Government Code § 532.0053

Sec. 532.0053. GRIEVANCES. (a) The commission shall: (1) adopt a definition of "grievance" related to Medicaid and ensure the definition is consistent among divisions within the commission to ensure all grievances are managed consistently; (2) standardize Medicaid grievance data reporting and tracking among divisions within the commission; (3) implement a no-wrong-door system for Medicaid grievances reported to the commission; and (4) verify grievance data a Medicaid managed care organization reports. (b) The commission shall establish a procedure for expedited resolution of a grievance related to Medicaid that allows the commission to: (1) identify a grievance related to a Medicaid access-to-care issue that is urgent and requires an expedited resolution; and (2) resolve the grievance within a specified period. (c) The commission shall: (1) aggregate recipient and Medicaid provider grievance data to provide a comprehensive data set of grievances; and (2) make the aggregated data available to the legislature and the public in a manner that does not allow for the identification of a particular recipient or provider. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.