COMMUNITY-BASED LIAISONS
  Sec. 550.0053.  GENERAL POWERS AND DUTIES OF LIAISONS
  Sec. 550.0054.  INTERAGENCY COORDINATING GROUP
  Sec. 550.0055.  DUTIES OF INTERAGENCY COORDINATING
                   GROUP
  Sec. 550.0056.  INTERAGENCY COORDINATING GROUP ANNUAL
                   REPORT
  Sec. 550.0057.  TEXAS NONPROFIT COUNCIL
  Sec. 550.0058.  DUTIES OF TEXAS NONPROFIT COUNCIL
  Sec. 550.0059.  TEXAS NONPROFIT COUNCIL BIENNIAL REPORT
  SUBCHAPTER C. RENEWING OUR COMMUNITIES ACCOUNT
  Sec. 550.0101.  DEFINITION
  Sec. 550.0102.  PURPOSES OF SUBCHAPTER
  Sec. 550.0103.  RENEWING OUR COMMUNITIES ACCOUNT
  Sec. 550.0104.  COMMISSION POWERS AND DUTIES REGARDING
                   ACCOUNT
  Sec. 550.0105.  ACCEPTABLE USES OF ACCOUNT FUNDS
  Sec. 550.0106.  ADMINISTRATION OF ACCOUNT FUNDS
  Sec. 550.0107.  ACCOUNT MONITORING
  Sec. 550.0108.  PUBLIC INFORMATION; INTERNET POSTING
                   REQUIREMENT
  Sec. 550.0109.  REPORTS
  Sec. 550.0110.  CONSTRUCTION OF SUBCHAPTER
  SUBCHAPTER D. FAITH- AND COMMUNITY-BASED ORGANIZATION SUPPLEMENTAL
  ASSISTANCE PROGRAM FOR CERTAIN INDIVIDUALS RECEIVING PUBLIC
  ASSISTANCE
  Sec. 550.0151.  PROGRAM ESTABLISHMENT
  Sec. 550.0152.  RULES
  SUBCHAPTER D-1. PILOT PROGRAM FOR SELF-SUFFICIENCY OF CERTAIN
  INDIVIDUALS RECEIVING FINANCIAL ASSISTANCE OR SUPPLEMENTAL
  NUTRITION ASSISTANCE BENEFITS
  Sec. 550.0201.  DEFINITIONS
  Sec. 550.0202.  PILOT PROGRAM DEVELOPMENT AND
                   IMPLEMENTATION
  Sec. 550.0203.  PILOT PROGRAM DESIGN
  Sec. 550.0204.  BENEFIT ELIGIBILITY FOR PILOT PROGRAM
                   PARTICIPANTS
  Sec. 550.0205.  FAMILY ELIGIBILITY REQUIREMENTS
  Sec. 550.0206.  CASE MANAGEMENT REQUIREMENTS
  Sec. 550.0207.  PILOT PROGRAM MONITORING AND EVALUATION
  Sec. 550.0208.  REPORTS
  Sec. 550.0209.  RULES
  Sec. 550.0210.  SUBCHAPTER EXPIRATION
  SUBCHAPTER E. COMMUNITY-BASED NAVIGATOR PROGRAM
  Sec. 550.0251.  DEFINITION
  Sec. 550.0252.  ESTABLISHMENT OF COMMUNITY-BASED
                   NAVIGATOR PROGRAM
  Sec. 550.0253.  PROGRAM STANDARDS
  Sec. 550.0254.  NAVIGATOR TRAINING PROGRAM
  Sec. 550.0255.  CERTIFIED NAVIGATOR LIST
  CHAPTER 550. HUMAN SERVICES AND OTHER SOCIAL SERVICES PROVIDED
  THROUGH FAITH- AND COMMUNITY-BASED ORGANIZATIONS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 550.0001.  DEFINITIONS. In this chapter:
               (1)  "Community-based initiative" includes a social,
  health, human services, or volunteer income tax assistance
  initiative a community-based organization operates.
               (2)  "Community-based organization" means a nonprofit
  corporation or association that is located in close proximity to
  the population the organization serves.
               (3)  "Faith-based initiative" means a social, health,
  or human services initiative a faith-based organization operates.
               (4)  "Faith-based organization" means a nonprofit
  corporation or association that:
                     (A)  operates through a religious or
  denominational organization, including an organization that is:
                           (i)  operated for a religious, educational,
  or charitable purpose; and
                           (ii)  operated, supervised, or controlled,
  wholly or partly, by or in connection with a religious
  organization; or
                     (B)  clearly demonstrates through the
  organization's mission statement, policies, or practices that the
  organization is guided or motivated by religion.
               (5)  "Interagency coordinating group" means the
  interagency coordinating group for faith- and community-based
  initiatives established under Section 550.0054.
               (6)  "State Commission on National and Community
  Service" means the entity used as authorized by 42 U.S.C. Section
  12638(a) to carry out a state commission's duties under the
  National and Community Service Act of 1990 (42 U.S.C. Section 12501
  et seq.). (Gov. Code, Sec. 535.001; New.)
         Sec. 550.0002.  PURPOSE OF CHAPTER. The purpose of this
  chapter is to strengthen the capacity of faith- and community-based
  organizations and forge stronger partnerships between those
  organizations and state government for the legitimate public
  purpose of providing charitable and social services to persons in
  this state. (Gov. Code, Sec. 535.002.)
         Sec. 550.0003.  CONSTRUCTION OF CHAPTER. This chapter may
  not be construed to:
               (1)  exempt a faith- or community-based organization
  from any applicable state or federal law; or
               (2)  be an endorsement or sponsorship by this state of a
  faith-based organization's religious character, expression,
  beliefs, doctrines, or practices. (Gov. Code, Sec. 535.003.)
         Sec. 550.0004.  CONSISTENT APPLICATION WITH FEDERAL LAW. A
  power authorized or duty imposed under this chapter must be
  performed in a manner consistent with 42 U.S.C. Section 604a. (Gov.
  Code, Sec. 535.004.)
  SUBCHAPTER B. GOVERNMENTAL LIAISONS FOR FAITH- AND COMMUNITY-BASED
  ORGANIZATIONS
         Sec. 550.0051.  DEFINITION. In this subchapter, "council"
  means the Texas Nonprofit Council.  (New.)
         Sec. 550.0052.  DESIGNATION OF FAITH- AND COMMUNITY-BASED
  LIAISONS. (a) The executive commissioner, in consultation with
  the governor, shall designate one employee from the commission and
  from each health and human services agency to serve as a liaison for
  faith- and community-based organizations.
         (b)  The chief administrative officer of each of the
  following state agencies, in consultation with the governor, shall
  designate one employee from the agency to serve as a liaison for
  faith- and community-based organizations:
               (1)  the Department of Agriculture;
               (2)  the Department of Information Resources;
               (3)  the Department of Public Safety;
               (4)  the office of the attorney general;
               (5)  the office of the comptroller;
               (6)  the office of the governor;
               (7)  the office of the secretary of state;
               (8)  the Office of State-Federal Relations;
               (9)  the Public Utility Commission of Texas;
               (10)  the Texas Commission on Environmental Quality;
               (11)  the Texas Department of Criminal Justice;
               (12)  the Texas Department of Housing and Community
  Affairs;
               (13)  the Texas Department of Insurance;
               (14)  the Texas Juvenile Justice Department;
               (15)  the Texas Veterans Commission;
               (16)  the Texas Workforce Commission; and
               (17)  other state agencies as the governor determines.
         (c)  The commissioner of higher education, in consultation
  with the presiding officer of the interagency coordinating group,
  shall designate one employee from an institution of higher
  education, as defined by Section 61.003, Education Code, to serve
  as a liaison for faith- and community-based organizations. (Gov.
  Code, Sec. 535.051.)
         Sec. 550.0053.  GENERAL POWERS AND DUTIES OF LIAISONS. (a)
  A faith- and community-based liaison designated under Section
  550.0052 shall:
               (1)  identify and remove unnecessary barriers to
  partnerships between the state agency the liaison represents and
  faith- and community-based organizations;
               (2)  provide any necessary information and training for
  employees of the represented state agency regarding equal
  opportunity standards for faith- and community-based organizations
  seeking to partner with state government;
               (3)  facilitate the identification of practices with
  demonstrated effectiveness for faith- and community-based
  organizations that partner with the represented state agency;
               (4)  work with the appropriate departments and programs
  of the represented state agency to conduct outreach efforts to
  inform and welcome faith- and community-based organizations that
  have not traditionally formed partnerships with the agency;
               (5)  coordinate all efforts with the governor's office
  of faith- and community-based initiatives and provide any requested
  information, support, and assistance to that office to the extent
  permitted by law and as feasible; and
               (6)  attend conferences sponsored by federal agencies
  and offices and other relevant entities to become and remain
  informed of issues and developments regarding faith- and
  community-based initiatives.
         (b)  A designated faith- and community-based liaison may
  coordinate and interact with statewide organizations that
  represent faith- or community-based organizations as necessary to
  accomplish the purposes of this subchapter and Subchapters A and C.
  (Gov. Code, Sec. 535.052.)
         Sec. 550.0054.  INTERAGENCY COORDINATING GROUP. (a) The
  interagency coordinating group for faith- and community-based
  initiatives is composed of:
               (1)  each faith- and community-based liaison
  designated under Section 550.0052; and
               (2)  a liaison from the State Commission on National
  and Community Service.
         (b)  Service on the interagency coordinating group is an
  additional duty of the office or position held by each liaison
  designated under Section 550.0052(b).
         (c)  The liaison from the State Commission on National and
  Community Service is the presiding officer of the interagency
  coordinating group. If the State Commission on National and
  Community Service is abolished, the liaison from the office of the
  governor is the presiding officer of the group.
         (d)  The state agencies described by Section 550.0052(b)
  shall provide administrative support for the interagency
  coordinating group as coordinated by the presiding officer. (Gov.
  Code, Secs. 535.053(a), (a-1), (b).)
         Sec. 550.0055.  DUTIES OF INTERAGENCY COORDINATING
  GROUP.  The interagency coordinating group shall:
               (1)  meet periodically at the call of the presiding
  officer;
               (2)  work across state agencies and with the State
  Commission on National and Community Service to facilitate the
  removal of unnecessary interagency barriers to partnerships
  between state agencies and faith- and community-based
  organizations; and
               (3)  operate in a manner that promotes effective
  partnerships between those agencies and organizations to serve
  residents of this state who need assistance.  (Gov. Code, Sec.
  535.053(c).)
         Sec. 550.0056.  INTERAGENCY COORDINATING GROUP ANNUAL
  REPORT. Not later than December 1 of each year, the interagency
  coordinating group shall submit to the legislature a report
  describing in detail the activities, goals, and progress of the
  group.  The report must be made available to the public on the
  office of the governor's Internet website. (Gov. Code, Sec.
  535.054.)
         Sec. 550.0057.  TEXAS NONPROFIT COUNCIL. (a) The Texas
  Nonprofit Council is established to help direct the interagency
  coordinating group in carrying out the group's duties under this
  subchapter.
         (b)  The governor, in consultation with the presiding
  officer of the interagency coordinating group, shall appoint as
  council members two representatives from each of the following
  groups and entities to represent each group's and entity's
  appropriate sector:
               (1)  community-based groups;
               (2)  consultants to nonprofit corporations;
               (3)  faith-based groups, at least one of which must be a
  statewide interfaith group;
               (4)  local governments;
               (5)  statewide associations of nonprofit
  organizations; and
               (6)  statewide nonprofit organizations.
         (c)  A council member serves a three-year term expiring
  October 1. A council member may not serve more than two consecutive
  terms.
         (d)  The council shall:
               (1)  elect a presiding officer or presiding officers
  and a secretary from among the council members; and
               (2)  assist the executive commissioner in identifying
  an individual to fill a vacancy on the council.
         (e)  The state agencies described by Section 550.0052(b)
  shall provide administrative support to the council as coordinated
  by the presiding officer of the interagency coordinating group.
         (f)  Chapter 2110 does not apply to the council. (Gov. Code,
  Secs. 535.055(a), (b), (c-1), (c-2), (e).)
         Sec. 550.0058.  DUTIES OF TEXAS NONPROFIT COUNCIL.  The
  council, in coordination with the interagency coordinating group,
  shall:
               (1)  make recommendations for improving contracting
  relationships between state agencies and faith- and
  community-based organizations;
               (2)  develop best practices for cooperating and
  collaborating with faith- and community-based organizations; and
               (3)  identify and address:
                     (A)  duplication of services provided by this
  state and faith- and community-based organizations; and
                     (B)  gaps in state services that faith- and
  community-based organizations could fill. (Gov. Code, Sec.
  535.055(c).)
         Sec. 550.0059.  TEXAS NONPROFIT COUNCIL BIENNIAL REPORT.
  (a)  The council shall prepare a biennial report detailing the
  council's work. The report must include any recommendations
  relating to legislation necessary to address an issue identified
  under Section 550.0058.
         (b)  Not later than December 1 of each even-numbered year,
  the council shall present the report to:
               (1)  the House Committee on Human Services or its
  successor;
               (2)  the House Committee on Public Health or its
  successor; and
               (3)  the Senate Health and Human Services Committee or
  its successor. (Gov. Code, Sec. 535.055(d).)
  SUBCHAPTER C. RENEWING OUR COMMUNITIES ACCOUNT
         Sec. 550.0101.  DEFINITION. In this subchapter, "account"
  means the renewing our communities account established under
  Section 550.0103. (Gov. Code, Sec. 535.101.)
         Sec. 550.0102.  PURPOSES OF SUBCHAPTER. Recognizing that
  faith- and community-based organizations provide a range of vital
  charitable services to persons in this state, the purposes of this
  subchapter are to:
               (1)  increase the impact and effectiveness of those
  organizations;
               (2)  forge stronger partnerships between those
  organizations and state government so that:
                     (A)  communities are empowered to serve
  individuals in need; and
                     (B)  community capacity for providing services is
  strengthened; and
               (3)  create a funding mechanism that:
                     (A)  builds on the established efforts of those
  organizations; and
                     (B)  operates to create new partnerships in local
  communities for the benefit of this state. (Gov. Code, Sec.
  535.102.)
         Sec. 550.0103.  RENEWING OUR COMMUNITIES ACCOUNT. (a)  The
  renewing our communities account is an account in the general
  revenue fund that may be appropriated only to the commission for:
               (1)  the purposes and activities authorized by this
  subchapter; and
               (2)  reasonable administrative expenses under this
  subchapter.
         (b)  The purposes of the account are to:
               (1)  increase the capacity of faith- and
  community-based organizations to provide charitable services and
  to manage human resources and funds;
               (2)  assist local governmental entities in
  establishing local offices to promote faith- and community-based
  initiatives; and
               (3)  foster better partnerships between state
  government and faith- and community-based organizations.
         (c)  The account consists of:
               (1)  all money appropriated for the purposes of this
  subchapter; and
               (2)  any gifts, grants, or donations received for the
  purposes of this subchapter.
         (d)  The account is exempt from the application of Section
  403.095. (Gov. Code, Sec. 535.103.)
         Sec. 550.0104.  COMMISSION POWERS AND DUTIES REGARDING
  ACCOUNT. (a)  The commission shall:
               (1)  contract with the State Commission on National and
  Community Service to administer funds appropriated from the account
  in a manner that:
                     (A)  consolidates the capacity of and strengthens
  national service and community and faith- and community-based
  initiatives; and
                     (B)  leverages public and private funds to benefit
  this state;
               (2)  develop a competitive process for awarding grants
  from funds in the account that is consistent with state law and
  includes objective selection criteria;
               (3)  oversee the delivery of training and other
  assistance activities under this subchapter;
               (4)  develop criteria limiting grant awards under
  Section 550.0106(a)(1)(A) to small and medium-sized faith- and
  community-based organizations that provide charitable services to
  persons in this state;
               (5)  establish general state priorities for the
  account;
               (6)  establish and monitor performance and outcome
  measures for persons who are awarded grants under this subchapter;
  and
               (7)  establish policies and procedures to ensure that
  any money appropriated from the account to the commission that is
  allocated to build the capacity of a faith-based organization or
  for a faith-based initiative is not used to advance a sectarian
  purpose or to engage in any form of proselytization.
         (b)  The commission may award money in the account
  appropriated to the commission to the State Commission on National
  and Community Service in the form of a grant instead of contracting
  with that entity under Subsection (a)(1). (Gov. Code, Secs.
  535.104(a), (b).)
         Sec. 550.0105.  ACCEPTABLE USES OF ACCOUNT FUNDS. The
  commission or the State Commission on National and Community
  Service, in accordance with the terms of a contract or grant, as
  applicable, may:
               (1)  directly, or through agreements with one or more
  entities serving faith- and community-based organizations that
  provide charitable services to persons in this state:
                     (A)  assist the organizations with:
                           (i)  writing or managing grants through
  workshops or other forms of guidance;
                           (ii)  obtaining legal assistance related to
  forming a corporation or obtaining an exemption from taxation under
  the Internal Revenue Code; and
                           (iii)  obtaining information about or
  referrals to entities that provide expertise in accounting, legal,
  or tax issues, program development matters, or other organizational
  topics;
                     (B)  provide to the organizations information or
  assistance related to building the organizations' capacity for
  providing services;
                     (C)  facilitate the formation of networks, the
  coordination of services, and the sharing of resources among the
  organizations;
                     (D)  in cooperation with existing efforts, if
  possible, conduct needs assessments to identify gaps in services in
  a community that present a need for developing or expanding
  services;
                     (E)  work with the organizations to identify the
  organizations' needs for improvements in their internal capacity
  for providing services;
                     (F)  provide the organizations with information
  on and assistance in identifying or using practices with
  demonstrated effectiveness for delivering charitable services to
  persons, families, and communities and in replicating charitable
  services programs that have demonstrated effectiveness; and
                     (G)  encourage research into the impact of
  organizational capacity on program delivery for the organizations;
               (2)  assist a local governmental entity in creating a
  better partnership between government and faith- and
  community-based organizations to provide charitable services to
  persons in this state; and
               (3)  use funds appropriated from the account to provide
  matching money for federal or private grant programs that further
  the purposes of the account as described by Section 550.0103(b).
  (Gov. Code, Sec. 535.104(d).)
         Sec. 550.0106.  ADMINISTRATION OF ACCOUNT FUNDS. (a)  If
  under Section 550.0104 the commission contracts with or awards a
  grant to the State Commission on National and Community Service,
  that entity:
               (1)  may award grants from funds appropriated from the
  account to:
                     (A)  faith- and community-based organizations
  that provide charitable services to persons in this state for
  capacity-building purposes; and
                     (B)  local governmental entities to provide seed
  money for local offices for faith- and community-based initiatives;
  and
               (2)  shall monitor performance and outcome measures for
  persons to whom that entity awards grants using the measures the
  commission establishes under Section 550.0104(a)(6).
         (b)  Any funds awarded to the State Commission on National
  and Community Service under a contract or through a grant under
  Section 550.0104 must be administered in the manner required by
  this subchapter. (Gov. Code, Secs. 535.104(c), 535.105.)
         Sec. 550.0107.  ACCOUNT MONITORING. The commission shall
  monitor the use of the funds administered by the State Commission on
  National and Community Service under a contract or through a grant
  under Section 550.0104 to ensure that the funds are used in a manner
  consistent with the requirements of this subchapter. (Gov. Code,
  Sec. 535.104(e) (part).)  
         Sec. 550.0108.  PUBLIC INFORMATION; INTERNET POSTING
  REQUIREMENT.  (a)  Records relating to the award of a contract or
  grant to the State Commission on National and Community Service, or
  to grants that entity awards, and records relating to other uses of
  the awarded funds are public information subject to Chapter 552.
         (b)  If the commission contracts with or awards a grant to the
  State Commission on National and Community Service under Section
  550.0104, the commission shall provide a link on the commission's
  Internet website to that entity's Internet website.  The entity's
  Internet website must provide:
               (1)  a list of the names of each person to whom the
  entity awards a grant from money appropriated from the account and
  the amount and purpose of the grant; and
               (2)  information regarding the methods by which the
  public may request information about those grants. (Gov. Code,
  Secs. 535.104(e) (part), 535.106(a).)
         Sec. 550.0109.  REPORTS. (a)  If the State Commission on
  National and Community Service is awarded a contract or grant under
  Section 550.0104, that entity must provide to the commission
  periodic reports on a schedule the executive commissioner
  determines.  The schedule of periodic reports must include an
  annual report that provides:
               (1)  a specific accounting of that entity's use of money
  appropriated from the account, including the names of persons to
  whom grants have been awarded and the purposes of those grants; and
               (2)  a summary of the efforts of the faith- and
  community-based liaisons designated under Section 550.0052 to
  comply with the duties imposed by and the purposes of Sections
  550.0053 and 550.0055.
         (b)  The commission shall:
               (1)  post the annual report submitted under this
  section on the commission's Internet website; and
               (2)  provide copies of the report to the governor, the
  lieutenant governor, and the members of the legislature. (Gov.
  Code, Secs. 535.106(b), (c).)
         Sec. 550.0110.  CONSTRUCTION OF SUBCHAPTER.  If the
  commission contracts with or awards a grant to the State Commission
  on National and Community Service under Section 550.0104, this
  subchapter may not be construed to:
               (1)  release that entity from any regulations or
  reporting or other requirements applicable to a commission
  contractor or grantee;
               (2)  impose regulations or reporting or other
  requirements on that entity that do not apply to other commission
  contractors or grantees solely because of the entity's status;
               (3)  alter the nonprofit status of that entity or the
  requirements for maintaining that status; or
               (4)  convert that entity into a governmental entity
  because of the receipt of account funds through the contract or
  grant. (Gov. Code, Sec. 535.104(f).)
  SUBCHAPTER D. FAITH- AND COMMUNITY-BASED ORGANIZATION SUPPLEMENTAL
  ASSISTANCE PROGRAM FOR CERTAIN INDIVIDUALS RECEIVING PUBLIC
  ASSISTANCE
         Sec. 550.0151.  PROGRAM ESTABLISHMENT.  (a) The commission
  shall:
               (1)  establish a program under which faith- and
  community-based organizations may, on an applicant's request,
  contact and offer supplemental assistance to the applicant for
  benefits under:
                     (A)  the financial assistance program under
  Chapter 31, Human Resources Code;
                     (B)  the medical assistance program under Chapter
  32, Human Resources Code;
                     (C)  the supplemental nutrition assistance
  program under Chapter 33, Human Resources Code; or
                     (D)  the child health plan program under Chapter
  62, Health and Safety Code; and
               (2)  develop a procedure under which faith- and
  community-based organizations may apply to participate in the
  program.
         (b)  At the time an individual applies for benefits described
  by Subsection (a), the individual must be:
               (1)  informed about and given the opportunity to enroll
  in the program; and
               (2)  informed that enrolling in the program will not
  affect the individual's eligibility for benefits. (Gov. Code,
  Secs. 531.02482(b), (c), (d).)
         Sec. 550.0152.  RULES. The executive commissioner shall
  adopt rules to implement the program, including rules that:
               (1)  describe:
                     (A)  the types of faith- and community-based
  organizations that may apply to participate in the program; and
                     (B)  the qualifications and standards of service
  required of a participating organization;
               (2)  facilitate contact between an individual who
  enrolls in the program and a participating organization that
  provides supplemental services that may assist the individual;
               (3)  establish:
                     (A)  processes for suspending, revoking, and
  periodically renewing an organization's participation in the
  program, as appropriate; and
                     (B)  methods to ensure the confidentiality and
  appropriate use of applicant information shared with a
  participating organization; and
               (4)  permit an individual to terminate the individual's
  enrollment in the program. (Gov. Code, Sec. 531.02482(e).)
  SUBCHAPTER D-1. PILOT PROGRAM FOR SELF-SUFFICIENCY OF CERTAIN
  INDIVIDUALS RECEIVING FINANCIAL ASSISTANCE OR SUPPLEMENTAL
  NUTRITION ASSISTANCE BENEFITS
         Sec. 550.0201.  DEFINITIONS. In this subchapter:
               (1)  "Financial assistance benefits" means money
  payments under:
                     (A)  the federal Temporary Assistance for Needy
  Families program operated under Chapter 31, Human Resources Code;
  or
                     (B)  the state temporary assistance and support
  services program operated under Chapter 34, Human Resources Code.
               (2)  "Pilot program" means the pilot program for
  self-sufficiency of certain individuals receiving financial
  assistance or supplemental nutrition assistance benefits developed
  and implemented under this subchapter.
               (3)  "Self-sufficiency" means:
                     (A)  being employed in a position that pays a
  sufficient wage;
                     (B)  having financial savings in an amount equal
  to at least $1,000 per member of a family's household; and
                     (C)  maintaining a debt-to-income ratio that does
  not exceed 43 percent.
               (4)  "Slow reduction scale" means a graduated plan for
  reducing financial assistance or supplemental nutrition assistance
  benefits that correlates with a phase of the pilot program's
  progressive stages toward self-sufficiency.
               (5)  "Sufficient wage" means an amount of money
  sufficient to meet a family's minimum necessary spending on basic
  needs, including food, child care, health insurance, housing, and
  transportation, as determined by a market-based calculation that
  uses geographically specific expenditure data.
               (6)  "Supplemental nutrition assistance benefits"
  means money payments under the supplemental nutrition assistance
  program operated under Chapter 33, Human Resources Code. (Gov.
  Code, Sec. 531.02241(a); New.)
         Sec. 550.0202.  PILOT PROGRAM DEVELOPMENT AND
  IMPLEMENTATION. (a) The commission shall develop and implement a
  pilot program to assist not more than 500 eligible families in
  gaining permanent self-sufficiency and by eliminating the need for
  financial assistance, supplemental nutrition assistance, or other
  means-tested public benefits, notwithstanding the limitations and
  requirements of Section 31.043, Human Resources Code.  
         (b)  If the commission determines the number of families
  participating in the pilot program during a year reaches capacity
  for that year, the number of families that may be served under the
  program in the following year may be increased by 20 percent.
         (c)  The commission shall develop and implement the pilot
  program with the assistance of:
               (1)  faith-based and other relevant public or private
  organizations;
               (2)  local workforce development boards;
               (3)  the Texas Workforce Commission; and
               (4)  any other person the commission determines
  appropriate.
         (d)  The pilot program must operate for at least 24 months.
  The program must also include 16 additional months for:
               (1)  planning and designing the program before the
  program begins operation;
               (2)  recruiting eligible families to participate in the
  program;
               (3)  randomly placing each participating family in one
  of at least three research groups, including:
                     (A)  a control group;
                     (B)  a group consisting of families for whom the
  application of income, asset, and time limits described by Section
  550.0204 is waived; and
                     (C)  a group consisting of families for whom the
  application of income, asset, and time limits described by Section
  550.0204 is waived and who receive wraparound case management
  services under the program; and
               (4)  after the program begins operation, collecting and
  sharing data that allows for:
                     (A)  obtaining participating families'
  eligibility and identification data before a family is randomly
  placed in a research group under Subdivision (3);
                     (B)  conducting surveys or interviews of
  participating families to obtain information that is not contained
  in records related to a family's eligibility for financial
  assistance, supplemental nutrition assistance, or other
  means-tested public benefits;
                     (C)  providing quarterly reports for not more than
  60 months after a participating family's enrollment in the program
  regarding the program's effect on the family's labor market
  participation, income, and need for means-tested public benefits;
                     (D)  assessing the interaction of the program's
  components with the desired outcomes of the program using data
  collected during the program and data obtained from state agencies
  concerning means-tested public benefits; and
                     (E)  enlisting a third party to conduct a rigorous
  experimental impact evaluation of the program.
         (e)  The pilot program must provide through a
  community-based provider to each participating family placed in the
  research group described by Subsection (d)(3)(C) holistic,
  wraparound case management services that meet all applicable
  program requirements under 7 C.F.R. Section 273.7(e) or 45 C.F.R.
  Section 261.10, as applicable. Case management services provided
  under this subsection must include the strategic use of financial
  assistance and supplemental nutrition assistance benefits to
  ensure that the goals included in the family's service plan are
  achieved.  (Gov. Code, Secs. 531.02241(b), (i), (j), (k).)
         Sec. 550.0203.  PILOT PROGRAM DESIGN. (a) The commission
  shall design the pilot program to allow social services providers,
  public benefit offices, and other community partners to refer
  potential participating families to the program.
         (b)  The commission shall design the pilot program to assist
  eligible participating families in attaining self-sufficiency by:
               (1)  identifying eligibility requirements for the
  continuation of financial assistance or supplemental nutrition
  assistance benefits and time limits for the benefits, the
  application of which may be waived for a limited period and that, if
  applied, would impede self-sufficiency;
               (2)  implementing strategies, including waiving the
  application of the eligibility requirements and time limits
  identified in Subdivision (1), to remove barriers to
  self-sufficiency; and
               (3)  moving eligible participating families toward
  self-sufficiency through progressive stages that include the
  following phases:
                     (A)  an initial phase in which a family
  transitions out of an emergent crisis by securing housing, medical
  care, and financial assistance and supplemental nutrition
  assistance benefits, as necessary;
                     (B)  a second phase in which:
                           (i)  the family transitions toward stability
  by securing employment and any necessary child care and by
  participating in services that build the financial management
  skills necessary to meet financial goals; and
                           (ii)  the family's financial assistance and
  supplemental nutrition assistance benefits are reduced according
  to the following scale:
                                 (a)  on reaching 25 percent of the
  family's sufficient wage, the amount of benefits is reduced by 10
  percent;
                                 (b)  on reaching 50 percent of the
  family's sufficient wage, the amount of benefits is reduced by 25
  percent; and
                                 (c)  on reaching 75 percent of the
  family's sufficient wage, the amount of benefits is reduced by 50
  percent;
                     (C)  a third phase in which the family:
                           (i)  transitions to self-sufficiency by
  securing employment that pays a sufficient wage, reducing debt, and
  building savings; and
                           (ii)  becomes ineligible for financial
  assistance and supplemental nutrition assistance benefits on
  reaching 100 percent of the family's sufficient wage; and
                     (D)  a final phase in which the family attains
  self-sufficiency by retaining employment that pays a sufficient
  wage, amassing at least $1,000 per member of the family's
  household, and having manageable debt so that the family will no
  longer be dependent on financial assistance, supplemental
  nutrition assistance, or other means-tested public benefits for at
  least six months following the date the family stops participating
  in the program. (Gov. Code, Secs. 531.02241(d), (f).)
         Sec. 550.0204.  BENEFIT ELIGIBILITY FOR PILOT PROGRAM
  PARTICIPANTS. (a) To allow for continuation of financial
  assistance and supplemental nutrition assistance benefits and
  reduction of the benefits using a slow reduction scale, the pilot
  program will test extending the benefits for at least 24 months but
  not more than 60 months by waiving:
               (1)  the application of income and asset limit
  eligibility requirements for financial assistance and supplemental
  nutrition assistance benefits; and
               (2)  the time limits specified by Section 31.0065,
  Human Resources Code, for financial assistance benefits.
         (b)  The commission shall freeze a participating family's
  eligibility status for financial assistance and supplemental
  nutrition assistance benefits beginning on the date the
  participating family enters the pilot program and ending on the
  date the family ceases participating in the program.
         (c)  The waiver of the application of any asset limit
  requirement under this section must allow the participating family
  to have assets in an amount equal to at least $1,000 per member of
  the family's household. (Gov. Code, Sec. 531.02241(c).)
         Sec. 550.0205.  FAMILY ELIGIBILITY REQUIREMENTS. A family
  is eligible to participate in the pilot program if the family:
               (1)  includes one or more members who are recipients of
  financial assistance or supplemental nutrition assistance
  benefits, at least one of whom is:
                     (A)  at least 18 years of age but not older than 62
  years of age; and
                     (B)  willing, physically able, and legally able to
  be employed; and
               (2)  has a total household income that is less than a
  sufficient wage based on the family's makeup and geographical area
  of residence. (Gov. Code, Sec. 531.02241(e).)
         Sec. 550.0206.  CASE MANAGEMENT REQUIREMENTS. (a) An
  individual from a family that wishes to participate in the pilot
  program must attend an in-person intake meeting with a program case
  manager. During the intake meeting the case manager shall:
               (1)  determine whether:
                     (A)  the individual's family meets the
  eligibility requirements under Section 550.0205; and
                     (B)  the application of income or asset limit
  eligibility requirements for continuation of financial assistance
  and supplemental nutrition assistance benefits and the time limits
  specified by Section 31.0065, Human Resources Code, for financial
  assistance benefits may be waived under the program;
               (2)  review the family's demographic information and
  household financial budget;
               (3)  assess the family members' current financial and
  career situations;
               (4)  collaborate with the individual to develop and
  implement strategies for removing barriers to the family attaining
  self-sufficiency, including waiving the application of income and
  asset limit eligibility requirements and time limits described by
  Subdivision (1)(B) to allow for continuation of financial
  assistance and supplemental nutrition assistance benefits; and
               (5)  if the individual's family is determined eligible
  for and chooses to participate in the program, schedule a follow-up
  meeting to:
                     (A)  further assess the family's crisis;
                     (B)  review available referral services; and
                     (C)  create a service plan.
         (b)  A participating family must be assigned a program case
  manager who shall:
               (1)  if the family is determined eligible, provide the
  family with a verification of the waived application of asset,
  income, and time limits described by Section 550.0204, allowing the
  family to continue receiving financial assistance and supplemental
  nutrition assistance benefits on a slow reduction scale;
               (2)  during the initial phase of the program, create
  medium- and long-term goals consistent with the strategies
  developed under Subsection (a)(4); and
               (3)  assess, at the follow-up meeting scheduled under
  Subsection (a)(5), the family's crisis, review available referral
  services, and create a service plan. (Gov. Code, Secs.
  531.02241(g), (h).)
         Sec. 550.0207.  PILOT PROGRAM MONITORING AND EVALUATION.
  The commission shall monitor and evaluate the pilot program in a
  manner that allows for promoting research-informed results of the
  program. (Gov. Code, Sec. 531.02241(l).)
         Sec. 550.0208.  REPORTS. (a) On the conclusion of the pilot
  program but not later than 48 months following the date of the last
  participating family's enrollment in the program, the commission
  shall report to the legislature on the results of the program. The
  report must include:
               (1)  an evaluation of the program's effect on
  participating families in achieving self-sufficiency and
  eliminating the need for means-tested public benefits;
               (2)  the impact to this state on the costs of the
  financial assistance and supplemental nutrition assistance
  programs and of the child-care services program operated by the
  Texas Workforce Commission;
               (3)  a cost-benefit analysis of the program; and
               (4)  recommendations on the feasibility and
  continuation of the program.
         (b)  During the operation of the pilot program, the
  commission shall provide to the legislature additional reports
  concerning the program that the commission determines appropriate.
  (Gov. Code, Secs. 531.02241(m), (n).)
         Sec. 550.0209.  RULES. The executive commissioner and the
  Texas Workforce Commission may adopt rules to implement this
  subchapter. (Gov. Code, Sec. 531.02241(o).)
         Sec. 550.0210.  SUBCHAPTER EXPIRATION. This subchapter
  expires September 1, 2026. (Gov. Code, Sec. 531.02241(p).)
  SUBCHAPTER E. COMMUNITY-BASED NAVIGATOR PROGRAM
         Sec. 550.0251.  DEFINITION. In this subchapter, "navigator"
  means an individual who is:
               (1)  a volunteer or other representative of a faith- or
  community-based organization; and
               (2)  certified by the commission to provide or
  facilitate the provision of information or assistance through the
  faith- or community-based organization to individuals applying or
  seeking to apply online for public assistance benefits administered
  by the commission through the Texas Integrated Eligibility Redesign
  System (TIERS) or any other electronic eligibility system that is
  linked to or made a part of that system. (Gov. Code, Sec.
  531.751(2).)
         Sec. 550.0252.  ESTABLISHMENT OF COMMUNITY-BASED NAVIGATOR
  PROGRAM. (a) The commission shall establish a statewide
  community-based navigator program if the executive commissioner
  determines the program can be established and operated using
  existing resources and without disrupting other commission
  functions.
         (b)  Under the statewide community-based navigator program,
  the commission will train and certify as navigators volunteers and
  other representatives of faith- and community-based organizations.
  The navigators will assist individuals applying or seeking to apply
  online for public assistance benefits through the Texas Integrated
  Eligibility Redesign System (TIERS) or any other electronic
  eligibility system that is linked to or made a part of that system.
         (c)  In establishing the navigator program, the commission:
               (1)  shall solicit the expertise and assistance of
  interested persons, including faith- and community-based
  organizations; and
               (2)  may establish a work group or other temporary,
  informal group of interested persons to provide input and
  assistance. (Gov. Code, Sec. 531.752.)
         Sec. 550.0253.  PROGRAM STANDARDS. The executive
  commissioner shall adopt standards to implement this subchapter,
  including standards:
               (1)  subject to Section 550.0254, regarding the
  qualifications and training required for navigator certification;
               (2)  regarding the suspension, revocation, and, if
  appropriate, periodic renewal of a navigator certificate;
               (3)  to protect the confidentiality of applicant
  information handled by navigators; and
               (4)  regarding any other issues the executive
  commissioner determines are appropriate. (Gov. Code, Sec.
  531.753.)
         Sec. 550.0254.  NAVIGATOR TRAINING PROGRAM. The commission
  shall develop and administer a navigator training program that
  includes training on:
               (1)  the manner of completing an online application for
  public assistance benefits through the Texas Integrated
  Eligibility Redesign System (TIERS);
               (2)  the importance of maintaining the confidentiality
  of information a navigator handles;
               (3)  the importance of obtaining and submitting
  complete and accurate information when completing an application
  for public assistance benefits online through the Texas Integrated
  Eligibility Redesign System (TIERS);
               (4)  the financial assistance program, the
  supplemental nutrition assistance program, Medicaid, the child
  health plan program, and any other public assistance benefits
  program for which an individual may complete an online application
  through the Texas Integrated Eligibility Redesign System (TIERS);
  and
               (5)  the method by which an individual may apply for
  other public assistance benefits for which the individual may not
  complete an online application through the Texas Integrated
  Eligibility Redesign System (TIERS). (Gov. Code, Sec. 531.754.)
         Sec. 550.0255.  CERTIFIED NAVIGATOR LIST. The commission
  shall publish and maintain on the commission's Internet website a
  list of certified navigators. (Gov. Code, Sec. 531.755.)
  ARTICLE 2. CONFORMING AMENDMENTS
         SECTION 2.01.  Section 20.038, Business & Commerce Code, is
  amended to read as follows:
         Sec. 20.038.  EXEMPTION FROM SECURITY FREEZE. A security
  freeze does not apply to a consumer report provided to:
               (1)  a state or local governmental entity, including a
  law enforcement agency or court or private collection agency, if
  the entity, agency, or court is acting under a court order, warrant,
  subpoena, or administrative subpoena;
               (2)  a child support agency as defined by Section
  101.004, Family Code, acting to investigate or collect child
  support payments or acting under Title IV-D of the Social Security
  Act (42 U.S.C. Section 651 et seq.);
               (3)  the Health and Human Services Commission acting
  under the following provisions of the [Section 531.102,] Government
  Code:
                     (A)  Section 544.0052;
                     (B)  Section 544.0101;
                     (C)  Section 544.0102;
                     (D)  Section 544.0103;
                     (E)  Section 544.0104;
                     (F)  Section 544.0105;
                     (G)  Section 544.0106;
                     (H)  Section 544.0108;
                     (I)  Sections 544.0109(b) and (d);
                     (J)  Section 544.0110;
                     (K)  Section 544.0113;
                     (L)  Section 544.0114;
                     (M)  Section 544.0251;
                     (N)  Section 544.0252(b);
                     (O)  Section 544.0254;
                     (P)  Section 544.0255;
                     (Q)  Section 544.0257;
                     (R)  Section 544.0301;
                     (S)  Section 544.0302;
                     (T)  Section 544.0303; and
                     (U)  Section 544.0304;
               (4)  the comptroller acting to investigate or collect
  delinquent sales or franchise taxes;
               (5)  a tax assessor-collector acting to investigate or
  collect delinquent ad valorem taxes;
               (6)  a person for the purposes of prescreening as
  provided by the Fair Credit Reporting Act (15 U.S.C. Section 1681 et
  seq.), as amended;
               (7)  a person with whom the consumer has an account or
  contract or to whom the consumer has issued a negotiable
  instrument, or the person's subsidiary, affiliate, agent,
  assignee, prospective assignee, or private collection agency, for
  purposes related to that account, contract, or instrument;
               (8)  a subsidiary, affiliate, agent, assignee, or
  prospective assignee of a person to whom access has been granted
  under Section 20.037(b);
               (9)  a person who administers a credit file monitoring
  subscription service to which the consumer has subscribed;
               (10)  a person for the purpose of providing a consumer
  with a copy of the consumer's report on the consumer's request;
               (11)  a check service or fraud prevention service
  company that issues consumer reports:
                     (A)  to prevent or investigate fraud; or
                     (B)  for purposes of approving or processing
  negotiable instruments, electronic funds transfers, or similar
  methods of payment;
               (12)  a deposit account information service company
  that issues consumer reports related to account closures caused by
  fraud, substantial overdrafts, automated teller machine abuses, or
  similar negative information regarding a consumer to an inquiring
  financial institution for use by the financial institution only in
  reviewing a consumer request for a deposit account with that
  institution; or
               (13)  a consumer reporting agency that:
                     (A)  acts only to resell credit information by
  assembling and merging information contained in a database of
  another consumer reporting agency or multiple consumer reporting
  agencies; and
                     (B)  does not maintain a permanent database of
  credit information from which new consumer reports are produced.
         SECTION 2.02.  Section 140.002(f), Civil Practice and
  Remedies Code, is amended to read as follows:
         (f)  This chapter does not apply to:
               (1)  a workers' compensation insurance policy or any
  other source of medical benefits under Title 5, Labor Code;
               (2)  Medicare;
               (3)  the Medicaid program under Chapter 32, Human
  Resources Code;
               (4)  a Medicaid managed care program operated under
  Chapter 540 or Chapter 540A [533], Government Code, as applicable;
               (5)  the state child health plan or any other program
  operated under Chapter 62 or 63, Health and Safety Code; or
               (6)  a self-funded plan that is subject to the Employee
  Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
  seq.).
         SECTION 2.03.  Section 33.096(b), Education Code, is amended
  to read as follows:
         (b)  A student may request an electrocardiogram from any
  health care professional, including a health care professional
  provided through the student's patient-centered medical home, as
  defined by Section 540.0712 [533.0029], Government Code, a health
  care professional provided through a school district program, or
  another health care professional chosen by the parent or person
  standing in parental relation to the student, provided that the
  health care professional is:
               (1)  appropriately licensed in this state; and
               (2)  authorized to administer and interpret
  electrocardiograms under the health care professional's scope of
  practice, as established by the health care professional's Texas
  licensing act.
         SECTION 2.04.  Section 114.106(b), Estates Code, is amended
  to read as follows:
         (b)  Notwithstanding Subsection (a), real property
  transferred at the transferor's death by a transfer on death deed is
  not considered property of the probate estate for any purpose,
  including for purposes of Section 546.0403 [531.077], Government
  Code.
         SECTION 2.05.  Section 53.011(a), Family Code, is amended to
  read as follows:
         (a)  In this section:
               (1)  "Community resource coordination group" has the
  meaning assigned by Section 547.0101 [531.421], Government Code.
               (2)  "Local-level interagency staffing group" means a
  group established under the memorandum of understanding described
  by Subchapter D, Chapter 522 [Section 531.055], Government Code.
         SECTION 2.06.  Section 58.0051(a)(2), Family Code, is
  amended to read as follows:
               (2)  "Juvenile service provider" means a governmental
  entity that provides juvenile justice or prevention, medical,
  educational, or other support services to a juvenile.  The term
  includes:
                     (A)  a state or local juvenile justice agency as
  defined by Section 58.101;
                     (B)  health and human services agencies, as
  defined by Section 521.0001 [531.001], Government Code, and the
  Health and Human Services Commission;
                     (C)  the Department of Family and Protective
  Services;
                     (D)  the Department of Public Safety;
                     (E)  the Texas Education Agency;
                     (F)  an independent school district;
                     (G)  a juvenile justice alternative education
  program;
                     (H)  a charter school;
                     (I)  a local mental health or mental retardation
  authority;
                     (J)  a court with jurisdiction over juveniles;
                     (K)  a district attorney's office;
                     (L)  a county attorney's office; and
                     (M)  a children's advocacy center established
  under Section 264.402.
         SECTION 2.07.  Section 261.401(b), Family Code, is amended
  to read as follows:
         (b)  Except as provided by Section 261.404 of this code and
  former Section 531.02013(1)(D), Government Code, a state agency
  that operates, licenses, certifies, registers, or lists a facility
  in which children are located or provides oversight of a program
  that serves children shall make a prompt, thorough investigation of
  a report that a child has been or may be abused, neglected, or
  exploited in the facility or program. The primary purpose of the
  investigation shall be the protection of the child.
         SECTION 2.08.  Sections 261.404(a-1) and (a-2), Family Code,
  are amended to read as follows:
         (a-1)  For an investigation of a child living in a residence
  owned, operated, or controlled by a provider of services under the
  home and community-based services waiver program described by
  Section 542.0001(11)(B) [534.001(11)(B)], Government Code, the
  department, in accordance with Subchapter E, Chapter 48, Human
  Resources Code, may provide emergency protective services
  necessary to immediately protect the child from serious physical
  harm or death and, if necessary, obtain an emergency order for
  protective services under Section 48.208, Human Resources Code.
         (a-2)  For an investigation of a child living in a residence
  owned, operated, or controlled by a provider of services under the
  home and community-based services waiver program described by
  Section 542.0001(11)(B) [534.001(11)(B)], Government Code,
  regardless of whether the child is receiving services under that
  waiver program from the provider, the department shall provide
  protective services to the child in accordance with Subchapter E,
  Chapter 48, Human Resources Code.
         SECTION 2.09.  Section 264.019(b), Family Code, is amended
  to read as follows:
         (b)  Not later than November 1 of each year, the department
  shall:
               (1)  prepare for the preceding year a report
  containing:
                     (A)  the information collected under Subsection
  (a); and
                     (B)  the data collected under Section 532.0204
  [531.02143], Government Code;
               (2)  post a copy of the report prepared under
  Subdivision (1) on the department's Internet website; and
               (3)  electronically submit to the legislature a copy of
  the report.
         SECTION 2.10.  Section 264.1212(a), Family Code, is amended
  to read as follows:
         (a)  In this section, "community resource coordination
  group" means a coordination group established under a memorandum of
  understanding under Subchapter D, Chapter 522 [Section 531.055],
  Government Code.
         SECTION 2.11.  Section 264.757, Family Code, is amended to
  read as follows:
         Sec. 264.757.  COORDINATION WITH OTHER AGENCIES. The
  department shall coordinate with other health and human services
  agencies, as defined by Section 521.0001 [531.001], Government
  Code, to provide assistance and services under this subchapter.
         SECTION 2.12.  Section 14.1025(a)(2), Finance Code, is
  amended to read as follows:
               (2)  "Health and human services agencies" has the
  meaning assigned by Section 521.0001 [531.001], Government Code.
         SECTION 2.13.  Section 322.020(f), Government Code, is
  amended to read as follows:
         (f)  In this section, "state agency" has the meaning assigned
  by Section 2054.003, except that the term does not include a
  university system or institution of higher education, the Health
  and Human Services Commission, an agency identified in Section
  521.0001(5) [531.001(4)], or the Texas Department of
  Transportation.
         SECTION 2.14.  Section 411.1143(a), Government Code, is
  amended to read as follows:
         (a)  The Health and Human Services Commission, an agency
  operating part of the medical assistance program under Chapter 32,
  Human Resources Code, or the office of inspector general
  established under Subchapter C, Chapter 544 [Chapter 531],
  Government Code, is entitled to obtain from the department the
  criminal history record information maintained by the department
  that relates to a provider under the medical assistance program or a
  person applying to enroll as a provider under the medical
  assistance program.
         SECTION 2.15.  Section 418.043, Government Code, is amended
  to read as follows:
         Sec. 418.043.  OTHER POWERS AND DUTIES.  The division shall:
               (1)  determine requirements of the state and its
  political subdivisions for food, clothing, and other necessities in
  event of a disaster;
               (2)  procure and position supplies, medicines,
  materials, and equipment;
               (3)  adopt standards and requirements for local and
  interjurisdictional emergency management plans;
               (4)  periodically review local and interjurisdictional
  emergency management plans;
               (5)  coordinate deployment of mobile support units;
               (6)  establish and operate training programs and
  programs of public information or assist political subdivisions and
  emergency management agencies to establish and operate the
  programs;
               (7)  make surveys of public and private industries,
  resources, and facilities in the state that are necessary to carry
  out the purposes of this chapter;
               (8)  plan and make arrangements for the availability
  and use of any private facilities, services, and property and
  provide for payment for use under terms and conditions agreed on if
  the facilities are used and payment is necessary;
               (9)  establish a register of persons with types of
  training and skills important in disaster mitigation,
  preparedness, response, and recovery;
               (10)  establish a register of mobile and construction
  equipment and temporary housing available for use in a disaster;
               (11)  assist political subdivisions in developing
  plans for the humane evacuation, transport, and temporary
  sheltering of service animals and household pets in a disaster;
               (12)  prepare, for issuance by the governor, executive
  orders and regulations necessary or appropriate in coping with
  disasters;
               (13)  cooperate with the federal government and any
  public or private agency or entity in achieving any purpose of this
  chapter and in implementing programs for disaster mitigation,
  preparation, response, and recovery;
               (14)  develop a plan to raise public awareness and
  expand the capability of the information and referral network under
  Section 526.0004 [531.0312];
               (15)  improve the integration of volunteer groups,
  including faith-based organizations, into emergency management
  plans;
               (16)  cooperate with the Federal Emergency Management
  Agency to create uniform guidelines for acceptable home repairs
  following disasters and promote public awareness of the guidelines;
               (17)  cooperate with state agencies to:
                     (A)  encourage the public to participate in
  volunteer emergency response teams and organizations that respond
  to disasters; and
                     (B)  provide information on those programs in
  state disaster preparedness and educational materials and on
  Internet websites;
               (18)  establish a liability awareness program for
  volunteers, including medical professionals;
               (19)  define "individuals with special needs" in the
  context of a disaster;
               (20)  establish and operate, subject to the
  availability of funds, a search and rescue task force in each field
  response region established by the division to assist in search,
  rescue, and recovery efforts before, during, and after a natural or
  man-made disaster; and
               (21)  do other things necessary, incidental, or
  appropriate for the implementation of this chapter.
         SECTION 2.16.  Section 441.203(j), Government Code, is
  amended to read as follows:
         (j)  The council shall categorize state agency programs and
  telephone numbers by subject matter as well as by agency. The
  council shall cooperate with the Texas Information and Referral
  Network under Section 526.0004 [531.0312] to ensure that the
  council and the network use a single method of defining and
  organizing information about health and human services.
         SECTION 2.17.  Section 2001.223, Government Code, is amended
  to read as follows:
         Sec. 2001.223.  EXCEPTIONS FROM DECLARATORY JUDGMENT, COURT
  ENFORCEMENT, AND CONTESTED CASE PROVISIONS. Section 2001.038 and
  Subchapters C through H do not apply to:
               (1)  except as provided by Subchapter D, Chapter 545
  [Section 531.019], the granting, payment, denial, or withdrawal of
  financial or medical assistance or benefits under service programs
  that were operated by the former Texas Department of Human Services
  before September 1, 2003, and are operated on and after that date by
  the Health and Human Services Commission or a health and human
  services agency, as defined by Section 521.0001 [531.001];
               (2)  action by the Banking Commissioner or the Finance
  Commission of Texas regarding the issuance of a state bank or state
  trust company charter for a bank or trust company to assume the
  assets and liabilities of a financial institution that the
  commissioner considers to be in hazardous condition as defined by
  Section 31.002(a) or 181.002(a), Finance Code, as applicable;
               (3)  a hearing or interview conducted by the Board of
  Pardons and Paroles or the Texas Department of Criminal Justice
  relating to the grant, rescission, or revocation of parole or other
  form of administrative release; or
               (4)  the suspension, revocation, or termination of the
  certification of a breath analysis operator or technical supervisor
  under the rules of the Department of Public Safety.
         SECTION 2.18.  Section 2055.001(4), Government Code, is
  amended to read as follows:
               (4)  "State agency" has the meaning assigned by Section
  2054.003, except that the term does not include a university system
  or institution of higher education or an agency identified in
  Section 521.0001(5) [531.001(4)].
         SECTION 2.19.  Section 2055.002(a), Government Code, is
  amended to read as follows:
         (a)  Except as provided by Subsection (b), the requirements
  of this chapter regarding electronic government projects do not
  apply to institutions of higher education or a health and human
  services agency identified in Section 521.0001(5) [531.001(4)],
  Government Code.
         SECTION 2.20.  Sections 2155.144(i), (j), (k), (m), and (p),
  Government Code, are amended to read as follows:
         (i)  Subject to Section 524.0001(b) [531.0055(c)], the
  Health and Human Services Commission shall develop a single
  statewide risk analysis procedure. Each health and human services
  agency shall comply with the procedure. The procedure must provide
  for:
               (1)  assessing the risk of fraud, abuse, or waste in
  health and human services agencies contractor selection processes,
  contract provisions, and payment and reimbursement rates and
  methods for the different types of goods and services for which
  health and human services agencies contract;
               (2)  identifying contracts that require enhanced
  contract monitoring; and
               (3)  coordinating contract monitoring efforts among
  health and human services agencies.
         (j)  Subject to Section 524.0001(b) [531.0055(c)], the
  Health and Human Services Commission shall publish a contract
  management handbook that establishes consistent contracting
  policies and practices to be followed by health and human services
  agencies. The handbook may include standard contract provisions
  and formats for health and human services agencies to incorporate
  as applicable in their contracts.
         (k)  Subject to Section 524.0001(b) [531.0055(c)], the
  Health and Human Services Commission, in cooperation with the
  comptroller, shall establish a central contract management
  database that identifies each contract made with a health and human
  services agency.  The comptroller may use the database to monitor
  health and human services agency contracts, and health and human
  services agencies may use the database in contracting.  A state
  agency shall send to the comptroller in the manner prescribed by the
  comptroller the information the agency possesses that the
  comptroller requires for inclusion in the database.
         (m)  Subject to Section 524.0001(b) [531.0055(c)], the
  Health and Human Services Commission shall develop and implement a
  statewide plan to ensure that each entity that contracts with a
  health and human services agency and any subcontractor of the
  entity complies with the accessibility requirements of the
  Americans with Disabilities Act of 1990 (42 U.S.C. Section 12101 et
  seq.).
         (p)  In this section, "health and human services agency" has
  the meaning assigned by Section 521.0001 [531.001].
         SECTION 2.21.  Section 2167.004(c), Government Code, is
  amended to read as follows:
         (c)  In this section, "health and human services agency" has
  the meaning assigned by Section 521.0001 [531.001].
         SECTION 2.22.  Section 2306.252(g), Government Code, is
  amended to read as follows:
         (g)  The center shall provide information regarding the
  department's housing and community affairs programs to the Texas
  Information and Referral Network for inclusion in the statewide
  information and referral network as required by Section 526.0004
  [531.0312].
         SECTION 2.23.  Section 12.0001, Health and Safety Code, is
  amended to read as follows:
         Sec. 12.0001.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW.  To the extent a power or duty given to the
  commissioner by this title or another law conflicts with any of the
  following provisions of the Government Code, the [Section
  531.0055,] Government Code provision[, Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.24.  Section 32.101, Health and Safety Code, is
  amended to read as follows:
         Sec. 32.101.  ENHANCED PRENATAL SERVICES FOR CERTAIN
  WOMEN.  The commission, in collaboration with managed care
  organizations that contract with the commission to provide health
  care services to medical assistance recipients under Chapter 540 or
  540A [533], Government Code, as applicable, shall develop and
  implement cost-effective, evidence-based, and enhanced prenatal
  services for high-risk pregnant women covered under the medical
  assistance program.
         SECTION 2.25.  Section 32.151(3), Health and Safety Code, is
  amended to read as follows:
               (3)  "Medicaid managed care organization" means a
  managed care organization as defined by Section 540.0001 [533.001],
  Government Code, that contracts with the commission under Chapter
  540 or 540A [533], Government Code, as applicable, to provide
  health care services to medical assistance program recipients.
         SECTION 2.26.  Section 32.155(e), Health and Safety Code, is
  amended to read as follows:
         (e)  The commission may submit the report required under
  Subsection (d) with the report required under Section 543A.0008
  [536.008], Government Code.
         SECTION 2.27.  Section 33.018(a)(4), Health and Safety Code,
  is amended to read as follows:
               (4)  "Health agency" means the commission and the
  health and human services agencies listed in Section 521.0001
  [531.001], Government Code.
         SECTION 2.28.  Section 34.0159, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.0159.  PROGRAM EVALUATIONS.  The commission, in
  collaboration with the task force and other interested parties,
  shall:
               (1)  explore options for expanding the pilot program
  for pregnancy medical homes established under former Section
  531.0996, Government Code;
               (2)  explore methods for increasing the benefits
  provided under Medicaid, including specialty care and
  prescriptions, for women at greater risk of a high-risk pregnancy
  or premature delivery;
               (3)  evaluate the impact of supplemental payments made
  to obstetrics providers for pregnancy risk assessments on
  increasing access to maternal health services;
               (4)  evaluate a waiver to fund managed care
  organization payments for case management and care coordination
  services for women at high risk of severe maternal morbidity on
  conclusion of their eligibility for Medicaid;
               (5)  evaluate the average time required for pregnant
  women to complete the Medicaid enrollment process;
               (6)  evaluate the use of Medicare codes for Medicaid
  care coordination;
               (7)  study the impact of programs funded from the Teen
  Pregnancy Prevention Program federal grant and evaluate whether the
  state should continue funding the programs; and
               (8)  evaluate the use of telemedicine medical services
  for women during pregnancy and the postpartum period.
         SECTION 2.29.  Section 34.020(c), Health and Safety Code, is
  amended to read as follows:
         (c)  The commission shall develop criteria for selecting
  participants for the program by analyzing information in the
  reports prepared by the task force under this chapter and the
  outcomes of the study conducted under former Section 531.02163,
  Government Code.
         SECTION 2.30.  Section 35.0021(5), Health and Safety Code,
  is amended to read as follows:
               (5)  "Family support services" means support,
  resources, or other assistance provided to the family of a child
  with special health care needs. The term may include services
  described by Part A of the Individuals with Disabilities Education
  Act (20 U.S.C. Section 1400 et seq.), as amended, and permanency
  planning, as that term is defined by Section 546.0201 [531.151],
  Government Code.
         SECTION 2.31.  Section 62.1571, Health and Safety Code, as
  amended by Chapters 624 (H.B. 4) and 811 (H.B. 2056), Acts of the
  87th Legislature, Regular Session, 2021, is reenacted and amended
  to read as follows:
         Sec. 62.1571.  TELEMEDICINE MEDICAL SERVICES, [AND]
  TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.  (a)  In
  providing covered benefits to a child, a health plan provider must
  permit benefits to be provided through telemedicine medical
  services, [and] teledentistry dental services, and telehealth
  services in accordance with policies developed by the commission.
         (b)  The policies must provide for:
               (1)  the availability of covered benefits
  appropriately provided through telemedicine medical services,
  [and] teledentistry dental services, and [or] telehealth services
  that are comparable to the same types of covered benefits provided
  without the use of telemedicine medical services, [and]
  teledentistry dental services, and [or] telehealth services; and
               (2)  the availability of covered benefits for different
  services performed by multiple health care providers during a
  single session of telemedicine medical services, teledentistry
  dental services, or both services, or of telehealth services, if
  the executive commissioner determines that delivery of the covered
  benefits in that manner is cost-effective in comparison to the
  costs that would be involved in obtaining the services from
  providers without the use of telemedicine medical services, [or]
  teledentistry dental services, or telehealth services, including
  the costs of transportation and lodging and other direct costs.
         (c)  In this section, "teledentistry dental service," [and]
  "telehealth service," and "telemedicine medical service" have the
  meanings assigned by Section 521.0001 [531.001], Government Code.
         SECTION 2.32.  Section 75.151, Health and Safety Code, is
  amended to read as follows:
         Sec. 75.151.  DEFINITION. In this subchapter, "health
  opportunity pool trust fund" means the trust fund established under
  Subchapter D [N], Chapter 526 [531], Government Code.
         SECTION 2.33.  Section 75.153, Health and Safety Code, is
  amended to read as follows:
         Sec. 75.153.  ELIGIBILITY FOR FUNDS; STATEWIDE ELIGIBILITY
  CRITERIA. To be eligible for funding from money in the health
  opportunity pool trust fund, a regional or local health care
  program must:
               (1)  comply with any requirement imposed under the
  waiver obtained under Section 526.0152 [531.502], Government Code,
  including, to the extent applicable, any requirement that health
  care benefits or services provided under the program be provided in
  accordance with statewide eligibility criteria; and
               (2)  provide health care benefits or services under the
  program to a person receiving premium payment assistance for health
  benefits coverage through a program established under Section
  526.0157 [531.507], Government Code, regardless of whether the
  person is an employee, or dependent of an employee, of a small
  employer.
         SECTION 2.34.  Section 94.001(b), Health and Safety Code, is
  amended to read as follows:
         (b)  In developing the plan, the department shall seek the
  input of:
               (1)  the public, including members of the public that
  have hepatitis C;
               (2)  each state agency that provides services to
  persons with hepatitis C or the functions of which otherwise
  involve hepatitis C, including any appropriate health and human
  services agency described by Section 521.0001 [531.001],
  Government Code;
               (3)  any advisory body that addresses issues related to
  hepatitis C;
               (4)  public advocates concerned with issues related to
  hepatitis C; and
               (5)  providers of services to persons with hepatitis C.
         SECTION 2.35.  Section 94A.001(b), Health and Safety Code,
  is amended to read as follows:
         (b)  In developing the plan, the department shall seek the
  advice of:
               (1)  the public, including members of the public who
  have been infected with Streptococcus pneumoniae;
               (2)  each state agency that provides services to
  persons infected with Streptococcus pneumoniae or that is assigned
  duties related to diseases caused by Streptococcus pneumoniae,
  including any appropriate health and human services agency
  described by Section 521.0001 [531.001], Government Code, the
  Employees Retirement System of Texas, and the Teacher Retirement
  System of Texas;
               (3)  any advisory body that addresses issues related to
  diseases caused by Streptococcus pneumoniae;
               (4)  public advocates concerned with issues related to
  diseases caused by Streptococcus pneumoniae;
               (5)  providers of services to persons with diseases
  caused by Streptococcus pneumoniae;
               (6)  a statewide professional association of
  physicians; and
               (7)  a statewide professional association of nurses.
         SECTION 2.36.  Section 98.110(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Notwithstanding any other law, the department may
  disclose information reported by health care facilities under
  Section 98.103 or 98.1045 to other programs within the department,
  to the commission, to other health and human services agencies, as
  defined by Section 521.0001 [531.001], Government Code, and to the
  federal Centers for Disease Control and Prevention, or any other
  agency of the United States Department of Health and Human
  Services, for public health research or analysis purposes only,
  provided that the research or analysis relates to health
  care-associated infections or preventable adverse events.  The
  privilege and confidentiality provisions contained in this chapter
  apply to such disclosures.
         SECTION 2.37.  Section 103.0131(a), Health and Safety Code,
  is amended to read as follows:
         (a)  In conjunction with developing each state plan
  described in Section 103.013, the council shall conduct a statewide
  assessment of existing programs for the prevention of diabetes and
  treatment of individuals with diabetes that are administered by the
  commission or a health and human services agency, as defined by
  Section 521.0001 [531.001], Government Code. As part of the
  assessment, the council shall collect data regarding:
               (1)  the number of individuals served by the programs;
               (2)  the areas where services to prevent diabetes and
  treat individuals with diabetes are unavailable; and
               (3)  the number of health care providers treating
  individuals with diabetes under the programs.
         SECTION 2.38.  Section 108.0065(a), Health and Safety Code,
  is amended to read as follows:
         (a)  In this section,  "Medicaid managed care organization"
  means a managed care organization, as defined by Section 540.0001
  [533.001], Government Code, that is contracting with the commission
  to implement the Medicaid managed care program under Chapter 540 or
  540A [533], Government Code, as applicable.
         SECTION 2.39.  Section 142.001(11-c), Health and Safety
  Code, is amended to read as follows:
               (11-c)  "Habilitation" means habilitation services, as
  defined by Section 542.0001 [534.001], Government Code, delivered
  by a licensed home and community support services agency.
         SECTION 2.40.  Section 142.003(a), Health and Safety Code,
  is amended to read as follows:
         (a)  The following persons need not be licensed under this
  chapter:
               (1)  a physician, dentist, registered nurse,
  occupational therapist, or physical therapist licensed under the
  laws of this state who provides home health services to a client
  only as a part of and incidental to that person's private office
  practice;
               (2)  a registered nurse, licensed vocational nurse,
  physical therapist, occupational therapist, speech therapist,
  medical social worker, or any other health care professional as
  determined by the department who provides home health services as a
  sole practitioner;
               (3)  a registry that operates solely as a clearinghouse
  to put consumers in contact with persons who provide home health,
  hospice, habilitation, or personal assistance services and that
  does not maintain official client records, direct client services,
  or compensate the person who is providing the service;
               (4)  an individual whose permanent residence is in the
  client's residence;
               (5)  an employee of a person licensed under this
  chapter who provides home health, hospice, habilitation, or
  personal assistance services only as an employee of the license
  holder and who receives no benefit for providing the services,
  other than wages from the license holder;
               (6)  a home, nursing home, convalescent home, assisted
  living facility, special care facility, or other institution for
  individuals who are elderly or who have disabilities that provides
  home health or personal assistance services only to residents of
  the home or institution;
               (7)  a person who provides one health service through a
  contract with a person licensed under this chapter;
               (8)  a durable medical equipment supply company;
               (9)  a pharmacy or wholesale medical supply company
  that does not furnish services, other than supplies, to a person at
  the person's house;
               (10)  a hospital or other licensed health care facility
  that provides home health or personal assistance services only to
  inpatient residents of the hospital or facility;
               (11)  a person providing home health or personal
  assistance services to an injured employee under Title 5, Labor
  Code;
               (12)  a visiting nurse service that:
                     (A)  is conducted by and for the adherents of a
  well-recognized church or religious denomination; and
                     (B)  provides nursing services by a person exempt
  from licensing by Section 301.004, Occupations Code, because the
  person furnishes nursing care in which treatment is only by prayer
  or spiritual means;
               (13)  an individual hired and paid directly by the
  client or the client's family or legal guardian to provide home
  health or personal assistance services;
               (14)  a business, school, camp, or other organization
  that provides home health or personal assistance services,
  incidental to the organization's primary purpose, to individuals
  employed by or participating in programs offered by the business,
  school, or camp that enable the individual to participate fully in
  the business's, school's, or camp's programs;
               (15)  a person or organization providing
  sitter-companion services or chore or household services that do
  not involve personal care, health, or health-related services;
               (16)  a licensed health care facility that provides
  hospice services under a contract with a hospice;
               (17)  a person delivering residential acquired immune
  deficiency syndrome hospice care who is licensed and designated as
  a residential AIDS hospice under Chapter 248;
               (18)  the Texas Department of Criminal Justice;
               (19)  a person that provides home health, hospice,
  habilitation, or personal assistance services only to persons
  receiving benefits under:
                     (A)  the home and community-based services (HCS)
  waiver program;
                     (B)  the Texas home living (TxHmL) waiver program;
                     (C)  the STAR + PLUS or other Medicaid managed
  care program under the program's HCS or TxHmL certification; or
                     (D)  Section 542.0152 [534.152], Government Code;
               (20)  a person who provides intellectual and
  developmental disabilities habilitative specialized services under
  Medicaid and is:
                     (A)  a certified HCS or TxHmL provider; or
                     (B)  a local intellectual and developmental
  disability authority contracted under Section 534.105; or
               (21)  an individual who provides home health or
  personal assistance services as the employee of a consumer or an
  entity or employee of an entity acting as a consumer's fiscal agent
  under Subchapter C, Chapter 546 [Section 531.051], Government Code.
         SECTION 2.41.  Section 161.0095(b), Health and Safety Code,
  is amended to read as follows:
         (b)  The department shall establish a work group to assist
  the department in developing the continuing education programs and
  educational information.  The work group shall include physicians,
  nurses, department representatives, representatives of managed
  care organizations that provide health care services under Chapter
  540 or 540A [533], Government Code, as applicable, representatives
  of health plan providers that provide health care services under
  Chapter 62, and members of the public.
         SECTION 2.42.  Section 191.0048(d), Health and Safety Code,
  is amended to read as follows:
         (d)  Notwithstanding Section 191.005, the local registrar or
  county clerk who collects the voluntary contribution under this
  section shall send the voluntary contribution to the comptroller,
  who shall deposit the voluntary contribution in the Texas Home
  Visiting Program trust fund under Section 523.0306 [531.287],
  Government Code.
         SECTION 2.43.  Section 242.0395(a), Health and Safety Code,
  is amended to read as follows:
         (a)  An institution licensed under this chapter shall
  register with the Texas Information and Referral Network under
  Section 526.0004 [531.0312], Government Code, to assist the state
  in identifying persons needing assistance if an area is evacuated
  because of a disaster or other emergency.
         SECTION 2.44.  Section 242.061(a-3), Health and Safety Code,
  is amended to read as follows:
         (a-3)  The executive commissioner may not revoke a license
  under Subsection (a-2) due to a violation described by Subsection
  (a-2)(1), if:
               (1)  the violation and the determination of immediate
  threat to health and safety are not included on the written list of
  violations left with the facility at the time of the initial exit
  conference under Section 242.0445(b) for a survey, inspection, or
  investigation;
               (2)  the violation is not included on the final
  statement of violations described by Section 242.0445; or
               (3)  the violation has been reviewed under the informal
  dispute resolution process established by Section 526.0202
  [531.058], Government Code, and a determination was made that:
                     (A)  the violation should be removed from the
  license holder's record; or
                     (B)  the violation is reduced in severity so that
  the violation is no longer cited as an immediate threat to health
  and safety related to the abuse or neglect of a resident.
         SECTION 2.45.  Section 247.0275(a), Health and Safety Code,
  is amended to read as follows:
         (a)  An assisted living facility licensed under this chapter
  shall register with the Texas Information and Referral Network
  under Section 526.0004 [531.0312], Government Code, to assist the
  state in identifying persons needing assistance if an area is
  evacuated because of a disaster or other emergency.
         SECTION 2.46.  Section 247.043(b), Health and Safety Code,
  is amended to read as follows:
         (b)  If the thorough investigation reveals that abuse,
  exploitation, or neglect has occurred, the department shall:
               (1)  implement enforcement measures, including closing
  the facility, revoking the facility's license, relocating
  residents, and making referrals to law enforcement agencies;
               (2)  notify the Department of Family and Protective
  Services of the results of the investigation;
               (3)  notify a health and human services agency, as
  defined by Section 521.0001 [531.001], Government Code, that
  contracts with the facility for the delivery of personal care
  services of the results of the investigation; and
               (4)  provide to a contracting health and human services
  agency access to the department's documents or records relating to
  the investigation.
         SECTION 2.47.  Sections 250.001(1-b) and (3-a), Health and
  Safety Code, are amended to read as follows:
               (1-b)  "Consumer-directed service option" has the
  meaning assigned by Section 546.0101 [531.051], Government Code.
               (3-a) "Financial management services agency" means an
  entity that contracts with the commission [Department of Aging and
  Disability Services] to serve as a fiscal and employer agent for an
  individual employer in the consumer-directed service option
  described by Section 546.0101 [531.051], Government Code.
         SECTION 2.48.  Section 253.001(1-b), Health and Safety Code,
  is amended to read as follows:
               (1-b)  "Consumer-directed service option" has the
  meaning assigned by Section 546.0101 [531.051], Government Code.
         SECTION 2.49.  Section 322.001(2), Health and Safety Code,
  is amended to read as follows:
               (2)  "Health and human services agency" means an agency
  listed in Section 521.0001 [531.001], Government Code.
         SECTION 2.50.  Section 461A.005, Health and Safety Code, is
  amended to read as follows:
         Sec. 461A.005.  CONFLICT WITH OTHER LAW.  To the extent a
  power or duty given to the department or commissioner by this
  chapter conflicts with any of the following provisions of the 
  [Section 531.0055,] Government Code, the Government Code provision 
  [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.51.  Section 461A.052(b), Health and Safety Code,
  is amended to read as follows:
         (b)  The department may establish regional alcohol advisory
  committees consistent with the regions established under Section
  525.0151 [531.024], Government Code.
         SECTION 2.52.  Section 461A.056(a), Health and Safety Code,
  is amended to read as follows:
         (a)  The department shall develop and adopt a statewide
  service delivery plan.  The department shall update the plan not
  later than February 1 of each even-numbered year.  The plan must
  include:
               (1)  a statement of the department's mission, goals,
  and objectives regarding chemical dependency prevention,
  intervention, and treatment;
               (2)  a statement of how chemical dependency services
  and chemical dependency case management services should be
  organized, managed, and delivered;
               (3)  a comprehensive assessment of:
                     (A)  chemical dependency services available in
  this state at the time the plan is prepared; and
                     (B)  future chemical dependency services needs;
               (4)  a service funding process that ensures equity in
  the availability of chemical dependency services across this state
  and within each service region established under Section 525.0151
  [531.024], Government Code;
               (5)  a provider selection and monitoring process that
  emphasizes quality in the provision of services;
               (6)  a description of minimum service levels for each
  region;
               (7)  a mechanism for the department to obtain and
  consider local public participation in identifying and assessing
  regional needs for chemical dependency services;
               (8)  a process for coordinating and assisting
  administration and delivery of services among federal, state, and
  local public and private chemical dependency programs that provide
  similar services; and
               (9)  a process for coordinating the department's
  activities with those of other state health and human services
  agencies and criminal justice agencies to avoid duplications and
  inconsistencies in the efforts of the agencies in chemical
  dependency prevention, intervention, treatment, rehabilitation,
  research, education, and training.
         SECTION 2.53.  Section 533.0002, Health and Safety Code, is
  amended to read as follows:
         Sec. 533.0002.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW.  To the extent a power or duty given to the
  commissioner by this title or another law conflicts with any of the
  following provisions of the [Section 531.0055,] Government Code,
  the Government Code provision [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.54.  Section 533.016(a), Health and Safety Code,
  is amended to read as follows:
         (a)  This section does not apply to a "health and human
  services agency," as that term is defined by Section 521.0001
  [531.001], Government Code.
         SECTION 2.55.  Section 533.017(a), Health and Safety Code,
  is amended to read as follows:
         (a)  This section does not apply to a "health and human
  services agency," as that term is defined by Section 521.0001
  [531.001], Government Code.
         SECTION 2.56.  Section 533.032(a), Health and Safety Code,
  is amended to read as follows:
         (a)  The department shall have a long-range plan relating to
  the provision of services under this title covering at least six
  years that includes at least the provisions required by Sections
  525.0154, 525.0155, [531.022] and 525.0156 [531.023], Government
  Code, and Chapter 2056, Government Code.  The plan must cover the
  provision of services in and policies for state-operated
  institutions and ensure that the medical needs of the most
  medically fragile persons with mental illness the department serves
  are met.
         SECTION 2.57.  Section 533A.002, Health and Safety Code, is
  amended to read as follows:
         Sec. 533A.002.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW.  To the extent a power or duty given to the
  commissioner by this title or another law conflicts with any of the
  following provisions of the [Section 531.0055,] Government Code,
  the Government Code provision [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.58.  Section 533A.016(a), Health and Safety Code,
  is amended to read as follows:
         (a)  This section does not apply to a "health and human
  services agency," as that term is defined by Section 521.0001
  [531.001], Government Code.
         SECTION 2.59.  Section 533A.017(a), Health and Safety Code,
  is amended to read as follows:
         (a)  This section does not apply to a "health and human
  services agency," as that term is defined by Section 521.0001
  [531.001], Government Code.
         SECTION 2.60.  Section 533A.032(a), Health and Safety Code,
  is amended to read as follows:
         (a)  The department shall have a long-range plan relating to
  the provision of services under this title covering at least six
  years that includes at least the provisions required by Sections
  525.0154, 525.0155, [531.022] and 525.0156 [531.023], Government
  Code, and Chapter 2056, Government Code.  The plan must cover the
  provision of services in and policies for state-operated
  institutions and ensure that the medical needs of the most
  medically fragile persons with an intellectual disability the
  department serves are met.
         SECTION 2.61.  Section 533A.0335(a), Health and Safety Code,
  is amended to read as follows:
         (a)  In this section:
               (1)  "Advisory committee" means the Intellectual and
  Developmental Disability System Redesign Advisory Committee
  established under Section 542.0052 [534.053], Government Code.
               (2)  "Functional need," "ICF-IID program," and
  "Medicaid waiver program" have the meanings assigned those terms by
  Section 542.0001 [534.001], Government Code.
         SECTION 2.62.  Section 533A.03551(b), Health and Safety
  Code, is amended to read as follows:
         (b)  The department, in cooperation with the Texas
  Department of Housing and Community Affairs, the Department of
  Agriculture, the Texas State Affordable Housing Corporation, and
  the Intellectual and Developmental Disability System Redesign
  Advisory Committee established under Section 542.0052 [534.053],
  Government Code, shall coordinate with federal, state, and local
  public housing entities as necessary to expand opportunities for
  accessible, affordable, and integrated housing to meet the complex
  needs of individuals with disabilities, including individuals with
  intellectual and developmental disabilities.
         SECTION 2.63.  Section 773.05711(a), Health and Safety Code,
  is amended to read as follows:
         (a)  In addition to the requirements for obtaining or
  renewing an emergency medical services provider license under this
  subchapter, a person who applies for a license or for a renewal of a
  license must:
               (1)  provide the department with a letter of credit
  issued by a federally insured bank or savings institution in the
  amount of:
                     (A)  $100,000 for the initial license and for
  renewal of the license on the second anniversary of the date the
  initial license is issued;
                     (B)  $75,000 for renewal of the license on the
  fourth anniversary of the date the initial license is issued;
                     (C)  $50,000 for renewal of the license on the
  sixth anniversary of the date the initial license is issued; and
                     (D)  $25,000 for renewal of the license on the
  eighth anniversary of the date the initial license is issued;
               (2)  if the applicant participates in the medical
  assistance program operated under Chapter 32, Human Resources Code,
  the Medicaid managed care program operated under Chapters 540 and
  540A [Chapter 533], Government Code, or the child health plan
  program operated under Chapter 62 of this code, provide the Health
  and Human Services Commission with a surety bond in the amount of
  $50,000; and
               (3)  submit for approval by the department the name and
  contact information of the provider's administrator of record who
  satisfies the requirements under Section 773.05712.
         SECTION 2.64.  Section 773.06141(a), Health and Safety Code,
  is amended to read as follows:
         (a)  The department may suspend, revoke, or deny an emergency
  medical services provider license on the grounds that the
  provider's administrator of record, employee, or other
  representative:
               (1)  has been convicted of, or placed on deferred
  adjudication community supervision or deferred disposition for, an
  offense that directly relates to the duties and responsibilities of
  the administrator, employee, or representative, other than an
  offense described by Section 542.304, Transportation Code;
               (2)  has been convicted of or placed on deferred
  adjudication community supervision or deferred disposition for an
  offense, including:
                     (A)  an offense listed in Article 42A.054(a)(2),
  (3), (4), (7), (8), (9), (11), or (16), Code of Criminal Procedure;
  or
                     (B)  an offense, other than an offense described
  by Subdivision (1), for which the person is subject to registration
  under Chapter 62, Code of Criminal Procedure; or
               (3)  has been convicted of Medicare or Medicaid fraud,
  has been excluded from participation in the state Medicaid program,
  or has a hold on payment for reimbursement under the state Medicaid
  program under Subchapter G [C], Chapter 544 [531], Government Code.
         SECTION 2.65.  Sections 1001.002(a) and (c), Health and
  Safety Code, are amended to read as follows:
         (a)  In this section, "function" includes a power, duty,
  program, or activity and an administrative support services
  function associated with the power, duty, program, or activity,
  unless consolidated under former Section 531.02012, Government
  Code.
         (c)  In accordance with former Subchapter A-1, Chapter 531,
  Government Code, and notwithstanding any other law, the department
  performs only functions related to public health, including health
  care data collection and maintenance of the Texas Health Care
  Information Collection program.
         SECTION 2.66.  Section 1001.004, Health and Safety Code, is
  amended to read as follows:
         Sec. 1001.004.  REFERENCES IN LAW MEANING DEPARTMENT.  In
  this code or any other law, a reference to the department in
  relation to a function described by Section 1001.002(c) means the
  department. A reference in law to the department in relation to any
  other function has the meaning assigned by Section 521.0002
  [531.0011], Government Code.
         SECTION 2.67.  Section 1001.005, Health and Safety Code, is
  amended to read as follows:
         Sec. 1001.005.  REFERENCES IN LAW MEANING COMMISSIONER OR
  DESIGNEE.  In this code or in any other law, a reference to the
  commissioner in relation to a function described by Section
  1001.002(c) means the commissioner.  A reference in law to the
  commissioner in relation to any other function has the meaning
  assigned by Section 521.0003 [531.0012], Government Code.
         SECTION 2.68.  Sections 1001.051(a-1), (c), and (d), Health
  and Safety Code, are amended to read as follows:
         (a-1)  The executive commissioner shall employ the
  commissioner in accordance with Subchapter B, Chapter 524,
  Government Code, and Section 524.0101(b) [531.0056], Government
  Code.
         (c)  Subject to the control of the executive commissioner,
  the commissioner shall:
               (1)  act as the department's chief administrative
  officer;
               (2)  in accordance with the procedures prescribed by
  Section 524.0152 [531.00551], Government Code, assist the
  executive commissioner in the development and implementation of
  policies and guidelines needed for the administration of the
  department's functions;
               (3)  in accordance with the procedures adopted by the
  executive commissioner under Section 524.0152 [531.00551],
  Government Code, assist the executive commissioner in the
  development of rules relating to the matters within the
  department's jurisdiction, including the delivery of services to
  persons and the rights and duties of persons who are served or
  regulated by the department; and
               (4)  serve as a liaison between the department and
  commission.
         (d)  The commissioner shall administer this chapter under
  operational policies established by the executive commissioner and
  in accordance with the memorandum of understanding under Section
  524.0101(a) [531.0055(k)], Government Code, between the
  commissioner and the executive commissioner, as adopted by rule.
         SECTION 2.69.  Section 1001.075, Health and Safety Code, is
  amended to read as follows:
         Sec. 1001.075.  RULES. The executive commissioner may adopt
  rules reasonably necessary for the department to administer this
  chapter, consistent with the memorandum of understanding under
  Section 524.0101(a) [531.0055(k)], Government Code, between the
  commissioner and the executive commissioner, as adopted by rule.
         SECTION 2.70.  Sections 1001.084(a) and (d), Health and
  Safety Code, as added by Chapter 1 (S.B. 219), Acts of the 84th
  Legislature, Regular Session, 2015, are amended to read as follows:
         (a)  The executive commissioner, as authorized by Section
  524.0002 [531.0055], Government Code, may delegate to the
  department the executive commissioner's authority under that
  section for contracting and auditing relating to the department's
  powers, duties, functions, and activities.
         (d)  It is the legislature's intent that the executive
  commissioner retain the authority over and responsibility for
  contracting and auditing at each health and human services agency
  as provided by Section 524.0002 [531.0055], Government Code. A
  statute enacted on or after January 1, 2015, that references the
  contracting or auditing authority of the department does not give
  the department direct contracting or auditing authority unless the
  statute expressly provides that the contracting or auditing
  authority:
               (1)  is given directly to the department; and
               (2)  is an exception to the exclusive contracting and
  auditing authority given to the executive commissioner under
  Section 524.0002 [531.0055], Government Code.
         SECTION 2.71.  Section 1001.085, Health and Safety Code, is
  amended to read as follows:
         Sec. 1001.085.  MANAGEMENT AND DIRECTION BY EXECUTIVE
  COMMISSIONER.  The department's powers and duties prescribed by
  this chapter and other law, including enforcement activities and
  functions, are subject to the executive commissioner's oversight
  under the revised provisions derived from Chapter 531, Government
  Code, as that chapter existed on March 31, 2025, to manage and
  direct the operations of the department.
         SECTION 2.72.  Section 11.004, Human Resources Code, is
  amended to read as follows:
         Sec. 11.004.  POWERS AND FUNCTIONS NOT AFFECTED.  The
  provisions of this title are not intended to interfere with the
  powers and functions of the commission, the health and human
  services agencies, as defined by Section 521.0001 [531.001],
  Government Code, or county juvenile boards.
         SECTION 2.73.  Section 22.0001, Human Resources Code, is
  amended to read as follows:
         Sec. 22.0001.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW.  To the extent a power or duty given to the
  commissioner of aging and disability services by this title or
  another law conflicts with any of the following provisions of the
  Government Code, the [Section 531.0055,] Government Code provision
  [, Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524, Government Code;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b), Government Code;
               (4)  Section 524.0202, Government Code; and
               (5)  Section 525.0254, Government Code.
         SECTION 2.74.  Section 31.0032(d), Human Resources Code, is
  amended to read as follows:
         (d)  This section does not prohibit the Texas Workforce
  Commission, the commission, or any health and human services
  agency, as defined by Section 521.0001 [531.001], Government Code,
  from providing child care or any other related social or support
  services for an individual who is eligible for financial assistance
  but to whom that assistance is not paid because of the individual's
  failure to cooperate.
         SECTION 2.75.  Sections 31.0127(b) and (e), Human Resources
  Code, are amended to read as follows:
         (b)  The Health and Human Services Commission shall require
  the Texas Workforce Commission to comply with the revised
  provisions derived from Chapter 531, Government Code, as that
  chapter existed on March 31, 2025, solely for:
               (1)  the promulgation of rules relating to the programs
  described by Subsection (a);
               (2)  the expenditure of funds relating to the programs
  described by Subsection (a), within the limitations established by
  and subject to the General Appropriations Act and federal and other
  law applicable to the use of the funds;
               (3)  data collection and reporting relating to the
  programs described by Subsection (a); and
               (4)  evaluation of services relating to the programs
  described by Subsection (a).
         (e)  Subsection (b) does not authorize the Health and Human
  Services Commission to require a state agency, other than a health
  and human services agency, to comply with revised provisions
  derived from Chapter 531, Government Code, as that chapter existed
  on March 31, 2025, except as specifically provided by Subsection
  (b). The authority granted under Subsection (b) does not affect
  Section 301.041, Labor Code.
         SECTION 2.76.  Section 32.003(1), Human Resources Code, is
  amended to read as follows:
               (1)  "Health and human services agencies" has the
  meaning assigned by Section 521.0001 [531.001], Government Code.
         SECTION 2.77.  Section 32.021(d), Human Resources Code, is
  amended to read as follows:
         (d)  The commission shall include in its contracts for the
  delivery of medical assistance by nursing facilities provisions for
  monetary penalties to be assessed for violations as required by 42
  U.S.C. Section 1396r, including without limitation the Omnibus
  Budget Reconciliation Act of 1987 (OBRA), Pub. L. No. 100-203,
  Nursing Home Reform Amendments of 1987, provided that the executive
  commissioner shall:
               (1)  provide for an informal dispute resolution process
  in the commission as provided by Section 526.0202 [531.058],
  Government Code; and
               (2)  develop rules to adjudicate claims in contested
  cases, including claims unresolved by the informal dispute
  resolution process of the commission.
         SECTION 2.78.  Section 32.0212, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0212.  DELIVERY OF MEDICAL ASSISTANCE.
  Notwithstanding any other law and subject to Sections 540.0502,
  540.0701, and 540.0753 [Section 533.0025], Government Code, the
  commission shall provide medical assistance for acute care services
  through the Medicaid managed care system implemented under Chapters
  540 and 540A [Chapter 533], Government Code, or another Medicaid
  capitated managed care program.
         SECTION 2.79.  Section 32.0214(b), Human Resources Code, is
  amended to read as follows:
         (b)  A recipient who receives medical assistance through a
  Medicaid managed care model or arrangement under Chapter 540 or
  540A [533], Government Code, as applicable, that requires the
  designation of a primary care provider shall designate the
  recipient's primary care provider as required by that model or
  arrangement.
         SECTION 2.80.  Section 32.0246, Human Resources Code, is
  amended to read as follows:
         Sec. 32.0246.  MEDICAL ASSISTANCE REIMBURSEMENT FOR CERTAIN
  BEHAVIORAL HEALTH AND PHYSICAL HEALTH SERVICES. (a)  In this
  section, "behavioral health services" has the meaning assigned by
  Section 540.0703(a) [533.00255(a)], Government Code, and includes
  targeted case management and psychiatric rehabilitation services.
         (b)  The commission shall provide to a public or private
  provider of behavioral health services medical assistance
  reimbursement through a fee-for-service delivery model for
  behavioral health or physical health services provided to a
  recipient before that recipient's enrollment with and receipt of
  medical assistance services through a managed care organization
  under Chapter 540 or 540A [533], Government Code, as applicable.
         (c)  The commission shall ensure that a public or private
  provider of behavioral health services who is reimbursed under
  Subsection (b) through a fee-for-service delivery model is provided
  medical assistance reimbursement through a managed care model for
  behavioral health or physical health services provided to a
  recipient after that recipient's enrollment with and receipt of
  medical assistance services through a managed care organization
  under Chapter 540 or 540A [533], Government Code, as applicable.
         SECTION 2.81.  Sections 32.0291(b) and (c), Human Resources
  Code, are amended to read as follows:
         (b)  Subject to Sections 544.0104 and 544.0105 and
  Subchapter G, Chapter 544 [Section 531.102], Government Code, and
  notwithstanding any other law, the commission may impose a payment
  hold on future claims submitted by a provider.
         (c)  A payment hold authorized by this section is governed by
  the requirements and procedures specified for a payment hold under
  Sections 544.0104 and 544.0105 and Subchapter G, Chapter 544
  [Section 531.102], Government Code, including the notice
  requirements under Section 544.0302 [Subsection (g) of that
  section].
         SECTION 2.82.  Section 32.03115(b), Human Resources Code, as
  added by Chapters 640 (S.B. 1564) and 1167 (H.B. 3285), Acts of the
  86th Legislature, Regular Session, 2019, is amended to read as
  follows:
         (b)  Notwithstanding Subchapters E [Sections 531.072] and F,
  Chapter 549 [531.073], Government Code, or any other law and
  subject to Subsections (c) and (d), the commission shall provide
  medical assistance reimbursement for medication-assisted opioid or
  substance use disorder treatment without requiring a recipient of
  medical assistance or health care provider to obtain prior
  authorization or precertification for the treatment.
         SECTION 2.83.  Section 32.0322(a), Human Resources Code, is
  amended to read as follows:
         (a)  The commission or the office of inspector general
  established under Subchapter C, Chapter 544 [Chapter 531],
  Government Code, may obtain from any law enforcement or criminal
  justice agency the criminal history record information that relates
  to a provider under the medical assistance program or a person
  applying to enroll as a provider under the medical assistance
  program.
         SECTION 2.84.  Section 32.046(a), Human Resources Code, is
  amended to read as follows:
         (a)  The executive commissioner shall adopt rules governing
  sanctions and penalties that apply to a provider who participates
  in the vendor drug program or is enrolled as a network pharmacy
  provider of a managed care organization contracting with the
  commission under Chapter 540 [533], Government Code, or its
  subcontractor and who submits an improper claim for reimbursement
  under the program.
         SECTION 2.85.  Section 32.053(b), Human Resources Code, is
  amended to read as follows:
         (b)  The executive commissioner shall adopt rules as
  necessary to implement this section.  In adopting rules, the
  executive commissioner shall:
               (1)  use the Bienvivir Senior Health Services of El
  Paso initiative as a model for the program;
               (2)  ensure that a person is not required to hold a
  certificate of authority as a health maintenance organization under
  Chapter 843, Insurance Code, to provide services under the PACE
  program;
               (3)  ensure that participation in the PACE program is
  available as an alternative to enrollment in a Medicaid managed
  care plan under Chapter 540 [533], Government Code, for eligible
  recipients, including recipients eligible for assistance under
  both the medical assistance and Medicare programs;
               (4)  ensure that managed care organizations that
  contract under Chapter 540 [533], Government Code, consider the
  availability of the PACE program when considering whether to refer
  a recipient to a nursing facility or other long-term care facility;
  and
               (5)  establish protocols for the referral of eligible
  persons to the PACE program.
         SECTION 2.86.  Section 32.057(c-1), Human Resources Code, is
  amended to read as follows:
         (c-1)  A managed care health plan that develops and
  implements a disease management program under Section 540.0708
  [533.009], Government Code, and a provider of a disease management
  program under this section shall coordinate during a transition
  period beneficiary care for patients that move from one disease
  management program to another program.
         SECTION 2.87.  Section 32.064(a), Human Resources Code, is
  amended to read as follows:
         (a)  To the extent permitted under Title XIX, Social Security
  Act (42 U.S.C. Section 1396 et seq.), as amended, and any other
  applicable law or regulations, the executive commissioner shall
  adopt provisions requiring recipients of medical assistance to
  share the cost of medical assistance, including provisions
  requiring recipients to pay:
               (1)  an enrollment fee;
               (2)  a deductible; or
               (3)  coinsurance or a portion of the plan premium, if
  the recipients receive medical assistance under the Medicaid
  managed care program under Chapter 540 or 540A [533], Government
  Code, as applicable.
         SECTION 2.88.  Section 32.0705(a), Human Resources Code, is
  amended to read as follows:
         (a)  In this section, "Medicaid contractor" means an entity
  that:
               (1)  is not a health and human services agency as
  defined by Section 521.0001 [531.001], Government Code; and
               (2)  under a contract with the commission or otherwise
  on behalf of the commission, performs one or more administrative
  services in relation to the commission's operation of Medicaid,
  such as claims processing, utilization review, client enrollment,
  provider enrollment, quality monitoring, or payment of claims.
         SECTION 2.89.  Sections 32.101(3) and (4), Human Resources
  Code, are amended to read as follows:
               (3)  "Managed care organization" has the meaning
  assigned by Section 540.0001 [533.001], Government Code.
               (4)  "Managed care plan" has the meaning assigned by
  Section 540.0001 [533.001], Government Code.
         SECTION 2.90.  Section 36.005(a), Human Resources Code, is
  amended to read as follows:
         (a)  A health and human services agency, as defined by
  Section 521.0001 [531.001], Government Code:
               (1)  shall suspend or revoke:
                     (A)  a provider agreement between the agency and a
  person, other than a person who operates a nursing facility or an
  ICF-IID, found liable under Section 36.052; and
                     (B)  a permit, license, or certification granted
  by the agency to a person, other than a person who operates a
  nursing facility or an ICF-IID, found liable under Section 36.052;
  and
               (2)  may suspend or revoke:
                     (A)  a provider agreement between the agency and a
  person who operates a nursing facility or an ICF-IID and who is
  found liable under Section 36.052; or
                     (B)  a permit, license, or certification granted
  by the agency to a person who operates a nursing facility or an
  ICF-IID and who is found liable under Section 36.052.
         SECTION 2.91.  Section 40.0025, Human Resources Code, is
  amended to read as follows:
         Sec. 40.0025.  AGENCY FUNCTIONS. (a)  In this section,
  "function" includes a power, duty, program, or activity and an
  administrative support services function associated with the
  power, duty, program, or activity, unless consolidated under former
  Section 531.02012, Government Code.
         (b)  In accordance with former Subchapter A-1, Chapter 531,
  Government Code, and notwithstanding any other law, the department
  performs only functions, including the statewide intake of reports
  and other information, related to the following services:
               (1)  child protective services, including services
  that are required by federal law to be provided by this state's
  child welfare agency;
               (2)  adult protective services, other than
  investigations of the alleged abuse, neglect, or exploitation of an
  elderly person or person with a disability:
                     (A)  in a facility operated, or in a facility or by
  a person licensed, certified, or registered, by a state agency; or
                     (B)  by a provider that has contracted to provide
  home and community-based services; and
               (3)  prevention and early intervention services
  functions, including:
                     (A)  prevention and early intervention services
  as defined under Section 265.001, Family Code; and
                     (B)  programs that:
                           (i)  provide parent education;
                           (ii)  promote healthier parent-child
  relationships; or
                           (iii)  prevent family violence.
         SECTION 2.92.  Section 40.021(c), Human Resources Code, is
  amended to read as follows:
         (c)  The council shall study and make recommendations to the
  commissioner regarding the management and operation of the
  department, including policies and rules governing the delivery of
  services to persons who are served by the department, the rights and
  duties of persons who are served or regulated by the department, and
  the consolidation of the provision of administrative support
  services as provided by Subchapter E, Chapter 524 [Section
  531.00553], Government Code. The council may not develop policies
  or rules relating to administrative support services provided by
  the commission for the department.
         SECTION 2.93.  Sections 40.0515(d) and (e), Human Resources
  Code, are amended to read as follows:
         (d)  A performance review conducted under Subsection (b)(3)
  is considered a performance evaluation for purposes of Section
  40.032(c) of this code or Section 523.0055(b) [531.009(c)],
  Government Code, as applicable.  The department shall ensure that
  disciplinary or other corrective action is taken against a
  supervisor or other managerial employee who is required to conduct
  a performance evaluation for adult protective services personnel
  under Section 40.032(c) of this code or Section 523.0055(b)
  [531.009(c)], Government Code, as applicable, or a performance
  review under Subsection (b)(3) and who fails to complete that
  evaluation or review in a timely manner.
         (e)  The annual performance evaluation required under
  Section 40.032(c) of this code or Section 523.0055(b) [531.009(c)],
  Government Code, as applicable, of the performance of a supervisor
  in the adult protective services division must:
               (1)  be performed by an appropriate program
  administrator; and
               (2)  include:
                     (A)  an evaluation of the supervisor with respect
  to the job performance standards applicable to the supervisor's
  assigned duties; and
                     (B)  an evaluation of the supervisor with respect
  to the compliance of employees supervised by the supervisor with
  the job performance standards applicable to those employees'
  assigned duties.
         SECTION 2.94.  Section 48.103(a), Human Resources Code, is
  amended to read as follows:
         (a)  Except as otherwise provided by Subsection (c), on
  determining after an investigation that an elderly person or a
  person with a disability has been abused, exploited, or neglected
  by an employee of a home and community support services agency
  licensed under Chapter 142, Health and Safety Code, the department
  shall:
               (1)  notify the state agency responsible for licensing
  the home and community support services agency of the department's
  determination;
               (2)  notify any health and human services agency, as
  defined by Section 521.0001 [531.001], Government Code, that
  contracts with the home and community support services agency for
  the delivery of health care services of the department's
  determination; and
               (3)  provide to the licensing state agency and any
  contracting health and human services agency access to the
  department's records or documents relating to the department's
  investigation.
         SECTION 2.95.  Sections 48.251(a)(4), (8), and (9), Human
  Resources Code, are amended to read as follows:
               (4)  "Health and human services agency" has the meaning
  assigned by Section 521.0001 [531.001], Government Code.
               (8)  "Managed care organization" has the meaning
  assigned by Section 540.0001 [533.001], Government Code.
               (9)  "Provider" means:
                     (A)  a facility;
                     (B)  a community center, local mental health
  authority, and local intellectual and developmental disability
  authority;
                     (C)  a person who contracts with a health and
  human services agency or managed care organization to provide home
  and community-based services;
                     (D)  a person who contracts with a Medicaid
  managed care organization to provide behavioral health services;
                     (E)  a managed care organization;
                     (F)  an officer, employee, agent, contractor, or
  subcontractor of a person or entity listed in Paragraphs (A)-(E);
  and
                     (G)  an employee, fiscal agent, case manager, or
  service coordinator of an individual employer participating in the
  consumer-directed service option, as defined by Section 546.0101
  [531.051], Government Code.
         SECTION 2.96.  Section 48.252(c), Human Resources Code, is
  amended to read as follows:
         (c)  The department shall receive and investigate under this
  subchapter reports of abuse, neglect, or exploitation of an
  individual who lives in a residence that is owned, operated, or
  controlled by a provider who provides home and community-based
  services under the home and community-based services waiver program
  described by Section 542.0001(11)(B) [534.001(11)(B)], Government
  Code, regardless of whether the individual is receiving services
  under that waiver program from the provider.
         SECTION 2.97.  Section 48.256(c), Human Resources Code, is
  amended to read as follows:
         (c)  A provider of home and community-based services under
  the home and community-based services waiver program described by
  Section 542.0001(11)(B) [534.001(11)(B)], Government Code, shall
  post in a conspicuous location inside any residence owned,
  operated, or controlled by the provider in which home and
  community-based waiver services are provided, a sign that states:
               (1)  the name, address, and telephone number of the
  provider;
               (2)  the effective date of the provider's contract with
  the applicable health and human services agency to provide home and
  community-based services; and
               (3)  the name of the legal entity that contracted with
  the applicable health and human services agency to provide those
  services.
         SECTION 2.98.  Section 48.401(3), Human Resources Code, is
  amended to read as follows:
               (3)  "Employee" means a person who:
                     (A)  works for:
                           (i)  an agency; or
                           (ii)  an individual employer participating
  in the consumer-directed service option, as defined by Section
  546.0101 [531.051], Government Code;
                     (B)  provides personal care services, active
  treatment, or any other services to an individual receiving agency
  services, an individual who is a child for whom an investigation is
  authorized under Section 261.404, Family Code, or an individual
  receiving services through the consumer-directed service option,
  as defined by Section 546.0101 [531.051], Government Code; and
                     (C)  is not licensed by the state to perform the
  services the person performs for the agency or the individual
  employer participating in the consumer-directed service option, as
  defined by Section 546.0101 [531.051], Government Code.
         SECTION 2.99.  Section 73.0045, Human Resources Code, is
  amended to read as follows:
         Sec. 73.0045.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW. To the extent a power or duty given to the
  commissioner of assistive and rehabilitative services by this
  chapter or another law conflicts with any of the following
  provisions of the [Section 531.0055,] Government Code, the
  Government Code provision [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.100.  Section 81.0055, Human Resources Code, is
  amended to read as follows:
         Sec. 81.0055.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW. To the extent a power or duty given to the
  commissioner of assistive and rehabilitative services by this
  chapter, or another law relating to services for persons who are
  deaf or hard of hearing, conflicts with any of the following
  provisions of the [Section 531.0055,] Government Code, the
  Government Code provision [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.101.  Section 91.0205, Human Resources Code, is
  amended to read as follows:
         Sec. 91.0205.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW. To the extent a power or duty given to the
  commissioner  by this chapter, or another law relating to services
  for the blind or persons with visual disabilities, conflicts with
  any of the following provisions of the [Section 531.0055,]
  Government Code, the Government Code provision [Section 531.0055]
  controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.102.  Section 101A.002, Human Resources Code, is
  amended to read as follows:
         Sec. 101A.002.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW.  To the extent a power or duty given to the
  commissioner by this chapter or another law relating to state
  services for the aging conflicts with any of the following
  provisions of the [Section 531.0055,] Government Code, the
  Government Code provision [Section 531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.103.  Section 111.0505, Human Resources Code, is
  amended to read as follows:
         Sec. 111.0505.  COMMISSIONER'S POWERS AND DUTIES; EFFECT OF
  CONFLICT WITH OTHER LAW. To the extent a power or duty given to the
  commissioner by this chapter, or another law relating to
  rehabilitation services for individuals with disabilities,
  conflicts with any of the following provisions of the [Section
  531.0055,] Government Code, the Government Code provision [Section
  531.0055] controls:
               (1)  Subchapter A, Chapter 524;
               (2)  Section 524.0101;
               (3)  Sections 524.0151(a)(2) and (b);
               (4)  Section 524.0202; and
               (5)  Section 525.0254.
         SECTION 2.104.  Section 117.003, Human Resources Code, is
  amended to read as follows:
         Sec. 117.003.  SUNSET PROVISION.  Unless the commission is
  continued in existence as provided by Chapter 325, Government Code,
  after the review required by Section 523.0003 [531.004], Government
  Code, this chapter expires on the date the commission is abolished
  under that section.
         SECTION 2.105.  Section 117.073, Human Resources Code, is
  amended to read as follows:
         Sec. 117.073.  RULES. The executive commissioner may adopt
  rules reasonably necessary for the department to administer this
  chapter, consistent with the memorandum of understanding under
  Section 524.0101(a) [531.0055(k)], Government Code, between the
  commissioner and the executive commissioner, as adopted by rule.
         SECTION 2.106.  Section 121.0014(b), Human Resources Code,
  is amended to read as follows:
         (b)  In this section, "health and human services agency"
  means an agency listed by Section 521.0001(5) [531.001(4)],
  Government Code.
         SECTION 2.107.  Section 122.0057(k), Human Resources Code,
  is amended to read as follows:
         (k)  The advisory committee shall provide input to the
  workforce commission in adopting rules applicable to the program
  administered under this chapter relating to the employment-first
  policies described by Sections 546.0003 [531.02447] and 546.0451
  [531.02448], Government Code.
         SECTION 2.108.  Section 161.003, Human Resources Code, is
  amended to read as follows:
         Sec. 161.003.  SUNSET PROVISION.  Unless the commission is
  continued in existence as provided by Chapter 325, Government Code,
  after the review required by Section 523.0003 [531.004], Government
  Code, this chapter expires on the date the commission is abolished
  under that section.
         SECTION 2.109.  Section 161.073, Human Resources Code, is
  amended to read as follows:
         Sec. 161.073.  RULES. The executive commissioner may adopt
  rules reasonably necessary for the department to administer this
  chapter, consistent with the memorandum of understanding under
  Section 524.0101(a) [531.0055(k)], Government Code, between the
  commissioner and the executive commissioner, as adopted by rule.
         SECTION 2.110.  Section 161.080(e), Human Resources Code, is
  amended to read as follows:
         (e)  Notwithstanding Subsection (c), a state supported
  living center, based on negotiations between the center and a
  managed care organization, as defined by Section 540.0001
  [533.001], Government Code, may charge a fee for a service other
  than the fee provided by the schedule of fees created by the
  commission under this section.
         SECTION 2.111.  Sections 161.081(a), (c), and (d), Human
  Resources Code, are amended to read as follows:
         (a)  In this section, "Section 1915(c) waiver program" has
  the meaning assigned by Section 521.0001 [531.001], Government
  Code.
         (c)  The department shall ensure that actions taken under
  Subsection (b) do not conflict with any requirements of the
  commission under Sections 546.0402(a), (b), and (c) [Section
  531.0218], Government Code.
         (d)  The department and the commission shall jointly explore
  the development of uniform licensing and contracting standards that
  would:
               (1)  apply to all contracts for the delivery of Section
  1915(c) waiver program services;
               (2)  promote competition among providers of those
  program services; and
               (3)  integrate with other department and commission
  efforts to streamline and unify the administration and delivery of
  the program services, including those required by this section or
  Sections 546.0402(a), (b), and (c) [Section 531.0218], Government
  Code.
         SECTION 2.112.  Section 161.082(a), Human Resources Code, is
  amended to read as follows:
         (a)  In this section, "Section 1915(c) waiver program" has
  the meaning assigned by Section 521.0001 [531.001], Government
  Code.
         SECTION 2.113.  Sections 161.084(a) and (b), Human Resources
  Code, are amended to read as follows:
         (a)  In this section, "Section 1915(c) waiver program" has
  the meaning assigned by Section 521.0001 [531.001], Government
  Code.
         (b)  The department, in cooperation with the commission,
  shall educate the public on:
               (1)  the availability of home and community-based
  services under a Medicaid state plan program, including the primary
  home care and community attendant services programs, and under a
  Section 1915(c) waiver program; and
               (2)  the various service delivery options available
  under the Medicaid program, including the consumer direction models
  available to recipients under Subchapter C, Chapter 546 [Section
  531.051], Government Code.
         SECTION 2.114.  Section 161.251(2), Human Resources Code, is
  amended to read as follows:
               (2)  "Health and human services agency" has the meaning
  assigned by Section 521.0001 [531.001], Government Code.
         SECTION 2.115.  Section 38.254(a), Insurance Code, is
  amended to read as follows:
         (a)  Upon request from the commissioner, the Texas Health and
  Human Services Commission shall provide to the commissioner data,
  including utilization and cost data, which is related to the
  mandate being assessed to the population covered by the Medicaid
  program, including a program administered under Chapter 32, Human
  Resources Code, and a program administered under Chapter 540 or
  540A [533], Government Code, as applicable, even if the program is
  not necessarily subject to the mandate.
         SECTION 2.116.  Section 38.353(d), Insurance Code, is
  amended to read as follows:
         (d)  This subchapter does not apply to:
               (1)  standard health benefit plans provided under
  Chapter 1507;
               (2)  children's health benefit plans provided under
  Chapter 1502;
               (3)  health care benefits provided under a workers'
  compensation insurance policy;
               (4)  Medicaid managed care programs operated under
  Chapter 540 or 540A [533], Government Code, as applicable;
               (5)  Medicaid programs operated under Chapter 32, Human
  Resources Code; or
               (6)  the state child health plan operated under Chapter
  62 or 63, Health and Safety Code.
         SECTION 2.117.  Section 38.402(7), Insurance Code, is
  amended to read as follows:
               (7)  "Payor" means any of the following entities that
  pay, reimburse, or otherwise contract with a health care provider
  for the provision of health care services, supplies, or devices to a
  patient:
                     (A)  an insurance company providing health or
  dental insurance;
                     (B)  the sponsor or administrator of a health or
  dental plan;
                     (C)  a health maintenance organization operating
  under Chapter 843;
                     (D)  the state Medicaid program, including the
  Medicaid managed care program operating under Chapters 540 and 540A
  [Chapter 533], Government Code;
                     (E)  a health benefit plan offered or administered
  by or on behalf of this state or a political subdivision of this
  state or an agency or instrumentality of the state or a political
  subdivision of this state, including:
                           (i)  a basic coverage plan under Chapter
  1551;
                           (ii)  a basic plan under Chapter 1575; and
                           (iii)  a primary care coverage plan under
  Chapter 1579; or
                     (F)  any other entity providing a health insurance
  or health benefit plan subject to regulation by the department.
         SECTION 2.118.  Section 222.001(a), Insurance Code, is
  amended to read as follows:
         (a)  This chapter applies to any insurer, including a group
  hospital service corporation, any health maintenance organization,
  and any managed care organization that receives gross premiums or
  revenues subject to taxation under Section 222.002, including
  companies operating under Chapter 841, 842, 843, 861, 881, 882,
  883, 884, 941, 942, 982, or 984, Insurance Code, Chapter 540 or 540A
  [533], Government Code, as applicable, or Title XIX of the federal
  Social Security Act.
         SECTION 2.119.  Section 843.010, Insurance Code, is amended
  to read as follows:
         Sec. 843.010.  APPLICABILITY OF CERTAIN PROVISIONS TO
  GOVERNMENTAL HEALTH BENEFIT PLANS.  Sections 843.306(f) and
  843.363(a)(4) do not apply to coverage under:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (2)  a Medicaid program, including a Medicaid managed
  care program operated under Chapter 540 or 540A [533], Government
  Code, as applicable.
         SECTION 2.120.  Section 1217.002(d), Insurance Code, is
  amended to read as follows:
         (d)  Notwithstanding any other law, this chapter applies to
  coverage under:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; and
               (2)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable, or a
  Medicaid program operated under Chapter 32, Human Resources Code.
         SECTION 2.121.  Section 1222.0002(b), Insurance Code, is
  amended to read as follows:
         (b)  Notwithstanding any other law, this chapter applies to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
  1601;
               (7)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (8)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (9)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapters 540 and 540A [Chapter
  533], Government Code;
               (10)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (11)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (12)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         SECTION 2.122.  Section 1301.0041(c), Insurance Code, is
  amended to read as follows:
         (c)  This chapter does not apply to:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code; or
               (2)  a Medicaid managed care program under Chapter 540
  or 540A [533], Government Code, as applicable.
         SECTION 2.123.  Section 1356.002(i), Insurance Code, is
  amended to read as follows:
         (i)  To the extent allowed by federal law, this chapter
  applies to:
               (1)  the state Medicaid program operated under Chapter
  32, Human Resources Code; and
               (2)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable.
         SECTION 2.124.  Section 1367.252, Insurance Code, is amended
  to read as follows:
         Sec. 1367.252.  EXCEPTION.  This subchapter does not apply
  to:
               (1)  a plan that provides coverage:
                     (A)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (B)  as a supplement to a liability insurance
  policy;
                     (C)  for credit insurance;
                     (D)  only for dental or vision care;
                     (E)  only for hospital expenses; or
                     (F)  only for indemnity for hospital confinement;
               (2)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (5)  a long-term care policy, including a nursing home
  fixed indemnity policy, unless the commissioner determines that the
  policy provides benefit coverage so comprehensive that the policy
  is a health benefit plan as described by Section 1367.251; or
               (6)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapters 540 and 540A [Chapter
  533], Government Code.
         SECTION 2.125.  Section 1369.053, Insurance Code, is amended
  to read as follows:
         Sec. 1369.053.  EXCEPTION.  This subchapter does not apply
  to:
               (1)  a health benefit plan that provides coverage:
                     (A)  only for a specified disease or for another
  single benefit;
                     (B)  only for accidental death or dismemberment;
                     (C)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (D)  as a supplement to a liability insurance
  policy;
                     (E)  for credit insurance;
                     (F)  only for dental or vision care;
                     (G)  only for hospital expenses; or
                     (H)  only for indemnity for hospital confinement;
               (2)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
  as amended;
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (5)  a long-term care insurance policy, including a
  nursing home fixed indemnity policy, unless the commissioner
  determines that the policy provides benefit coverage so
  comprehensive that the policy is a health benefit plan as described
  by Section 1369.052;
               (6)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (7)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable, or a
  Medicaid program operated under Chapter 32, Human Resources Code.
         SECTION 2.126.  Section 1369.212(b), Insurance Code, is
  amended to read as follows:
         (b)  Notwithstanding any other law, this subchapter applies
  to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
  1601;
               (7)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (8)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (9)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapters 540 and 540A [Chapter
  533], Government Code;
               (10)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (11)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (12)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         SECTION 2.127.  Section 1369.352, Insurance Code, is amended
  to read as follows:
         Sec. 1369.352.  CERTAIN BENEFITS EXCLUDED.  This subchapter
  does not apply to maximum allowable costs for pharmacy benefits
  provided under:
               (1)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable;
               (2)  a Medicaid program operated under Chapter 32,
  Human Resources Code;
               (3)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (4)  the health benefits plan for children under
  Chapter 63, Health and Safety Code;
               (5)  a health benefit plan issued under Chapter 1551,
  1575, 1579, or 1601; or
               (6)  a workers' compensation insurance policy or other
  form of providing medical benefits under Title 5, Labor Code.
         SECTION 2.128.  Section 1369.452(f), Insurance Code, is
  amended to read as follows:
         (f)  To the extent allowed by federal law, the child health
  plan program operated under Chapter 62, Health and Safety Code, and
  the state Medicaid program, including the Medicaid managed care
  program operated under Chapters 540 and 540A [Chapter 533],
  Government Code, shall provide the coverage required under this
  subchapter to a recipient.
         SECTION 2.129.  Section 1369.552, Insurance Code, as added
  by Chapter 1012 (H.B. 1919), Acts of the 87th Legislature, Regular
  Session, 2021, is amended to read as follows:
         Sec. 1369.552.  EXCEPTIONS TO APPLICABILITY OF
  SUBCHAPTER.  Notwithstanding the definition of "health benefit
  plan" provided by Section 1369.551, this subchapter does not apply
  to an issuer or provider of health benefits under or a pharmacy
  benefit manager administering pharmacy benefits under:
               (1)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapters 540 and 540A [Chapter
  533], Government Code;
               (2)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (3)  the TRICARE military health system;
               (4)  a basic coverage plan under Chapter 1551;
               (5)  a basic plan under Chapter 1575;
               (6)  a coverage plan under Chapter 1579;
               (7)  a plan providing basic coverage under Chapter
  1601; or
               (8)  a workers' compensation insurance policy or other
  form of providing medical benefits under Title 5, Labor Code.
         SECTION 2.130.  Section 1451.109(d), Insurance Code, is
  amended to read as follows:
         (d)  This section does not apply to:
               (1)  workers' compensation insurance coverage as
  defined by Section 401.011, Labor Code;
               (2)  a self-insured employee welfare benefit plan
  subject to the Employee Retirement Income Security Act of 1974 (29
  U.S.C. Section 1001 et seq.);
               (3)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (4)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable, or a
  Medicaid program operated under Chapter 32, Human Resources Code.
         SECTION 2.131.  Section 1451.1261(b), Insurance Code, is
  amended to read as follows:
         (b)  This section does not apply to:
               (1)  a basic coverage plan under Chapter 1551;
               (2)  a basic plan under Chapter 1575;
               (3)  a primary care coverage plan under Chapter 1579;
               (4)  a plan providing basic coverage under Chapter
  1601;
               (5)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapters 540 and 540A [Chapter
  533], Government Code; or
               (6)  the child health plan program under Chapter 62,
  Health and Safety Code.
         SECTION 2.132.  Section 1451.451(a), Insurance Code, is
  amended to read as follows:
         (a)  An insurance company, health maintenance organization,
  or preferred provider organization that contracts with a health
  care provider to provide services in connection with Chapter 540 or
  540A [533], Government Code, as applicable, or Chapter 62, Health
  and Safety Code, may not require the health care provider to provide
  access to or transfer the provider's name and contracted discounted
  fee for use with health benefit plans issued to individuals and
  groups under Chapter 1271 or 1301.
         SECTION 2.133.  Section 1451.503, Insurance Code, is amended
  to read as follows:
         Sec. 1451.503.  EXCEPTION.  This subchapter does not apply
  to:
               (1)  a health benefit plan that provides coverage:
                     (A)  only for a specified disease or for another
  single benefit;
                     (B)  only for accidental death or dismemberment;
                     (C)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (D)  as a supplement to a liability insurance
  policy;
                     (E)  for credit insurance;
                     (F)  only for dental or vision care;
                     (G)  only for hospital expenses; or
                     (H)  only for indemnity for hospital confinement;
               (2)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
  as amended;
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (5)  a long-term care insurance policy, including a
  nursing home fixed indemnity policy, unless the commissioner
  determines that the policy provides benefit coverage so
  comprehensive that the policy is a health benefit plan as described
  by Section 1451.502;
               (6)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (7)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable, or a
  Medicaid program operated under Chapter 32, Human Resources Code.
         SECTION 2.134.  Section 1456.002(c), Insurance Code, is
  amended to read as follows:
         (c)  This chapter does not apply to:
               (1)  Medicaid managed care programs operated under
  Chapter 540 or 540A [533], Government Code, as applicable;
               (2)  Medicaid programs operated under Chapter 32, Human
  Resources Code; or
               (3)  the state child health plan operated under Chapter
  62 or 63, Health and Safety Code.
         SECTION 2.135.  Section 1460.002, Insurance Code, is amended
  to read as follows:
         Sec. 1460.002.  EXEMPTION. This chapter does not apply to:
               (1)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable;
               (2)  a Medicaid program operated under Chapter 32,
  Human Resources Code;
               (3)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (4)  a Medicare supplement benefit plan, as defined by
  Chapter 1652.
         SECTION 2.136.  Section 1510.003(b), Insurance Code, is
  amended to read as follows:
         (b)  The pool may not be used to expand the Medicaid program,
  including the program administered under Chapter 32, Human
  Resources Code, and the program administered under Chapter 540 or
  540A [533], Government Code, as applicable.
         SECTION 2.137.  Section 1660.003(b), Insurance Code, is
  amended to read as follows:
         (b)  This chapter does not apply to:
               (1)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable;
               (2)  a Medicaid program operated under Chapter 32,
  Human Resources Code;
               (3)  the state child health plan or any similar plan
  operated under Chapter 62 or 63, Health and Safety Code; or
               (4)  a health benefit plan offered by an insurer or
  health maintenance organization that provides coverage only for
  dental services.
         SECTION 2.138.  Section 1661.003, Insurance Code, is amended
  to read as follows:
         Sec. 1661.003.  EXCEPTIONS. This chapter does not apply to:
               (1)  a health benefit plan that provides coverage only:
                     (A)  for a specified disease or diseases or under
  a limited benefit policy;
                     (B)  for accidental death or dismemberment;
                     (C)  as a supplement to a liability insurance
  policy; or
                     (D)  for dental or vision care;
               (2)  disability income insurance coverage;
               (3)  credit insurance coverage;
               (4)  a hospital confinement indemnity policy;
               (5)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (6)  a workers' compensation insurance policy;
               (7)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (8)  a long-term care insurance policy, including a
  nursing home fixed indemnity policy, unless the commissioner
  determines that the policy provides benefits so comprehensive that
  the policy is a health benefit plan and should not be subject to the
  exemption provided under this section;
               (9)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (10)  a Medicaid managed care program operated under
  Chapter 540 or 540A [533], Government Code, as applicable, or a
  Medicaid program operated under Chapter 32, Human Resources Code.
         SECTION 2.139.  Section 4201.053(b), Insurance Code, is
  amended to read as follows:
         (b)  Sections 4201.303(c), 4201.304(b), 4201.357(a-1), and
  4201.3601 do not apply to:
               (1)  the child health program under Chapter 62, Health
  and Safety Code, or the health benefits plan for children under
  Chapter 63, Health and Safety Code;
               (2)  the Employees Retirement System of Texas or
  another entity issuing or administering a coverage plan under
  Chapter 1551;
               (3)  the Teacher Retirement System of Texas or another
  entity issuing or administering a plan under Chapter 1575 or 1579;
               (4)  The Texas A&M University System or The University
  of Texas System or another entity issuing or administering coverage
  under Chapter 1601; and
               (5)  a managed care organization providing a Medicaid
  managed care plan under Chapter 540 or 540A [533], Government Code,
  as applicable.
         SECTION 2.140.  Section 4201.652, Insurance Code, is amended
  to read as follows:
         Sec. 4201.652.  APPLICABILITY OF SUBCHAPTER.  This
  subchapter applies only to:
               (1)  a health benefit plan offered by a health
  maintenance organization operating under Chapter 843, except that
  this subchapter does not apply to:
                     (A)  the child health plan program under Chapter
  62, Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
                     (B)  the state Medicaid program, including the
  Medicaid managed care program operated under Chapter 540 or 540A
  [533], Government Code, as applicable;
               (2)  a preferred provider benefit plan or exclusive
  provider benefit plan offered by an insurer under Chapter 1301; and
               (3)  a person who contracts with a health maintenance
  organization or insurer to issue preauthorization determinations
  or perform the functions described in this subchapter for a health
  benefit plan to which this subchapter applies.
         SECTION 2.141.  Section 310.005(b), Labor Code, is amended
  to read as follows:
         (b)  In addition to providing referrals to child-care and
  early childhood education services, the network, through its
  members, shall provide:
               (1)  referrals to available support services,
  including:
                     (A)  parenting education classes; and
                     (B)  services for parents or children offered by
  health and human services agencies, as defined by Section 521.0001
  [531.001], Government Code, or otherwise available in the
  community; and
               (2)  information for consumers of child-care and early
  childhood education services, including:
                     (A)  information regarding early childhood
  development;
                     (B)  criteria for identifying quality child-care
  and early childhood education services that support the healthy
  development of children; and
                     (C)  other information that will assist consumers
  in making informed and effective choices regarding child-care and
  early childhood education services.
         SECTION 2.142.  Sections 352.105(b) and (c), Labor Code, are
  amended to read as follows:
         (b)  The training program must provide employees with
  information regarding:
               (1)  supports and services available from health and
  human services agencies, as defined by Section 521.0001 [531.001],
  Government Code, for:
                     (A)  youth with disabilities who are
  transitioning into post-schooling activities, services for adults,
  or community living; and
                     (B)  adults with disabilities;
               (2)  community resources available to improve the
  quality of life for:
                     (A)  youth with disabilities who are
  transitioning into post-schooling activities, services for adults,
  or community living; and
                     (B)  adults with disabilities; and
               (3)  other available resources that may remove
  transitional barriers for youth with disabilities who are
  transitioning into post-schooling activities, services for adults,
  or community living.
         (c)  In developing the training program required by this
  section, the commission shall collaborate with health and human
  services agencies, as defined by Section 521.0001 [531.001],
  Government Code, as necessary.
         SECTION 2.143.  Section 118.022(d), Local Government Code,
  is amended to read as follows:
         (d)  The comptroller shall deposit the money received under
  Subsection (a)(3) in the Texas Home Visiting Program trust fund
  under Section 523.0306 [531.287], Government Code.
         SECTION 2.144.  Section 157.101(g), Occupations Code, is
  amended to read as follows:
         (g)  In this section, "federally qualified health center"
  has the meaning assigned by 42 U.S.C. Section 1396d(l)(2)(B)
  [531.02192, Government Code].
  ARTICLE 3.  REPEALER
         SECTION 3.01.  The following laws are repealed:
               (1)  Sections 531.021 through 531.083 and Sections
  531.0841 through 531.0999, Government Code;
               (2)  Subchapters A, C, D, D-1, E, F, G, G-1, H, I, J,
  J-1, L, M, M-1, N, O, S, U, V, W, and X, Chapter 531, Government
  Code; and
               (3)  Chapters 533, 534, 535, 536, 537, 538, 539, and
  541, Government Code.
  ARTICLE 4.  GENERAL MATTERS
         SECTION 4.01.  This Act is enacted under Section 43, Article
  III, Texas Constitution. This Act is intended as a recodification
  only, and no substantive change in the law is intended by this Act.
         SECTION 4.02.  This Act takes effect April 1, 2025.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 4611 was passed by the House on May 2,
  2023, by the following vote:  Yeas 137, Nays 7, 3 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 4611 on May 19, 2023, by the following vote:  Yeas 139, Nays 0,
  2 present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 4611 was passed by the Senate, with
  amendments, on May 17, 2023, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor