Texas § GV.540.0208 - CONTRACT IMPLEMENTATION PLAN

§ GV.540.0208. CONTRACT IMPLEMENTATION PLAN

CONTRACT IMPLEMENTATION PLAN. (a) Each Medicaid managed care organization that contracts to provide health care services to recipients in a health care service region shall submit an implementation plan not later than the 90th day before the date the organization plans to begin providing those services in that region through managed care. The implementation plan must include: (1) specific staffing patterns by function for all operations, including enrollment, information systems, member services, quality improvement, claims management, case management, and provider and recipient training; and (2) specific time frames for demonstrating preparedness for implementation before the date the organization plans to begin providing those services in that region through managed care. (b) The commission shall respond to an implementation plan not later than the 10th day after the date a Medicaid managed care organization submits the plan if the plan does not adequately meet preparedness guidelines. (c) Each Medicaid managed care organization that contracts to provide health care services to recipients in a health care service region shall submit status reports on the implementation plan: (1) not later than the 60th day and the 30th day before the date the organization plans to begin providing those services in that region through managed care; and (2) every 30th day after that date until the 180th day after that date. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.