Sec. 533.059. USE OF 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 Medicaid recipients and, if applicable, child health plan program enrollees, caregivers of those recipients and enrollees, and 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.
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 533.052. 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