(a) This section applies only to a recipient receiving benefits through a Medicaid managed care model or arrangement.
(b) The commission shall ensure that a federally qualified health center, rural health clinic, or municipal health department’s public clinic is reimbursed for health care services provided to a recipient outside of regular business hours, including on a weekend or holiday, at a rate that is equal to the allowable rate for those services as determined under § 32.028, Human Resources Code, regardless of whether the recipient has a referral from the recipient’s primary care provider.

(c) The executive commissioner shall adopt rules regarding the days, times of days, and holidays that are considered to be outside of regular business hours for purposes of Subsection (b).

Text of section effective on April 01, 2025