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Input on Proposed Medicaid, CHIP Formulary, PDL, and Prior Authorization Management Transition Policy Due December 4, 2022

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The Texas Health and Human Services Commission (HHSC) seeks public input on the draft contract requirements for the transition of the statutory requirements of Section 533.005 of the Texas Government Code. Stakeholders may submit comments via survey no later than 5:00 p.m. (Central Time) on December 4, 2022. HHSC may propose additional contract requirements based on further guidance or information from the Centers for Medicare & Medicaid Services (CMS) or the Texas Department of Insurance (TDI). The statute requires Texas Medicaid and Children’s Health Insurance Program (CHIP) managed care organizations (MCOs) to exclusively use the Vendor Drug Program’s (VDP’s) formulary, preferred drug list (PDL), and prior authorization requirements found in Section 531.073 (b), (c), and (g). This statute and the requirement expire on August 31, 2023. Under current law, these statutory requirements will no longer apply, and management of these functions will transfer to each MCO, on September 1, 2023. 

In preparation for the transition, HHSC is working with CMS to obtain guidance regarding formulary, PDL, and prior authorization requirements to comply with federal provisions for amount, duration, and scope as required by 42 C.F.R. §438.210(a)(2). Additionally, HHSC will collaborate with TDI on CHIP requirements.

Contact vdp-operations@hhsc.state.tx.us with comments or any questions.