Sec. 533.0063. PROVIDER NETWORK DIRECTORIES. (a) The commission shall ensure that a managed care organization that contracts with the commission to provide health care services to recipients:
(1) posts on the organization's Internet website:
(A) the organization's provider network directory; and
(B) a direct telephone number and e-mail address through which a recipient enrolled in the organization's managed care plan or the recipient's provider may contact the organization to receive assistance with:
(i) identifying in-network providers and services available to the recipient; and
(ii) scheduling an appointment for the recipient with an available in-network provider or to access available in-network services; and
(2) updates the online directory required under Subdivision (1)(A) at least monthly.
(b) Except as provided by Subsection (c), a managed care organization is required to send a paper form of the organization's provider network directory for the program only to a recipient who requests to receive the directory in paper form.
(c) A managed care organization participating in the STAR + PLUS Medicaid managed care program or STAR Kids Medicaid managed care program established under Section 533.00253 shall, for a recipient in that program, issue a provider network directory for the program in paper form unless the recipient opts out of receiving the directory in paper form.
Added by Acts 2015, 84th Leg., R.S., Ch. 1272 (S.B. 760), Sec. 5, eff. September 1, 2015.
Section: Previous 533.0052 533.0053 533.0055 533.006 533.0061 533.0062 533.0063 533.0064 533.0066 533.007 533.0071 533.0072 533.0073 533.0075 NextLast modified: September 28, 2016