Sec. 533.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services Commission or an agency operating part of the state Medicaid managed care program, as appropriate.
(2) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.
(3) "Health and human services agencies" has the meaning assigned by Section 531.001.
(4) "Managed care organization" means a person who is authorized or otherwise permitted by law to arrange for or provide a managed care plan.
(5) "Managed care plan" means a plan under which a person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services. A part of the plan must consist of arranging for or providing health care services as distinguished from indemnification against the cost of those services on a prepaid basis through insurance or otherwise. The term includes a primary care case management provider network. The term does not include a plan that indemnifies a person for the cost of health care services through insurance.
(6) "Recipient" means a recipient of Medicaid.
(7) "Health care service region" or "region" means a Medicaid managed care service area as delineated by the commission.
Added by Acts 1997, 75th Leg., ch. 1262, Sec. 2, eff. June 20, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.209, eff. April 2, 2015.
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