AI-assisted research summary: The commission must set what information to collect, require quarterly reports from participating managed care organizations, establish reporting/tracking mechanisms before the pilot starts, and analyze pilot information for future recommendations.
Sec. 542.0117. PILOT PROGRAM INFORMATION COLLECTION AND ANALYSIS. (a) The commission, in collaboration with the advisory committee and pilot program work group, shall determine the information to collect from a managed care organization participating in the pilot program for use in conducting the evaluation and preparing the report under Section 542.0119. (b) For the duration of the pilot program, a managed care organization participating in the pilot program shall submit to the commission and the advisory committee quarterly reports on the services provided to each pilot program participant. The reports must include information on: (1) the level of each requested service and the authorization and utilization rates for those services; (2) timelines of: (A) the authorization of each requested service; (B) the initiation of each requested service; (C) the delivery of each requested service; and (D) each unplanned break in the delivery of requested services and the duration of the break; (3) the number of pilot program participants using employment assistance and supported employment services; (4) the number of service denials and fair hearings and the dispositions of the fair hearings; (5) the number of complaints and inquiries the managed care organization received and the outcome of each complaint; and (6) the number of pilot program participants who choose the consumer direction model and the reasons other participants did not choose the consumer direction model. (c) The commission shall ensure that the mechanisms to report and track the information and data required by Subsections (a) and (b) are established before implementing the pilot program. (d) For purposes of making a recommendation about a system of programs and services for implementation through future state legislation or rules, the commission, in collaboration with the advisory committee and pilot program work group, shall analyze: (1) information provided by managed care organizations participating in the pilot program; and (2) any information the commission collects during the operation of the pilot program. (e) The analysis under Subsection (d) must include an assessment of the effect of the managed care strategies implemented in the pilot program on the goals described by Sections 542.0102(b) and (c), 542.0103, 542.0110(a), 542.0113, and 542.0116(c). Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.