The executive commissioner must describe and notify others about the process for setting medical assistance payment rates, and the commission must include public-data procedures in the Medicaid plan.
Sec. 32.0281. RULES AND NOTICE RELATING TO PAYMENT RATES. (a) The executive commissioner shall by rule describe the process used to determine payment rates for medical assistance and shall notify providers, consumers, the Legislative Budget Board, and the Governor's Office of Budget, Planning, and Policy of that process. (b) The executive commissioner shall adopt rules relating to payment rates that include: (1) a description of the process used to determine payment rates; (2) a description of each cost of living index used in calculating inflation rates and the procedure for determining the level of inflation used in the executive commissioner's calculations; (3) the criteria for desk audits; (4) the procedure for notifying providers of exclusions and adjustments to reported expenses, if notification is requested; and (5) a method of adjusting rates if new legislation, regulations, or economic factors affect costs. (c) The commission shall include in the Title XIX State Medicaid Plan submitted to the federal government for approval the procedures for making available to the public the data and methodology used in establishing payment rates. (d) The procedures for adopting rules under this section shall be governed by Chapter 2001, Government Code. (e) An interested party may appeal an action taken by the commission under this section, and an appeal of such action shall be governed by the procedures for a contested case hearing under Chapter 2001, Government Code. The filing of an appeal under this section shall not stay the implementation of payment rates adopted by the executive commissioner in accordance with commission rules. Added by Acts 1989, 71st Leg., ch. 1085, Sec. 2, eff. Sept. 1, 1989. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(49), eff. Sept. 1, 1995. Amended by: Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 4.097, eff. April 2, 2015.