Texas Statutes
Subchapter A. General Provisions
Section 533.0073. Medical Director Qualifications

Texas Statutes

Government Code

Title 4 - Executive Branch

Subtitle I - Health and Human Services

Chapter 533 - Medicaid Managed Care Program

Subchapter A. General Provisions

Section 533.001. Definitions

Section 533.002. Purpose

Section 533.0025. Delivery of Services

Section 533.00251. Delivery of Certain Benefits, Including Nursing Facility Benefits, Through Star + Plus Medicaid Managed Care Program

Section 533.00253. Star Kids Medicaid Managed Care Program

Section 533.00254. Star Kids Managed Care Advisory Committee

Section 533.00255. Behavioral Health and Physical Health Services Network

Section 533.002551. Monitoring of Compliance With Behavioral Health Integration

Section 533.002552. Targeted Case Management and Psychiatric Rehabilitative Services for Children, Adolescents, and Families

Section 533.002553. Behavioral Health Services Provided Through Third Party or Subsidiary

Section 533.002555. Transition of Case Management for Children and Pregnant Women Program Recipients to Managed Care Program

Section 533.00256. Managed Care Clinical Improvement Program

Section 533.00257. Delivery of Medical Transportation Program Services Through Managed Transportation Organization

Section 533.002571. Delivery of Nonemergency Transportation Services to Certain Medicaid Recipients Through Medicaid Managed Care Organization

Section 533.00258. Nonmedical Transportation Services Under Medicaid Managed Care Program

Section 533.002581. Delivery of Nonmedical Transportation Services Under Medicaid Managed Care Program

Section 533.0026. Direct Access to Eye Health Care Services Under Medicaid Managed Care Model or Arrangement

Section 533.0027. Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan

Section 533.0028. Evaluation of Certain Star + Plus Medicaid Managed Care Program Services

Section 533.00281. Utilization Review for Star + Plus Medicaid Managed Care Organizations

Section 533.00282. Utilization Review and Prior Authorization Procedures

Section 533.002821. Prior Authorization Procedures for Hospitalized Recipient

Section 533.00283. Annual Review of Prior Authorization Requirements

Section 533.00284. Reconsideration Following Adverse Determinations on Certain Prior Authorization Requests

Section 533.002841. Maximum Period for Prior Authorization Decision; Access to Care

Section 533.0029. Promotion and Principles of Patient-Centered Medical Homes for Recipients

Section 533.003. Considerations in Awarding Contracts

Section 533.0031. Medicaid Managed Care Plan Accreditation

Section 533.0035. Certification by Commission

Section 533.004. Mandatory Contracts

Section 533.005. Required Contract Provisions

Section 533.0051. Performance Measures and Incentives for Value-Based Contracts

Section 533.00511. Quality-Based Enrollment Incentive Program for Managed Care Organizations

Section 533.00515. Medication Therapy Management

Section 533.0052. Star Health Program: Trauma-Informed Care Training

Section 533.00521. Star Health Program: Health Care for Foster Children

Section 533.00522. Star Health Program: Mental Health Providers

Section 533.0053. Compliance With Texas Health Steps

Section 533.00531. Medicaid Benefits for Certain Children Formerly in Foster Care

Section 533.0054. Health Screening Requirements for Enrollee Under Star Health Program

Section 533.0055. Provider Protection Plan

Section 533.0056. Star Health Program: Notification of Placement Change

Section 533.006. Provider Networks

Section 533.0061. Provider Access Standards; Report

Section 533.0062. Penalties and Other Remedies for Failure to Comply With Provider Access Standards

Section 533.0063. Provider Network Directories

Section 533.0064. Expedited Credentialing Process for Certain Providers

Section 533.0065. Frequency of Provider Credentialing

Section 533.0066. Provider Incentives

Section 533.0067. Eye Health Care Service Providers

Section 533.007. Contract Compliance

Section 533.0071. Administration of Contracts

Section 533.0072. Internet Posting of Sanctions Imposed for Contractual Violations

Section 533.0073. Medical Director Qualifications

Section 533.0075. Recipient Enrollment

Section 533.00751. Recipient Directory

Section 533.0076. Limitations on Recipient Disenrollment

Section 533.0077. Statewide Effort to Promote Maintenance of Eligibility

Section 533.008. Marketing Guidelines

Section 533.009. Special Disease Management

Section 533.010. Special Protocols

Section 533.011. Public Notice

Section 533.012. Information for Fraud Control

Section 533.013. Premium Payment Rate Determination; Review and Comment

Section 533.0131. Use of Encounter Data in Determining Premium Payment Rates

Section 533.01315. Reimbursement for Services Provided Outside of Regular Business Hours

Section 533.0132. State Taxes

Section 533.014. Profit Sharing

Section 533.015. Coordination of External Oversight Activities

Section 533.016. Provider Reporting of Encounter Data

Section 533.0161. Monitoring of Psychotropic Drug Prescriptions for Certain Children

Section 533.017. Qualifications of Certifier of Encounter Data

Section 533.018. Certification of Encounter Data

Section 533.019. Value-Added Services

Section 533.020. Managed Care Organizations: Fiscal Solvency and Complaint System Guidelines

Section 533.038. Coordination of Benefits; Continuity of Specialty Care for Certain Recipients

Section 533.039. Delivery of Benefits Using Telecommunications and Information Technology