Texas Statutes
Subchapter B. Powers and Duties
Section 531.058. Informal Dispute Resolution for Certain Long-Term Care Facilities

Sec. 531.058. INFORMAL DISPUTE RESOLUTION FOR CERTAIN LONG-TERM CARE FACILITIES.
Text of subsection as amended by Acts 2017, 85th Leg., R.S., Ch. 590 (S.B. 924), Sec. 2
(a) The executive commissioner by rule shall establish an informal dispute resolution process in accordance with this section. The process must provide for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action or related proceeding of the commission under Section 32.021(d), Human Resources Code, or under Chapter 242, 247, or 252, Health and Safety Code. The informal dispute resolution process must require:
(1) an institution or facility to request informal dispute resolution not later than the 10th calendar day after notification by the commission of the violation of a standard or standards; and
(2) the completion of the process not later than:
(A) the 30th calendar day after receipt of a request from an institution or facility, other than an assisted living facility, for informal dispute resolution; or
(B) the 90th calendar day after receipt of a request from an assisted living facility for informal dispute resolution.
Text of subsection as amended by Acts 2017, 85th Leg., R.S., Ch. 836 (H.B. 2025), Sec. 1
(a) The executive commissioner by rule shall establish an informal dispute resolution process in accordance with this section. The process must provide for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action or related proceeding of the commission under Section 32.021(d), Human Resources Code, or the Department of Aging and Disability Services or its successor agency under Chapter 242, 247, or 252, Health and Safety Code. The informal dispute resolution process must require:
(1) an institution or facility to request informal dispute resolution not later than the 10th calendar day after notification by the commission or department, as applicable, of the violation of a standard or standards; and
(2) the commission to complete the process not later than:
(A) the 30th calendar day after receipt of a request from an institution or facility, other than an assisted living facility, for informal dispute resolution; or
(B) the 90th calendar day after receipt of a request from an assisted living facility for informal dispute resolution.
(a-1) As part of the informal dispute resolution process established under this section, the commission shall contract with an appropriate disinterested person to adjudicate disputes between an institution or facility licensed under Chapter 242, Health and Safety Code, or a facility licensed under Chapter 247, Health and Safety Code, and the commission concerning a statement of violations prepared by the commission in connection with a survey conducted by the commission of the institution or facility. Section 2009.053 does not apply to the selection of an appropriate disinterested person under this subsection. The person with whom the commission contracts 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 related to the facility or the statement that are asked by the person reviewing the dispute or by the facility; and
(2) the commission's review of the institution's or facility's informal dispute resolution request to be conducted by a registered nurse with long-term care experience for a standard of care violation.
(b) The executive commissioner shall adopt rules to adjudicate claims in contested cases.
(c) The commission may not delegate its responsibility to administer the informal dispute resolution process established by this section to another state agency.
(d) The rules adopted by the executive commissioner 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.
Added by Acts 2001, 77th Leg., ch. 1284, Sec. 7.02, eff. June 15, 2001.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 218 (H.B. 33), Sec. 3, eff. September 1, 2013.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.096, eff. April 2, 2015.
Acts 2015, 84th Leg., R.S., Ch. 1142 (S.B. 304), Sec. 5, eff. June 19, 2015.
Acts 2017, 85th Leg., R.S., Ch. 590 (S.B. 924), Sec. 2, eff. September 1, 2017.
Acts 2017, 85th Leg., R.S., Ch. 836 (H.B. 2025), Sec. 1, eff. September 1, 2017.
Acts 2019, 86th Leg., R.S., Ch. 637 (S.B. 1519), Sec. 1, eff. June 10, 2019.
Acts 2019, 86th Leg., R.S., Ch. 805 (H.B. 2205), Sec. 1, eff. June 10, 2019.

Structure Texas Statutes

Texas Statutes

Government Code

Title 4 - Executive Branch

Subtitle I - Health and Human Services

Chapter 531 - Health and Human Services Commission

Subchapter B. Powers and Duties

Section 531.021. Administration of Medicaid

Section 531.0211. Managed Care Medicaid Program: Rules; Education Programs

Section 531.02111. Biennial Medicaid Financial Report

Section 531.02113. Optimization of Medicaid Financing

Section 531.021135. Commission's Authority to Retain Certain Money to Administer Certain Medicaid Programs; Report Required

Section 531.02114. Dental Director

Section 531.02115. Marketing Activities by Providers Participating in Medicaid or Child Health Plan Program

Section 531.02118. Streamlining Medicaid Provider Enrollment and Credentialing Processes

Section 531.021182. Use of National Provider Identifier Number

Section 531.021191. Medicaid Enrollment of Certain Eye Health Care Providers

Section 531.0212. Medicaid Bill of Rights and Bill of Responsibilities

Section 531.0213. Support Services for Medicaid Recipients

Section 531.02131. Grievances Related to Medicaid

Section 531.0214. Medicaid Data Collection System

Section 531.02141. Medicaid Information Collection and Analysis

Section 531.02142. Public Access to Certain Medicaid Data

Section 531.02143. Data Regarding Postnatal Alcohol and Controlled Substance Treatment

Section 531.0215. Compilation of Statistics Relating to Fraud

Section 531.0216. Participation and Reimbursement of Telemedicine Medical Service Providers, Teledentistry Dental Service Providers, and Telehealth Service Providers Under Medicaid

Section 531.02161. Provision of Services Through Telecommunications and Information Technology Under Medicaid and Other Public Benefits Programs

Section 531.02162. Medicaid Services Provided Through Telemedicine Medical Services, Teledentistry Dental Services, and Telehealth Services to Children With Special Health Care Needs

Section 531.02164. Medicaid Services Provided Through Home Telemonitoring Services

Section 531.0217. Reimbursement for Certain Medical Consultations

Section 531.02171. Reimbursement for Certain Telehealth Services

Section 531.02172. Reimbursement for Teledentistry Dental Services

Section 531.02174. Additional Authority Regarding Telemedicine Medical Services

Section 531.02175. Reimbursement for Online Medical Consultations

Section 531.0218. Long-Term Care Medicaid Programs

Section 531.02191. Public Input

Section 531.02192. Federally Qualified Health Center and Rural Health Clinic Services

Section 531.02193. Certain Conditions on Medicaid Reimbursement of Rural Health Clinics Prohibited

Section 531.02194. Reimbursement Methodology for Rural Hospitals

Section 531.022. Coordinated Strategic Plan for Health and Human Services

Section 531.0222. Local Mental Health Authority Group Regional Planning

Section 531.0224. Planning and Policy Direction of Temporary Assistance for Needy Families Program

Section 531.02241. Pilot Program for Self-Sufficiency of Certain Persons Receiving Financial Assistance or Supplemental Nutrition Assistance Benefits

Section 531.0225. Mental Health and Substance Abuse Services

Section 531.02251. Ombudsman for Behavioral Health Access to Care

Section 531.02253. Telehealth Treatment for Substance Use Disorders

Section 531.0226. Chronic Health Conditions Services Medicaid Waiver Program

Section 531.0227. Person First Respectful Language Promotion

Section 531.023. Submission of Plans and Updates by Agencies

Section 531.024. Planning and Delivery of Health and Human Services; Data Sharing

Section 531.0241. Streamlining Delivery of Services

Section 531.02411. Streamlining Administrative Processes

Section 531.024115. Service Delivery Area Alignment

Section 531.02412. Service Delivery Audit Mechanisms

Section 531.02413. Billing Coordination System

Section 531.024131. Expansion of Billing Coordination and Information Collection Activities

Section 531.02414. Nonemergency Transportation Services Under Medical Transportation Program

Section 531.024141. Pilot Program for Providing Medical Transportation Program Services to Pregnant Women and New Mothers

Section 531.02415. Electronic Eligibility Information Pilot Project

Section 531.024161. Reimbursement Claims for Certain Medicaid or Child Health Plan Services Involving Supervised Providers

Section 531.024162. Notice Requirements Regarding Medicaid Coverage or Prior Authorization Denial and Incomplete Requests

Section 531.024163. Accessibility of Information Regarding Medicaid Prior Authorization Requirements

Section 531.024164. External Medical Review

Section 531.024165. Medical Review of Medicaid Service Denials for Foster Care Youth

Section 531.02417. Medicaid Nursing Services Assessments

Section 531.024171. Therapy Services Assessments

Section 531.024172. Electronic Visit Verification System

Section 531.02418. Medicaid and Child Health Plan Program Eligibility Determinations for Certain Individuals

Section 531.024181. Verification of Immigration Status of Applicants for Certain Benefits Who Are Qualified Aliens

Section 531.024182. Verification of Sponsorship Information for Certain Benefits Recipients; Reimbursement

Section 531.0242. Use of Agency Staff

Section 531.0244. Ensuring Appropriate Care Setting for Persons With Disabilities

Section 531.02442. Community Living Options Information Process for Certain Persons With an Intellectual Disability

Section 531.02443. Implementation of Community Living Options Information Process at State Institutions for Certain Adult Residents

Section 531.02444. Medicaid Buy-in Programs for Certain Persons With Disabilities

Section 531.02445. Transition Services for Youth With Disabilities

Section 531.02447. Employment-First Policy

Section 531.02448. Competitive and Integrated Employment Initiative for Certain Medicaid Recipients

Section 531.0245. Permanency Planning for Certain Children

Section 531.0246. Regional Management of Health and Human Services Agencies

Section 531.0247. Annual Business Plan

Section 531.0248. Community-Based Support Systems

Section 531.02481. Community-Based Support and Service Delivery Systems for Long-Term Care Services

Section 531.02482. Faith- and Community-Based Organization Support for Certain Persons Receiving Public Assistance

Section 531.02491. Joint Training for Certain Caseworkers

Section 531.02492. Delivery of Health and Human Services to Young Texans

Section 531.025. Statewide Needs Appraisal Project

Section 531.027. Appropriations Request by Agencies

Section 531.0271. Health and Human Services Agencies Operating Budgets

Section 531.0273. Information Resources Planning and Management

Section 531.02731. Report of Information Resources Manager to Commission

Section 531.0274. Coordination and Approval of Caseload Estimates

Section 531.028. Monitoring and Effective Management of Funds

Section 531.031. Management Information and Cost Accounting System

Section 531.0312. Texas Information and Referral Network

Section 531.0313. Electronic Access to Health and Human Services Referral Information

Section 531.03131. Electronic Access to Child-Care and Education Services Referral Information

Section 531.03132. Electronic Access to Referral Information About Housing Options for Persons With Mental Illness

Section 531.0315. Implementing National Electronic Data Interchange Standards for Health Care Information

Section 531.0317. Health and Human Services Information Made Available Through the Internet

Section 531.0318. Long-Term Care Consumer Information Made Available Through the Internet

Section 531.0319. Outreach Campaigns for Aging Adults With Visual Impairments

Section 531.032. Application of Other Laws

Section 531.033. Rules

Section 531.0335. Prohibition on Punitive Action for Failure to Immunize

Section 531.035. Dispute Arbitration

Section 531.036. Public Hearings

Section 531.037. Notice of Public Hearings

Section 531.038. Gifts and Grants

Section 531.0381. Certain Gifts and Grants to Health and Human Services Agencies

Section 531.039. Contracts

Section 531.0391. Subrogation and Third-Party Reimbursement Collection Contract

Section 531.0392. Recovery of Certain Third-Party Reimbursements Under Medicaid

Section 531.040. Reference Guide; Dictionary

Section 531.041. General Powers and Duties

Section 531.0411. Rules Regarding Refugee Resettlement

Section 531.042. Information and Assistance Regarding Care and Support Options

Section 531.043. Long-Term Care Vision

Section 531.044. Financial Assistance Recipients Eligible for Federal Programs

Section 531.047. Substitute Care Provider Outcome Standards

Section 531.048. Caseload Standards

Section 531.050. Minimum Collection Goal

Section 531.0501. Medicaid Waiver Programs: Interest List Management

Section 531.051. Consumer Direction of Certain Services for Persons With Disabilities and Elderly Persons

Section 531.0511. Medically Dependent Children Waiver Program: Consumer Direction of Services

Section 531.0512. Notification Regarding Consumer Direction Model

Section 531.0515. Risk Management Criteria for Certain Waiver Programs

Section 531.053. Leases and Subleases of Certain Office Space

Section 531.054. Assumption of Leases for Implementations of Integrated Enrollment Services Initiative

Section 531.055. Memorandum of Understanding on Services for Persons Needing Multiagency Services

Section 531.056. Review of Survey Process in Certain Institutions and Facilities

Section 531.057. Volunteer Advocate Program for the Elderly

Section 531.058. Informal Dispute Resolution for Certain Long-Term Care Facilities

Section 531.0581. Long-Term Care Facilities Council

Section 531.0585. Issuance of Materials to Certain Long-Term Care Facilities

Section 531.059. Voucher Program for Transitional Living Assistance for Persons With Disabilities

Section 531.060. Family-Based Alternatives for Children

Section 531.0601. Long-Term Care Services Waiver Program Interest Lists

Section 531.06011. Certain Medicaid Waiver Programs: Interest List Management

Section 531.0602. Medically Dependent Children (Mdcp) Waiver Program Assessments and Reassessments

Section 531.06021. Medically Dependent Children (Mdcp) Waiver Program Quality Monitoring; Report

Section 531.0603. Eligibility of Certain Children for Medically Dependent Children (Mdcp) or Deaf-Blind With Multiple Disabilities (Dbmd) Waiver Program

Section 531.0604. Medically Dependent Children Program Eligibility Requirements; Nursing Facility Level of Care

Section 531.0605. Advancing Care for Exceptional Kids Pilot Program

Section 531.061. Participation by Fathers

Section 531.062. Pilot Projects Relating to Technology Applications

Section 531.063. Call Centers

Section 531.066. Participation of Diagnostic Laboratory Service Providers in Certain Programs

Section 531.067. Program to Improve and Monitor Certain Outcomes of Recipients Under Child Health Plan Program and Medicaid

Section 531.069. Periodic Review of Vendor Drug Program

Section 531.0693. Prescription Drug Use and Expenditure Patterns

Section 531.0694. Period of Validity for Prescription

Section 531.0696. Considerations in Awarding Certain Contracts

Section 531.0697. Prior Approval and Provider Access to Certain Communications With Certain Recipients

Section 531.070. Supplemental Rebates

Section 531.0701. Value-Based Arrangements

Section 531.071. Confidentiality of Information Regarding Drug Rebates, Pricing, and Negotiations

Section 531.072. Preferred Drug Lists

Section 531.073. Prior Authorization for Certain Prescription Drugs

Section 531.0735. Medicaid Drug Utilization Review Program: Drug Use Reviews and Annual Report

Section 531.0736. Drug Utilization Review Board

Section 531.0737. Drug Utilization Review Board: Conflicts of Interest

Section 531.0741. Publication of Information Regarding Commission Decisions on Preferred Drug List Placement

Section 531.075. Prior Authorization for High-Cost Medical Services

Section 531.076. Review of Prior Authorization and Utilization Review Processes

Section 531.077. Recovery of Certain Assistance

Section 531.078. Quality Assurance Fees on Certain Waiver Program Services

Section 531.079. Waiver Program Quality Assurance Fee Account

Section 531.080. Reimbursement of Waiver Programs

Section 531.081. Invalidity; Federal Funds

Section 531.082. Expiration of Quality Assurance Fee on Waiver Programs

Section 531.083. Medicaid Long-Term Care System

Section 531.084. Medicaid Long-Term Care Cost Containment Strategies

Section 531.0841. Long-Term Care Insurance Awareness and Education Campaign

Section 531.0843. Durable Medical Equipment Reuse Program

Section 531.085. Hospital Emergency Room Use Reduction Initiatives

Section 531.0861. Physician Incentive Program to Reduce Hospital Emergency Room Use for Non-Emergent Conditions

Section 531.0862. Continued Implementation of Certain Interventions and Best Practices by Providers; Biannual Report

Section 531.087. Distribution of Earned Income Tax Credit Information

Section 531.088. Pooled Funding for Foster Care Preventive Services

Section 531.089. Certain Medication for Sex Offenders Prohibited

Section 531.090. Joint Purchasing of Prescription Drugs and Other Medications

Section 531.091. Integrated Benefits Issuance

Section 531.092. Transfer of Money for Community-Based Services

Section 531.0925. Veteran Suicide Prevention Action Plan

Section 531.093. Services for Military Personnel

Section 531.0931. Interest List or Other Waiting List Rules for Certain Military Members and Their Dependents

Section 531.0941. Medicaid Health Savings Account Pilot Program

Section 531.097. Tailored Benefit Packages for Certain Categories of the Medicaid Population

Section 531.0971. Tailored Benefit Packages for Non-Medicaid Populations

Section 531.0972. Pilot Program to Prevent the Spread of Certain Infectious or Communicable Diseases

Section 531.0973. Deaf-Blind With Multiple Disabilities Waiver Program: Career Ladder for Interveners

Section 531.0981. Wellness Screening Program

Section 531.099. Alignment of Medicaid Diabetic Equipment and Supplies Written Order Procedures With Medicare Diabetic Equipment and Supplies Written Order Procedures

Section 531.0991. Grant Program for Mental Health Services

Section 531.0992. Grant Program for Mental Health Services for Veterans and Their Families

Section 531.0993. Grant Program to Reduce Recidivism, Arrest, and Incarceration Among Individuals With Mental Illness and to Reduce Wait Time for Forensic Commitment

Section 531.09935. Grant Program to Reduce Recidivism, Arrest, and Incarceration Among Individuals With Mental Illness and to Reduce Wait Time for Forensic Commitment in Most Populous County

Section 531.0994. Study; Annual Report

Section 531.0995. Information for Certain Enrollees in the Healthy Texas Women Program

Section 531.0996. Pregnancy Medical Home Pilot Program

Section 531.0998. Memorandum of Understanding Regarding Public Assistance Reporting Information System; Maximization of Benefits

Section 531.0999. Peer Specialists