Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 87 - OMBUDSMAN SERVICES
Subchapter D - OMBUDSMAN FOR MANAGED CARE ASSISTANCE
Section 87.51 - Creation of the Program and Populations Served

(a) OMCAT is established by Texas Government Code § 531.9912 in accordance with Texas Government Code § 531.9932.

(b) OMCAT is responsible for assisting persons who are experiencing barriers in the Medicaid application and enrollment process and educating them so that they understand the concept of managed care; understand their rights under Medicaid, including grievance and appeal procedures; MCOs, health care providers, and any other appropriate entity on and can advocate for themselves. OMCAT intervenes promptly with HHSC Medicaid program staff, behalf of a person who has an urgent need for medical services.

(c) As a part of the support and information services, OMCAT is responsible for operating a statewide toll-free assistance telephone number.

(d) In accordance with Texas Government Code § 531.9932(e), OMCAT is sufficiently independent from other aspects of Medicaid managed care to represent the best interests of consumers in complaint resolution.

(e) OMCAT coordinates a network of entities to provide support and information services to persons enrolled in or applying for Medicaid who experience barriers to receiving health care services.