LONG-TERM CARE MEDICAID WAIVER PROGRAMS: UTILIZATION REVIEW

(a)In this section, "Section 1915(c) waiver program" has…#

(a) In this section, "Section 1915(c) waiver program" has the meaning assigned by Section 521.0001 , Government Code.

(b)The department shall perform a utilization review of…#

(b) The department shall perform a utilization review of services in all Section 1915(c) waiver programs. The utilization review must include, at a minimum, reviewing program recipients' levels of care and any plans of care for those recipients that exceed service level thresholds established in the applicable waiver program guidelines. Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7 ), Sec. 1.06(b), eff. September 28, 2011. Amended by: Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 2.112, eff. April 1, 2025.

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LONG-TERM CARE MEDICAID WAIVER PROGRAMS: UTILIZATION REVIEW

Official source

(a)In this section, "Section 1915(c) waiver program" has…#

(a) In this section, "Section 1915(c) waiver program" has the meaning assigned by Section 521.0001 , Government Code.

(b)The department shall perform a utilization review of…#

(b) The department shall perform a utilization review of services in all Section 1915(c) waiver programs. The utilization review must include, at a minimum, reviewing program recipients' levels of care and any plans of care for those recipients that exceed service level thresholds established in the applicable waiver program guidelines. Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7 ), Sec. 1.06(b), eff. September 28, 2011. Amended by: Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 2.112, eff. April 1, 2025.