Texas Health and Safety Code 62.052 – Authority of Commission Relating to Health Plan Provider Contracts
The commission may:
(1) implement contracts with health plan providers under § 62.155;
(2) monitor the health plan providers, through reporting requirements and other means, to ensure performance under the contracts and quality delivery of services;
(3) monitor the quality of services delivered to enrollees through outcome measurements including:
(A) rate of hospitalization for ambulatory sensitive conditions, including asthma, diabetes, epilepsy, dehydration, gastroenteritis, pneumonia, and UTI/kidney infection;
(B) rate of hospitalization for injuries;
(C) percent of enrolled adolescents reporting risky health behavior such as injuries, tobacco use, alcohol/drug use, dietary behavior, physical activity, or other health related behaviors; and
(D) percent of adolescents reporting attempted suicide; and
(4) provide payment under the contracts to the health plan providers.