A contract to which this subchapter applies must require the contracting Medicaid managed care organization to:
(1) develop and submit to the commission, before the organization begins providing health care services to recipients, a comprehensive plan that describes how the organization’s provider network complies with the provider access standards the commission establishes under § 540.0652;
(2) as a condition of contract retention and renewal:
(A) continue to comply with the provider access standards; and
(B) make substantial efforts, as the commission determines, to mitigate or remedy any noncompliance with the provider access standards;
(3) pay liquidated damages for each failure, as the commission determines, to comply with the provider access standards in amounts that are reasonably related to the noncompliance; and
(4) regularly, as the commission determines, submit to the commission and make available to the public a report containing:
(A) data on the organization’s provider network sufficiency with regard to providing the care and services described by § 540.0652(a); and
(B) specific data with respect to access to primary care, specialty care, long-term services and supports, nursing services, and therapy services on the average length of time between:
(i) the date a provider requests prior authorization for the care or service and the date the organization approves or denies the request; and
(ii) the date the organization approves a request for prior authorization for the care or service and the date the care or service is initiated.

Text of section effective on April 01, 2025