Texas Code — 540
Browse 138 sections in division 540 of the Texas code. Each section page includes the full statutory text, official source links, and citation guidance.
Sections (showing up to 300)
- § GV.540.0001. DEFINITIONS
- § GV.540.0051. PURPOSE AND IMPLEMENTATION
- § GV.540.0052. RECIPIENT DIRECTORY
- § GV.540.0053. STATEWIDE EFFORT TO PROMOTE MEDICAID ELIGIBILITY MAINTENANCE
- § GV.540.0054. PROVIDER AND RECIPIENT EDUCATION PROGRAMS
- § GV.540.0055. MARKETING GUIDELINES
- § GV.540.0056. GUIDELINES FOR COMMUNICATIONS WITH RECIPIENTS
- § GV.540.0057. COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES
- § GV.540.0058. INFORMATION FOR FRAUD CONTROL
- § GV.540.0059. MANAGED CARE CLINICAL IMPROVEMENT PROGRAM
- § GV.540.0060. COMPLAINT SYSTEM GUIDELINES
- § GV.540.0101. FISCAL SOLVENCY STANDARDS
- § GV.540.0102. PROFIT SHARING
- § GV.540.0103. TREATMENT OF STATE TAXES IN CALCULATING EXPERIENCE REBATE OR PROFIT SHARING
- § GV.540.0104. TREATMENT AS QUALITY IMPROVEMENT COST OF CERTAIN SERVICES PROVIDED BY COMMUNITY H
- § GV.540.0151. DEFINITIONS
- § GV.540.0152. APPLICABILITY AND CONSTRUCTION OF SUBCHAPTER
- § GV.540.0153. OVERALL STRATEGY FOR MANAGING AUDIT RESOURCES
- § GV.540.0154. PERFORMANCE AUDIT SELECTION PROCESS AND FOLLOW-UP
- § GV.540.0155. AGREED-UPON PROCEDURES ENGAGEMENTS AND CORRECTIVE ACTION PLANS
- § GV.540.0156. AUDITS OF PHARMACY BENEFIT MANAGERS
- § GV.540.0157. COLLECTING COSTS FOR AUDIT-RELATED SERVICES
- § GV.540.0158. COLLECTION ACTIVITIES RELATED TO PROFIT SHARING
- § GV.540.0159. USING INFORMATION FROM EXTERNAL QUALITY REVIEWS
- § GV.540.0160. SECURITY OF AND PROCESSING CONTROLS OVER INFORMATION TECHNOLOGY SYSTEMS
- § GV.540.0201. CONTRACT ADMINISTRATION IMPROVEMENT EFFORTS
- § GV.540.0202. PUBLIC NOTICE OF REQUEST FOR CONTRACT APPLICATIONS
- § GV.540.0203. CERTIFICATION BY COMMISSION
- § GV.540.0204. CONTRACT CONSIDERATIONS RELATING TO MANAGED CARE ORGANIZATIONS
- § GV.540.0205. CONTRACT CONSIDERATIONS RELATING TO PHARMACY BENEFIT MANAGERS
- § GV.540.0206. MANDATORY CONTRACTS
- § GV.540.0207. CONTRACTUAL OBLIGATIONS REVIEW
- § GV.540.0208. CONTRACT IMPLEMENTATION PLAN
- § GV.540.0209. COMPLIANCE AND READINESS REVIEW
- § GV.540.0210. INTERNET POSTING OF SANCTIONS IMPOSED FOR CONTRACTUAL VIOLATIONS
- § GV.540.0211. PERFORMANCE MEASURES AND INCENTIVES FOR VALUE-BASED CONTRACTS
- § GV.540.0212. MONITORING COMPLIANCE WITH BEHAVIORAL HEALTH INTEGRATION
- § GV.540.0251. APPLICABILITY
- § GV.540.0252. ACCOUNTABILITY TO STATE
- § GV.540.0253. CAPITATION RATES
- § GV.540.0254. COST INFORMATION
- § GV.540.0255. FRAUD CONTROL
- § GV.540.0256. RECIPIENT OUTREACH AND EDUCATION
- § GV.540.0257. NOTICE OF MEDICAID CERTIFICATION DATE
- § GV.540.0258. PRIMARY CARE PROVIDER ASSIGNMENT
- § GV.540.0259. COMPLIANCE WITH PROVIDER NETWORK REQUIREMENTS
- § GV.540.0260. COMPLIANCE WITH PROVIDER ACCESS STANDARDS
- § GV.540.0261. PROVIDER NETWORK SUFFICIENCY
- § GV.540.0262. QUALITY MONITORING PROGRAM FOR HEALTH CARE SERVICES
- § GV.540.0263. OUT-OF-NETWORK PROVIDER USAGE AND REIMBURSEMENT
- § GV.540.0264. PROVIDER REIMBURSEMENT RATE REDUCTION
- § GV.540.0265. PROMPT PAYMENT OF CLAIMS
- § GV.540.0266. REIMBURSEMENT FOR CERTAIN SERVICES PROVIDED OUTSIDE REGULAR BUSINESS HOURS
- § GV.540.0267. PROVIDER APPEALS PROCESS
- § GV.540.0268. ASSISTANCE RESOLVING RECIPIENT AND PROVIDER ISSUES
- § GV.540.0269. USE OF ADVANCED PRACTICE REGISTERED NURSES AND PHYSICIAN ASSISTANTS
- § GV.540.0270. MEDICAL DIRECTOR AVAILABILITY
- § GV.540.0271. PERSONNEL REQUIRED IN CERTAIN SERVICE REGIONS
- § GV.540.0272. CERTAIN SERVICES PERMITTED IN LIEU OF STATE MEDICAID PLAN SERVICES
- § GV.540.02721. PILOT PROGRAM TO PROVIDE ADDITIONAL NUTRITION SUPPORT SERVICES TO CERTAIN PREGNAN
- § GV.540.0273. OUTPATIENT PHARMACY BENEFIT PLAN
- § GV.540.0274. PHARMACY BENEFIT PLAN
- § GV.540.0275. PHARMACY BENEFIT PLAN
- § GV.540.0276. PHARMACY BENEFIT PLAN
- § GV.540.0277. PHARMACY BENEFIT PLAN
- § GV.540.0278. PHARMACY BENEFIT PLAN
- § GV.540.0279. PHARMACY BENEFIT PLAN
- § GV.540.0280. PHARMACY BENEFIT PLAN
- § GV.540.0283. NURSING FACILITY PROVIDER AGREEMENTS
- § GV.540.0301. INAPPLICABILITY OF CERTAIN OTHER LAW TO MEDICAID MANAGED CARE UTILIZATION REVIEWS
- § GV.540.0302. PRIOR AUTHORIZATION PROCEDURES FOR HOSPITALIZED RECIPIENT
- § GV.540.0303. PRIOR AUTHORIZATION PROCEDURES FOR NONHOSPITALIZED RECIPIENT
- § GV.540.0304. ANNUAL REVIEW OF PRIOR AUTHORIZATION REQUIREMENTS
- § GV.540.0305. PHYSICIAN CONSULTATION BEFORE ADVERSE PRIOR AUTHORIZATION DETERMINATION
- § GV.540.0306. RECONSIDERATION FOLLOWING ADVERSE DETERMINATIONS ON CERTAIN PRIOR AUTHORIZATION R
- § GV.540.0307. MAXIMUM PERIOD FOR PRIOR AUTHORIZATION DECISION
- § GV.540.0351. PREMIUM PAYMENT RATE DETERMINATION
- § GV.540.0352. MAXIMUM PREMIUM PAYMENT RATES FOR CERTAIN PROGRAMS
- § GV.540.0353. USE OF ENCOUNTER DATA IN DETERMINING PREMIUM PAYMENT RATES AND OTHER PAYMENT AMOU
- § GV.540.0401. PROVIDER REPORTING OF ENCOUNTER DATA
- § GV.540.0402. CERTIFIER OF ENCOUNTER DATA QUALIFICATIONS
- § GV.540.0403. ENCOUNTER DATA CERTIFICATION
- § GV.540.0451. MEDICAID MANAGED CARE PLAN ACCREDITATION
- § GV.540.0452. MEDICAL DIRECTOR QUALIFICATIONS
- § GV.540.0501. RECIPIENT ENROLLMENT IN AND DISENROLLMENT FROM MEDICAID MANAGED CARE PLAN
- § GV.540.0502. AUTOMATIC ENROLLMENT IN MEDICAID MANAGED CARE PLAN
- § GV.540.0503. ENROLLMENT OF CERTAIN RECIPIENTS IN SAME MEDICAID MANAGED CARE PLAN
- § GV.540.0504. QUALITY-BASED ENROLLMENT INCENTIVE PROGRAM FOR MEDICAID MANAGED CARE ORGANIZATION
- § GV.540.0505. LIMITATIONS ON RECIPIENT DISENROLLMENT FROM MEDICAID MANAGED CARE PLAN
- § GV.540.0551. GUIDANCE REGARDING CONTINUATION OF SERVICES UNDER CERTAIN CIRCUMSTANCES
- § GV.540.0552. COORDINATION OF BENEFITS
- § GV.540.0601. MONITORING OF PROVIDER NETWORKS
- § GV.540.0602. REPORT ON OUT-OF-NETWORK PROVIDER SERVICES
- § GV.540.0603. REPORT ON COMMISSION INVESTIGATION OF PROVIDER COMPLAINT
- § GV.540.0604. ADDITIONAL REIMBURSEMENT FOLLOWING PROVIDER COMPLAINT
- § GV.540.0605. CORRECTIVE ACTION PLAN FOR INADEQUATE NETWORK AND PROVIDER REIMBURSEMENT
- § GV.540.0606. REMEDIES FOR NONCOMPLIANCE WITH CORRECTIVE ACTION PLAN
- § GV.540.0651. INCLUSION OF CERTAIN PROVIDERS IN MEDICAID MANAGED CARE ORGANIZATION PROVIDER NET
- § GV.540.0652. PROVIDER ACCESS STANDARDS
- § GV.540.0653. PENALTIES AND OTHER REMEDIES FOR FAILURE TO COMPLY WITH PROVIDER ACCESS STANDARDS
- § GV.540.0654. PROVIDER NETWORK DIRECTORIES
- § GV.540.0655. PROVIDER PROTECTION PLAN
- § GV.540.0656. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN PROVIDERS
- § GV.540.0657. FREQUENCY OF PROVIDER RECREDENTIALING
- § GV.540.0658. PROVIDER INCENTIVES FOR PROMOTING PREVENTIVE SERVICES
- § GV.540.0659. REIMBURSEMENT RATE FOR CERTAIN SERVICES PROVIDED BY CERTAIN HEALTH CENTERS AND CL
- § GV.540.0701. ACUTE CARE SERVICE DELIVERY THROUGH MOST COST-EFFECTIVE MODEL
- § GV.540.0702. TRANSITION OF CASE MANAGEMENT FOR CHILDREN AND PREGNANT WOMEN PROGRAM RECIPIENTS
- § GV.540.0703. BEHAVIORAL HEALTH AND PHYSICAL HEALTH SERVICES
- § GV.540.0704. TARGETED CASE MANAGEMENT AND PSYCHIATRIC REHABILITATIVE SERVICES FOR CHILDREN, AD
- § GV.540.0705. BEHAVIORAL HEALTH SERVICES PROVIDED THROUGH THIRD PARTY OR SUBSIDIARY
- § GV.540.0706. PSYCHOTROPIC MEDICATION MONITORING SYSTEM FOR CERTAIN CHILDREN
- § GV.540.0707. MEDICATION THERAPY MANAGEMENT
- § GV.540.0708. SPECIAL DISEASE MANAGEMENT
- § GV.540.0709. SPECIAL PROTOCOLS FOR INDIGENT POPULATIONS
- § GV.540.0710. DIRECT ACCESS TO EYE HEALTH CARE SERVICES
- § GV.540.0711. DELIVERY OF BENEFITS USING TELECOMMUNICATIONS OR INFORMATION TECHNOLOGY
- § GV.540.0712. PROMOTION AND PRINCIPLES OF PATIENT-CENTERED MEDICAL HOME
- § GV.540.0713. VALUE-ADDED SERVICES
- § GV.540.0714. SICKLE CELL DISEASE TREATMENT
- § GV.540.0751. DELIVERY OF ACUTE CARE SERVICES AND LONG-TERM SERVICES AND SUPPORTS
- § GV.540.0752. DELIVERY OF MEDICAID BENEFITS TO NURSING FACILITY RESIDENTS
- § GV.540.0753. DELIVERY OF BASIC ATTENDANT AND HABILITATION SERVICES
- § GV.540.0754. EVALUATION OF CERTAIN PROGRAM SERVICES
- § GV.540.0755. UTILIZATION REVIEW
- § GV.540.0801. TRAUMA-INFORMED CARE TRAINING
- § GV.540.0802. MENTAL HEALTH PROVIDERS
- § GV.540.0803. HEALTH SCREENING REQUIREMENTS AND COMPLIANCE WITH TEXAS HEALTH STEPS
- § GV.540.0804. HEALTH CARE AND OTHER SERVICES FOR CHILDREN IN SUBSTITUTE CARE
- § GV.540.0805. PLACEMENT CHANGE NOTICE AND CARE COORDINATION
- § GV.540.0806. MEDICAID BENEFITS FOR CERTAIN CHILDREN FORMERLY IN FOSTER CARE
- § GV.540.0807. ACCESS TO CARE PAID FOR BY CERTAIN MEDICAL CONSENTERS
- § GV.540.0851. STAR KIDS MANAGED CARE PROGRAM
- § GV.540.0852. CARE MANAGEMENT AND CARE NEEDS ASSESSMENT
- § GV.540.0853. BENEFITS FOR CHILDREN IN MEDICALLY DEPENDENT CHILDREN (MDCP) WAIVER PROGRAM
- § GV.540.0854. BENEFITS TRANSITION FROM STAR KIDS TO STAR
- § GV.540.0855. UTILIZATION REVIEW OF PRIOR AUTHORIZATIONS
- § GV.540.0901. PREFERRED DRUG LIST EXCEPTIONS