Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter B - PROVIDER AND MEMBER EDUCATION PROGRAMS
Section 353.104 - Member Education Program
Current through Reg. 49, No. 38; September 20, 2024
A member education program must present information in a manner that is easy to understand. In addition to any requirements specified in the contract between the managed care organization (MCO) and the Health and Human Services Commission, a program must include, at minimum, information on:
(1) a member's rights and responsibilities under the Bill of Rights and the Bill of Responsibilities prescribed in Subchapter C of this chapter (relating to Member Bill of Rights and Responsibilities);
(2) how to access dental services or health care services;
(3) how to access complaint and appeal procedures, the member's right to request a fair hearing, and the process for requesting a fair hearing;
(4) Medicaid policies, procedures, eligibility standards, and benefits;
(5) the policies and procedures of the MCO; and
(6) the importance of prevention, early intervention, and appropriate use of services.
