CHAPTER 353. MEDICAID MANAGED CARE  


SUBCHAPTER A. GENERAL PROVISIONS
§ 353.1. Purpose
§ 353.2. Definitions
§ 353.3. Experience Rebate in the Managed Care Program
§ 353.4. Managed Care Organization Requirements Concerning Out-of-Network Providers
§ 353.5. Internet Posting of Sanctions Imposed For Contractual Violations
§ 353.6. Audit of Managed Care Organizations
SUBCHAPTER B. PROVIDER AND MEMBER EDUCATION PROGRAMS
§ 353.101. Purpose
§ 353.102. Provider and Member Education Programs Generally
§ 353.104. Member Education Program
§ 353.105. Provider Education Program
SUBCHAPTER C. MEMBER BILL OF RIGHTS AND RESPONSIBILITIES
§ 353.201. Purpose
§ 353.202. Member Bill of Rights
§ 353.203. Member Bill of Responsibilities
SUBCHAPTER E. STANDARDS FOR MEDICAID MANAGED CARE
§ 353.403. Enrollment and Disenrollment
§ 353.405. Marketing
§ 353.407. Requirements of Managed Care Plans
§ 353.409. Scope of Services
§ 353.411. Accessibility of Services
§ 353.413. Managed Care Benefits and Services for Children Under 21 Years of Age
§ 353.415. Member Complaint and Appeal Procedures
§ 353.417. Quality Assessment and Performance Improvement
§ 353.419. Financial Standards
§ 353.421. Special Disease Management for Health Care MCOs
§ 353.423. Expedited Credentialing
SUBCHAPTER F. SPECIAL INVESTIGATIVE UNITS
§ 353.501. Purpose
§ 353.502. Managed Care Organization's Plans and Responsibilities in Preventing and Reducing Waste, Abuse, and Fraud
§ 353.503. Managed Care Organization's Contracts
§ 353.504. Review of Managed Care Organization's Records
§ 353.505. Recovery of Funds
SUBCHAPTER G. STAR+PLUS
§ 353.601. General Provisions
§ 353.603. Member Participation
§ 353.605. Participating Providers
§ 353.607. STAR+PLUS Handbook
§ 353.608. Minimum Payment Amounts to Qualified Nursing Facilities
§ 353.609. Service Coordination
SUBCHAPTER H. STAR HEALTH
§ 353.701. General Provisions
§ 353.702. Member Participation
SUBCHAPTER I. STAR
§ 353.801. General Provisions
§ 353.802. Member Participation
SUBCHAPTER J. OUTPATIENT PHARMACY SERVICES
§ 353.901. Purpose
§ 353.903. Definitions
§ 353.905. Managed Care Organization Requirements
§ 353.907. Prior Authorization Requirements
§ 353.909. Participating Pharmacy Providers
§ 353.911. Members
§ 353.913. Managed Care Organization Requirements Concerning Out-of-Network Outpatient Pharmacy Services
§ 353.915. Access to Network Pharmacies
SUBCHAPTER K. CHILDREN'S MEDICAID DENTAL SERVICES
§ 353.1001. General Provisions
§ 353.1003. Member Participation
SUBCHAPTER L. TEXAS DUAL ELIGIBLES INTEGRATED CARE DEMONSTRATION PROJECT
§ 353.1101. Purpose
§ 353.1103. General Provisions
§ 353.1105. Eligibility
§ 353.1107. Member Enrollment and Disenrollment
§ 353.1109. Participating Providers
§ 353.1111. Benefits
§ 353.1113. Appeals and Fair Hearings
§ 353.1115. Network Adequacy for Certain Service Providers
SUBCHAPTER M. HOME AND COMMUNITY BASED SERVICES IN MANAGED CARE
§ 353.1151. General Provisions
§ 353.1153. STAR+PLUS Home and Community Based Services (HCBS) Program
§ 353.1155. Medically Dependent Children Program
SUBCHAPTER N. STAR KIDS
§ 353.1201. General Provisions
§ 353.1203. Member Participation
§ 353.1205. Service Coordination
§ 353.1207. Participating Providers
§ 353.1209. STAR Kids Handbook
SUBCHAPTER O. DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
§ 353.1301. General Provisions
§ 353.1302. Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019
§ 353.1303. Quality Incentive Payment Program for Nursing Facilities before September 1, 2019
§ 353.1304. Quality Metrics for the Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019
§ 353.1305. Uniform Hospital Rate Increase Program
SUBCHAPTER P. MENTAL HEALTH TARGETED CASE MANAGEMENT AND MENTAL HEALTH REHABILITATION
§ 353.1401. Purpose
§ 353.1403. Definitions
§ 353.1405. Managed Care Organization Responsibilities
§ 353.1407. Information Systems and Medical Records Systems
§ 353.1409. Patient Safety, Rights, and Protections
§ 353.1411. Access to Mental Health Services
§ 353.1413. Staff Member Competency
§ 353.1415. Staff Member Credentialing
§ 353.1417. Comprehensive Provider Agency Requirements for Staff Member Credentialing and Appeals
§ 353.1419. Supervision Requirements