Texas Administrative Code

Texas Administrative Code

TITLE 1	ADMINISTRATION
PART 15	TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 353	MEDICAID MANAGED CARE
SUBCHAPTER A	GENERAL PROVISIONS
RULE §353.1	Purpose

(a) The purpose of this chapter is to define the requirements for the Medicaid Managed Care program.

(b) The rules in this chapter must be read in conjunction with:

(1) federal and state statutes;

(2) rules relating to Medicaid in Chapter 354 of this title (relating to Medicaid Health Services); and

(3) except where otherwise indicated, Texas Department of Insurance rules regarding:

(A) regulation of health maintenance organizations at 28 TAC Chapter 11; and

(B) exclusive provider benefit plans at 28 TAC Chapter 3, Subchapter KK.

(c) A managed care organization (MCO) must comply with all terms of its contract with the Health and Human Services Commission (HHSC).

(d) Unless otherwise provided in this chapter or incorporated by reference into an agreement with an MCO, HHSC's rules regarding Medicaid Health Services in Chapter 354 of this title do not apply to the Medicaid managed care program.

Source Note: The provisions of this §353.1 adopted to be effective February 28, 1997, 22 TexReg 1799; amended to be effective August 10, 2005, 30 TexReg 4466; amended to be effective March 1, 2012, 37 TexReg 1283