Texas Statutes
Subchapter C. Medicaid and Other Health and Human Services Fraud, Abuse, or Overcharges
Section 531.1034. Time to Determine Provider Eligibility; Performance Metrics

Sec. 531.1034. TIME TO DETERMINE PROVIDER ELIGIBILITY; PERFORMANCE METRICS. (a) Not later than the 10th day after the date the office receives the complete application of a health care professional seeking to participate in Medicaid, the office shall inform the commission or the health care professional, as appropriate, of the office's determination regarding whether the health care professional should be denied participation in Medicaid based on:
(1) information concerning the licensing status of the health care professional obtained as described by Section 531.1032(a);
(2) information contained in the criminal history record information check that is evaluated in accordance with guidelines adopted under Section 531.1032(c);
(3) a review of federal databases under Section 531.1033;
(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 shall develop performance metrics to measure the length of time for conducting a determination described by Subsection (a) with respect to applications that are complete when submitted and all other applications.
Added by Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 2.15(b), eff. September 1, 2015.
Added by Acts 2015, 84th Leg., R.S., Ch. 945 (S.B. 207), Sec. 5, eff. September 1, 2015.

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