Sec. 62.052. AUTHORITY OF COMMISSION RELATING TO HEALTH PLAN PROVIDER CONTRACTS. The commission may:
(1) implement contracts with health plan providers under Section 62.155;
(2) monitor the health plan providers, through reporting requirements and other means, to ensure performance under the contracts and quality delivery of services;
(3) monitor the quality of services delivered to enrollees through outcome measurements including:
(A) rate of hospitalization for ambulatory sensitive conditions, including asthma, diabetes, epilepsy, dehydration, gastroenteritis, pneumonia, and UTI/kidney infection;
(B) rate of hospitalization for injuries;
(C) percent of enrolled adolescents reporting risky health behavior such as injuries, tobacco use, alcohol/drug use, dietary behavior, physical activity, or other health related behaviors; and
(D) percent of adolescents reporting attempted suicide; and
(4) provide payment under the contracts to the health plan providers.
Added by Acts 1999, 76th Leg., ch. 235, Sec. 1, eff. Aug. 30, 1999.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0192, eff. April 2, 2015.
Structure Texas Statutes
Subtitle C - Programs Providing Health Care Benefits and Services
Chapter 62 - Child Health Plan for Certain Low-Income Children
Subchapter B. Administration of Child Health Plan Program
Section 62.051. Duties of Executive Commissioner and Commission in General
Section 62.052. Authority of Commission Relating to Health Plan Provider Contracts
Section 62.053. Authority of Commission Relating to Eligibility and Medicaid Coordination
Section 62.0531. Authority of Commission Relating to Third Party Administrator
Section 62.054. Duties of Texas Department of Insurance
Section 62.055. Contracts for Implementation of Child Health Plan
Section 62.056. Community Outreach Campaign; Toll-Free Hotline
Section 62.058. Fraud Prevention