Texas § GV.542.0110 - PROVIDER PARTICIPATION

§ GV.542.0110. PROVIDER PARTICIPATION

PROVIDER PARTICIPATION. (a) The pilot program must allow a comprehensive long-term services and supports provider for individuals with an intellectual or developmental disability or similar functional needs that contracts with the commission to provide Medicaid services before the date the pilot program is implemented to voluntarily participate in the pilot program. A provider's choice not to participate in the pilot program does not affect the provider's status as a significant traditional provider. (b) For the duration of the pilot program, the commission shall ensure that comprehensive long-term services and supports providers are: (1) considered significant traditional providers; and (2) included in the provider network of a managed care organization participating in the pilot program. (c) A comprehensive long-term services and supports provider may deliver services listed under the following provisions only if the provider also delivers the services under a Medicaid waiver program: (1) Sections 542.0109 (a)(2)(A) and (D); (2) Sections 542.0109 (a)(3)(B), (C), (D), (G), (H), (J), (K), (L), and (M); and (3) Section 542.0109 (a)(4). (d) A comprehensive long-term services and supports provider may deliver services listed under Sections 542.0109 (a)(5) and (6) only if the managed care organization in the network of which the provider participates agrees, in a contract with the provider, to the provision of those services. (e) Day habilitation services listed under Section 542.0109 (a)(4)(C) may be delivered by a provider who contracts or subcontracts with the commission to provide day habilitation services under the home and community-based services (HCS) waiver program or the ICF-IID program. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025.