COMPLIANCE WITH PROVIDER ACCESS STANDARDS; REPORT

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 Section 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 Section 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.