(a) The commission shall establish minimum provider access standards for a Medicaid managed care organization’s provider network. The provider access standards must ensure that a Medicaid managed care organization provides recipients sufficient access to:
(1) preventive care;
(2) primary care;
(3) specialty care;
(4) after-hours urgent care;
(5) chronic care;
(6) long-term services and supports;
(7) nursing services;
(8) therapy services, including services provided in a clinical setting or in a home or community-based setting; and
(9) any other services the commission identifies.
(b) To the extent feasible, the provider access standards must:
(1) distinguish between access to providers in urban and rural settings;
(2) consider the number and geographic distribution of Medicaid-enrolled providers in a particular service delivery area; and
(3) subject to § 548.0054(a) and consistent with § 111.007, Occupations Code, consider and include the availability of telehealth services and telemedicine medical services in a Medicaid managed care organization’s provider network.
(c) The commission shall biennially submit to the legislature and make available to the public a report that contains:
(1) information and statistics on:
(A) recipient access to providers through Medicaid managed care organizations’ provider networks; and
(B) Medicaid managed care organization compliance with contractual obligations related to provider access standards;
(2) a compilation and analysis of information Medicaid managed care organizations submit to the commission under § 540.0260(4);
(3) for both primary care providers and specialty providers, information on provider-to-recipient ratios in a Medicaid managed care organization’s provider network and benchmark ratios to indicate whether deficiencies exist in a given network; and
(4) a description of, and analysis of the results from, the commission’s monitoring process established under § 540.0601.

Text of section effective on April 01, 2025