In addition to the requirements of Subchapter F, Chapter 540, a contract between a managed care organization and the commission for the organization to provide Medicaid benefits under § 542.0201 must contain a requirement that the organization implement a process for individuals with an intellectual or developmental disability that:
(1) ensures that the individuals have a choice among acute care and comprehensive long-term services and supports providers and service delivery options, including the consumer direction model;
(2) to the greatest extent possible, protects those individuals’ continuity of care with respect to access to primary care providers, including through the use of single-case agreements with out-of-network providers; and
(3) provides access to a member services telephone line for individuals or their legally authorized representatives to obtain information on and assistance with accessing services through network providers, including providers of primary and specialty services and other long-term services and supports.

Text of section effective on April 01, 2025