Texas § GV.540.0652 - PROVIDER ACCESS STANDARDS

§ GV.540.0652. PROVIDER ACCESS STANDARDS

PROVIDER ACCESS STANDARDS; BIENNIAL REPORT. (a) The commission shall establish minimum provider access standards for a Medicaid managed care organization's provider network. The provider access standards must ensure that a Medicaid managed care organization provides recipients sufficient access to: (1) preventive care; (2) primary care; (3) specialty care; (4) after-hours urgent care; (5) chronic care; (6) long-term services and supports; (7) nursing services; (8) therapy services, including services provided in a clinical setting or in a home or community-based setting; and (9) any other services the commission identifies. (b) To the extent feasible, the provider access standards must: (1) distinguish between access to providers in urban and rural settings; (2) consider the number and geographic distribution of Medicaid-enrolled providers in a particular service delivery area; and (3) subject to Section 548.0054 (a) and consistent with Section 111.007 , Occupations Code, consider and include the availability of telehealth services and telemedicine medical services in a Medicaid managed care organization's provider network. (c) The commission shall biennially submit to the legislature and make available to the public a report that contains: (1) information and statistics on: (A) recipient access to providers through Medicaid managed care organizations' provider networks; and (B) Medicaid managed care organization compliance with contractual obligations related to provider access standards; (2) a compilation and analysis of information Medicaid managed care organizations submit to the commission under Section 540.0260 (4); (3) for both primary care providers and specialty providers, information on provider-to-recipient ratios in a Medicaid managed care organization's provider network and benchmark ratios to indicate whether deficiencies exist in a given network; and (4) a description of, and analysis of the results from, the commission's monitoring process established under Section 540.0601 . Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.