{"data":{"id":"us-tx/tex.-government-code-540.0701","jurisdiction":"us-tx","citation":"Tex. Government Code § 540.0701","heading":"ACUTE CARE SERVICE DELIVERY THROUGH MOST COST-EFFECTIVE MODEL; MANAGED CARE SERVICE DELIVERY AREAS.","body":"(a) Except as otherwise provided by this section and notwithstanding any other law, the commission shall provide Medicaid acute care services through the most cost-effective model of Medicaid capitated managed care as the commission determines. The commission shall require mandatory participation in a Medicaid capitated managed care program for all individuals eligible for Medicaid acute care benefits, but may implement alternative models or arrangements, including a traditional fee-for-service arrangement, if the commission determines the alternative would be more cost-effective or efficient.\n(b) In determining whether a model or arrangement described by Subsection (a) is more cost-effective, the executive commissioner must consider:\n(1) the scope, duration, and types of health benefits or services to be provided in a certain part of this state or to a certain recipient population;\n(2) administrative costs necessary to meet federal and state statutory and regulatory requirements;\n(3) the anticipated effect of market competition associated with the configuration of Medicaid service delivery models the commission determines; and\n(4) the gain or loss to this state of a tax collected under Chapter 222, Insurance Code.\n(c) If the commission determines that it is not more cost-effective to use a Medicaid managed care model to provide certain types of Medicaid acute care in a certain area or to certain recipients as prescribed by this section, the commission shall provide Medicaid acute care through a traditional fee-for-service arrangement.\n(d) The commission shall determine the most cost-effective alignment of managed care service delivery areas. The executive commissioner may consider:\n(1) the number of lives impacted;\n(2) the usual source of health care services for residents in an area; and\n(3) other factors that impact health care service delivery in the area.\nAdded by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.","path":["GOVERNMENT CODE","TITLE 4. EXECUTIVE BRANCH","SUBTITLE I. HEALTH AND HUMAN SERVICES","CHAPTER 540. MEDICAID MANAGED CARE PROGRAM","SUBCHAPTER O. DELIVERY OF SERVICES: GENERAL PROVISIONS"],"source_url":"https://statutes.capitol.texas.gov/Docs/GV/htm/GV.540.htm#540.0701","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:16Z","sha256":"f556e95f976a895e14e5dedcb2e95b2114da9a567449d6f96dc27099b0ef0150","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-government-code-540.0659","next":"us-tx/tex.-government-code-540.0702"},"notice":"GroundRules: Original legal text. Not legal advice."}