GroundRules
Browse Texas
Read the original sections, or search by topic.
- Tex. Government Code § 532.0505 · INITIAL MEDICAL AND NONMEDICAL HEALTH-RELATED SCREENINGS OF CERTAIN RECIPIENTS.
- Tex. Government Code § 532.0506 · SCREENING AND PROGRAM SERVICES OPTIONAL.
- Tex. Government Code § 540.0001 · DEFINITIONS.
- Tex. Government Code § 540.0051 · PURPOSE AND IMPLEMENTATION.
- Tex. Government Code § 540.0052 · RECIPIENT DIRECTORY.
- Tex. Government Code § 540.0053 · STATEWIDE EFFORT TO PROMOTE MEDICAID ELIGIBILITY MAINTENANCE.
- Tex. Government Code § 540.0054 · PROVIDER AND RECIPIENT EDUCATION PROGRAMS.
- Tex. Government Code § 540.0055 · MARKETING GUIDELINES.
- Tex. Government Code § 540.0056 · GUIDELINES FOR COMMUNICATIONS WITH RECIPIENTS.
- Tex. Government Code § 540.0057 · COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES.
- Tex. Government Code § 540.0058 · INFORMATION FOR FRAUD CONTROL.
- Tex. Government Code § 540.0059 · MANAGED CARE CLINICAL IMPROVEMENT PROGRAM.
- Tex. Government Code § 540.0060 · COMPLAINT SYSTEM GUIDELINES.
- Tex. Government Code § 540.0101 · FISCAL SOLVENCY STANDARDS.
- Tex. Government Code § 540.0102 · PROFIT SHARING.
- Tex. Government Code § 540.0103 · TREATMENT OF STATE TAXES IN CALCULATING EXPERIENCE REBATE OR PROFIT SHARING.
- Tex. Government Code § 540.0104 · TREATMENT AS QUALITY IMPROVEMENT COST OF CERTAIN SERVICES PROVIDED BY COMMUNITY HEALTH WORKERS.
- Tex. Government Code § 540.0151 · DEFINITIONS.
- Tex. Government Code § 540.0152 · APPLICABILITY AND CONSTRUCTION OF SUBCHAPTER.
- Tex. Government Code § 540.0153 · OVERALL STRATEGY FOR MANAGING AUDIT RESOURCES.
- Tex. Government Code § 540.0154 · PERFORMANCE AUDIT SELECTION PROCESS AND FOLLOW-UP.
- Tex. Government Code § 540.0155 · AGREED-UPON PROCEDURES ENGAGEMENTS AND CORRECTIVE ACTION PLANS.
- Tex. Government Code § 540.0156 · AUDITS OF PHARMACY BENEFIT MANAGERS.
- Tex. Government Code § 540.0157 · COLLECTING COSTS FOR AUDIT-RELATED SERVICES.
- Tex. Government Code § 540.0158 · COLLECTION ACTIVITIES RELATED TO PROFIT SHARING.
- Tex. Government Code § 540.0159 · USING INFORMATION FROM EXTERNAL QUALITY REVIEWS.
- Tex. Government Code § 540.0160 · SECURITY OF AND PROCESSING CONTROLS OVER INFORMATION TECHNOLOGY SYSTEMS.
- Tex. Government Code § 540.0201 · CONTRACT ADMINISTRATION IMPROVEMENT EFFORTS.
- Tex. Government Code § 540.0202 · PUBLIC NOTICE OF REQUEST FOR CONTRACT APPLICATIONS.
- Tex. Government Code § 540.0203 · CERTIFICATION BY COMMISSION.
- Tex. Government Code § 540.0204 · CONTRACT CONSIDERATIONS RELATING TO MANAGED CARE ORGANIZATIONS.
- Tex. Government Code § 540.0205 · CONTRACT CONSIDERATIONS RELATING TO PHARMACY BENEFIT MANAGERS.
- Tex. Government Code § 540.0206 · MANDATORY CONTRACTS.
- Tex. Government Code § 540.0207 · CONTRACTUAL OBLIGATIONS REVIEW.
- Tex. Government Code § 540.0208 · CONTRACT IMPLEMENTATION PLAN.
- Tex. Government Code § 540.0209 · COMPLIANCE AND READINESS REVIEW.
- Tex. Government Code § 540.0210 · INTERNET POSTING OF SANCTIONS IMPOSED FOR CONTRACTUAL VIOLATIONS.
- Tex. Government Code § 540.0211 · PERFORMANCE MEASURES AND INCENTIVES FOR VALUE-BASED CONTRACTS.
- Tex. Government Code § 540.0212 · MONITORING COMPLIANCE WITH BEHAVIORAL HEALTH INTEGRATION.
- Tex. Government Code § 540.0251 · APPLICABILITY.
- Tex. Government Code § 540.0252 · ACCOUNTABILITY TO STATE.
- Tex. Government Code § 540.0253 · CAPITATION RATES.
- Tex. Government Code § 540.0254 · COST INFORMATION.
- Tex. Government Code § 540.0255 · FRAUD CONTROL.
- Tex. Government Code § 540.0256 · RECIPIENT OUTREACH AND EDUCATION.
- Tex. Government Code § 540.0257 · NOTICE OF MEDICAID CERTIFICATION DATE.
- Tex. Government Code § 540.0258 · PRIMARY CARE PROVIDER ASSIGNMENT.
- Tex. Government Code § 540.0259 · COMPLIANCE WITH PROVIDER NETWORK REQUIREMENTS.
- Tex. Government Code § 540.0260 · COMPLIANCE WITH PROVIDER ACCESS STANDARDS; REPORT.
- Tex. Government Code § 540.0261 · PROVIDER NETWORK SUFFICIENCY.
- Tex. Government Code § 540.0262 · QUALITY MONITORING PROGRAM FOR HEALTH CARE SERVICES.
- Tex. Government Code § 540.0263 · OUT-OF-NETWORK PROVIDER USAGE AND REIMBURSEMENT.
- Tex. Government Code § 540.0264 · PROVIDER REIMBURSEMENT RATE REDUCTION.
- Tex. Government Code § 540.0265 · PROMPT PAYMENT OF CLAIMS.
- Tex. Government Code § 540.0266 · REIMBURSEMENT FOR CERTAIN SERVICES PROVIDED OUTSIDE REGULAR BUSINESS HOURS.
- Tex. Government Code § 540.0267 · PROVIDER APPEALS PROCESS.
- Tex. Government Code § 540.0268 · ASSISTANCE RESOLVING RECIPIENT AND PROVIDER ISSUES.
- Tex. Government Code § 540.0269 · USE OF ADVANCED PRACTICE REGISTERED NURSES AND PHYSICIAN ASSISTANTS.
- Tex. Government Code § 540.0270 · MEDICAL DIRECTOR AVAILABILITY.
- Tex. Government Code § 540.0271 · PERSONNEL REQUIRED IN CERTAIN SERVICE REGIONS.
- Tex. Government Code § 540.0272 · CERTAIN SERVICES PERMITTED IN LIEU OF STATE MEDICAID PLAN SERVICES; ANNUAL REPORT.
- Tex. Government Code § 540.02721 · PILOT PROGRAM TO PROVIDE ADDITIONAL NUTRITION SUPPORT SERVICES TO CERTAIN PREGNANT RECIPIENTS IN LIEU OF STATE MEDICAID PLAN SERVICES.
- Tex. Government Code § 540.0273 · OUTPATIENT PHARMACY BENEFIT PLAN.
- Tex. Government Code § 540.0274 · PHARMACY BENEFIT PLAN: REBATES AND RECEIPT OF CONFIDENTIAL INFORMATION PROHIBITED.
- Tex. Government Code § 540.0275 · PHARMACY BENEFIT PLAN: CERTAIN PHARMACY BENEFITS FOR SEX OFFENDERS PROHIBITED.
- Tex. Government Code § 540.0276 · PHARMACY BENEFIT PLAN: RECIPIENT SELECTION OF PHARMACEUTICAL SERVICES PROVIDER.
- Tex. Government Code § 540.0277 · PHARMACY BENEFIT PLAN: PHARMACY BENEFIT PROVIDERS.
- Tex. Government Code § 540.0278 · PHARMACY BENEFIT PLAN: PROMPT PAYMENT OF PHARMACY BENEFIT CLAIMS.
- Tex. Government Code § 540.0279 · PHARMACY BENEFIT PLAN: MAXIMUM ALLOWABLE COST PRICE AND LIST FOR PHARMACY BENEFITS.
- Tex. Government Code § 540.0280 · PHARMACY BENEFIT PLAN: PHARMACY BENEFITS FOR CHILD ENROLLED IN STAR KIDS MANAGED CARE PROGRAM.
- Tex. Government Code § 540.0283 · NURSING FACILITY PROVIDER AGREEMENTS: COMPLIANCE WITH PATIENT CARE EXPENSE RATIO.
- Tex. Government Code § 540.0301 · INAPPLICABILITY OF CERTAIN OTHER LAW TO MEDICAID MANAGED CARE UTILIZATION REVIEWS.
- Tex. Government Code § 540.0302 · PRIOR AUTHORIZATION PROCEDURES FOR HOSPITALIZED RECIPIENT.
- Tex. Government Code § 540.0303 · PRIOR AUTHORIZATION PROCEDURES FOR NONHOSPITALIZED RECIPIENT.
- Tex. Government Code § 540.0304 · ANNUAL REVIEW OF PRIOR AUTHORIZATION REQUIREMENTS.
- Tex. Government Code § 540.0305 · PHYSICIAN CONSULTATION BEFORE ADVERSE PRIOR AUTHORIZATION DETERMINATION.
- Tex. Government Code § 540.0306 · RECONSIDERATION FOLLOWING ADVERSE DETERMINATIONS ON CERTAIN PRIOR AUTHORIZATION REQUESTS.
- Tex. Government Code § 540.0307 · MAXIMUM PERIOD FOR PRIOR AUTHORIZATION DECISION; ACCESS TO CARE.
- Tex. Government Code § 540.0351 · PREMIUM PAYMENT RATE DETERMINATION.
- Tex. Government Code § 540.0352 · MAXIMUM PREMIUM PAYMENT RATES FOR CERTAIN PROGRAMS.
- Tex. Government Code § 540.0353 · USE OF ENCOUNTER DATA IN DETERMINING PREMIUM PAYMENT RATES AND OTHER PAYMENT AMOUNTS.
- Tex. Government Code § 540.0401 · PROVIDER REPORTING OF ENCOUNTER DATA.
- Tex. Government Code § 540.0402 · CERTIFIER OF ENCOUNTER DATA QUALIFICATIONS.
- Tex. Government Code § 540.0403 · ENCOUNTER DATA CERTIFICATION.
- Tex. Government Code § 540.0451 · MEDICAID MANAGED CARE PLAN ACCREDITATION.
- Tex. Government Code § 540.0452 · MEDICAL DIRECTOR QUALIFICATIONS.
- Tex. Government Code § 540.0501 · RECIPIENT ENROLLMENT IN AND DISENROLLMENT FROM MEDICAID MANAGED CARE PLAN.
- Tex. Government Code § 540.0502 · AUTOMATIC ENROLLMENT IN MEDICAID MANAGED CARE PLAN.
- Tex. Government Code § 540.0503 · ENROLLMENT OF CERTAIN RECIPIENTS IN SAME MEDICAID MANAGED CARE PLAN.
- Tex. Government Code § 540.0504 · QUALITY-BASED ENROLLMENT INCENTIVE PROGRAM FOR MEDICAID MANAGED CARE ORGANIZATIONS.
- Tex. Government Code § 540.0505 · LIMITATIONS ON RECIPIENT DISENROLLMENT FROM MEDICAID MANAGED CARE PLAN.
- Tex. Government Code § 540.0551 · GUIDANCE REGARDING CONTINUATION OF SERVICES UNDER CERTAIN CIRCUMSTANCES.
- Tex. Government Code § 540.0552 · COORDINATION OF BENEFITS; CONTINUITY OF SPECIALTY CARE FOR CERTAIN RECIPIENTS.
- Tex. Government Code § 540.0601 · MONITORING OF PROVIDER NETWORKS.
- Tex. Government Code § 540.0602 · REPORT ON OUT-OF-NETWORK PROVIDER SERVICES.
- Tex. Government Code § 540.0603 · REPORT ON COMMISSION INVESTIGATION OF PROVIDER COMPLAINT.
- Tex. Government Code § 540.0604 · ADDITIONAL REIMBURSEMENT FOLLOWING PROVIDER COMPLAINT.
- Tex. Government Code § 540.0605 · CORRECTIVE ACTION PLAN FOR INADEQUATE NETWORK AND PROVIDER REIMBURSEMENT.
- Tex. Government Code § 540.0606 · REMEDIES FOR NONCOMPLIANCE WITH CORRECTIVE ACTION PLAN.
- Tex. Government Code § 540.0651 · INCLUSION OF CERTAIN PROVIDERS IN MEDICAID MANAGED CARE ORGANIZATION PROVIDER NETWORK.