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Texas Statutes (Last Updated: January 4, 2014) |
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GOVERNMENT CODE |
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Title 4. EXECUTIVE BRANCH |
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Subtitle I. HEALTH AND HUMAN SERVICES |
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Chapter 531. HEALTH AND HUMAN SERVICES COMMISSION |
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Subchapter B. POWERS AND DUTIES |
Sec. 531.0213. SUPPORT SERVICES FOR MEDICAID RECIPIENTS
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(a) The commission shall provide support and information services to a person enrolled in or applying for Medicaid coverage who experiences barriers to receiving health care services.
(b) The commission shall give emphasis to assisting a person with an urgent or immediate medical or support need.
(c) The commission may provide support and information services by contracting with a nonprofit organization that is not involved in providing health care, health insurance, or health benefits.
(d) As a part of the support and information services required by this section, the commission or nonprofit organization shall:
(1) operate a statewide toll-free assistance telephone number that includes TDD lines and assistance for persons who speak Spanish;
(2) intervene promptly with the state Medicaid office, managed care organizations and providers, the Texas Department of Health, and any other appropriate entity on behalf of a person who has an urgent need for medical services;
(3) assist a person who is experiencing barriers in the Medicaid application and enrollment process and refer the person for further assistance if appropriate;
(4) educate persons so that they:
(A) understand the concept of managed care;
(B) understand their rights under the Medicaid program, including grievance and appeal procedures; and
(C) are able to advocate for themselves;
(5) collect and maintain statistical information on a regional basis regarding calls received by the assistance lines and publish quarterly reports that:
(A) list the number of calls received by region;
(B) identify trends in delivery and access problems;
(C) identify recurring barriers in the Medicaid system; and
(D) indicate other problems identified with Medicaid managed care; and
(6) assist the state Medicaid office, managed care organizations and providers, and the Texas Department of Health in identifying and correcting problems, including site visits to affected regions if necessary.