Rules and Statutes Handbook

Last Updated

R-1. About

The outpatient drug benefit managed by the Texas Health and Human Services Commission (HHSC) is subject to federal and state rules, statutes, and regulations. This handbook collects those resources in one volume.

Subchapter F: Pharmacy Services

Division 1: Participation

Division 2: Administration

Division 3: Medications

Division 4: Limitations

Division 5: Audits

Division 6: Pharmacy Claims

Division 7: Texas Drug Code Index--Additions, Retentions, And Deletions

Division 8: Drug Utilization Review Board

Subchapter J: Purchased Health Services

Division 5: General Administration

  • Section 355.8085: Reimbursement Methodology For Physicians And Other Practitioners

Division 28: Pharmacy Services: Reimbursement

Chapter 531: Health and Human Services Commission

Subchapter A - General Provisions; Organization of Commission

Title 2. Human Services And Protective Services In General

C. Assistance Programs

Chapter 32.  Medical Assistance Program

Subchapter B. Administrative Provisions

  • Section 32.024: Authority and Scope of Program; Eligibility (z,bb,ii)
  • Section 32.046: Sanctions and Penalties related to the Provision of Pharmacy Products. (a, b)
  • Section 32.0461: Vendor Drug Program; Competitive Bidding (A)
  • Section 32.0462: Vendor Drug Program; Pricing Standard (1,2,b) 

Chapter 36. Medicaid Fraud Prevention

Subchapter B. Action By Attorney General

Title 8. Health Insurance and Other Health Coverages

Subtitle A. Health Coverage in General

Chapter 1217. Standard Request Form for Prior Authorization of Health Services

Subtitle E. Benefits Payable Under Health Coverages

Chapter 1369. Benefits Related to Prescription Drugs and Devices and Related Services

Subchapter G. Standard Request Form for Prior Authorization of Prescription Drug Benefit

Subchapter J. Coverage Related to Prescription Drug Synchronization

Texas Penal Code

Title 8. Offenses Against Public Administration

Chapter 37. Perjury And Other Falsification

Part 447 - Payments for Services

Subpart I (Payment for Drugs)

Part 456 - Utilization Control

Subpart K (Drug Use Review Program and Electronic Claims Management System for Outpatient Drug Claims)

R-3. Revision History

Status Date Description
Revision Aug. 1, 2023 Updated Texas Health and Human Services Commission TAC citations
Revision March 1, 2023 Updated Texas State Board of Pharmacy TAC citations
Revision Feb. 1, 2023

Updated Texas Human Resources Code citations; added Texas Penal Code citations

Revision Dec. 1, 2022 Added links to HHSC Texas Administrative Code regarding the Children with Special Health Care Needs Services Program, Women's Health Services, and the Kidney Health Care program.
Revision Nov. 1, 2022 Added Texas Human Resources Code and Social Security Act citations
Revision Aug. 1, 2022 Added Texas Occupations Code citations
Revision July 25, 2022 Added Texas Insurance Code citations
Baseline July 15, 2022 Initial publication, incorporating the content on the static Texas Administrative Code, Texas Government Code, and U.S. Code of Federal Regulations pages on the VDP website.