Sec. 531.0211. MANAGED CARE MEDICAID PROGRAM: RULES; EDUCATION PROGRAMS. (a) In adopting rules to implement a managed care Medicaid program, the executive commissioner shall establish guidelines for, and require managed care organizations to provide, education programs for providers and clients using a variety of techniques and mediums.
(b) A provider education program must include information on:
(1) Medicaid policies, procedures, eligibility standards, and benefits;
(2) the specific problems and needs of Medicaid clients; and
(3) the rights and responsibilities of Medicaid clients under the bill of rights and the bill of responsibilities prescribed by Section 531.0212.
(c) A client education program must present information in a manner that is easy to understand. A program must include information on:
(1) a client's rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 531.0212;
(2) how to access health care services;
(3) how to access complaint procedures and the client's right to bypass the managed care organization's internal complaint system and use the notice and appeal procedures otherwise required by Medicaid;
(4) Medicaid policies, procedures, eligibility standards, and benefits;
(5) the policies and procedures of the managed care organization; and
(6) the importance of prevention, early intervention, and appropriate use of services.
Added by Acts 1997, 75th Leg., ch. 165, Sec. 14.03(a), eff. Sept. 1, 1997.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 2.020, eff. April 2, 2015.
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