Texas § GV.544.0155 - PERIOD FOR DETERMINING PROVIDER ELIGIBILITY FOR MEDICAID

§ GV.544.0155. PERIOD FOR DETERMINING PROVIDER ELIGIBILITY FOR MEDICAID

PERIOD FOR DETERMINING PROVIDER ELIGIBILITY FOR MEDICAID. (a) Not later than the 10th day after the date the office of inspector general receives a health care professional's complete application seeking to participate in Medicaid, the office shall inform the commission or the health care professional, as appropriate, of the office's determination of whether the health care professional should be denied participation in Medicaid based on: (1) information concerning the health care professional's licensing status obtained as described by Section 544.0153 (a); (2) information contained in the criminal history record information check that is evaluated in accordance with guidelines the executive commissioner adopts under Section 544.0153 (c); (3) a review of federal databases under Section 544.0154 ; (4) the pendency of an open investigation by the office; or (5) any other reason the office determines appropriate. (b) Completion of an on-site visit of a health care professional during the period prescribed by Subsection (a) is not required. (c) The office of inspector general shall develop performance metrics to measure the length of time for conducting a determination described by Subsection (a) with respect to: (1) applications that are complete when submitted; and (2) all other applications. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 1.01, eff. April 1, 2025. SUBCHAPTER E. PREVENTION AND DETECTION OF FRAUD, WASTE, AND ABUSE