Sec. 533.051. 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 engaged by the commission 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 the state according to the graduated rebate method described in the managed care 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.
Added by Acts 2017, 85th Leg., R.S., Ch. 909 (S.B. 894), Sec. 4, eff. September 1, 2017.
Structure Texas Statutes
Subtitle I - Health and Human Services
Chapter 533 - Medicaid Managed Care Program
Subchapter B. Strategy for Managing Audit Resources
Section 533.051. Definitions
Section 533.052. Applicability and Construction of Subchapter
Section 533.053. Overall Strategy for Managing Audit Resources
Section 533.054. Performance Audit Selection Process and Follow-Up
Section 533.055. Agreed-Upon Procedures Engagements and Corrective Action Plans
Section 533.056. Audits of Pharmacy Benefit Managers
Section 533.057. Collection of Costs for Audit-Related Services
Section 533.058. Collection Activities Related to Profit Sharing
Section 533.059. Use of Information From External Quality Reviews
Section 533.060. Security and Processing Controls Over Information Technology Systems