: Texas Administrative Code

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
RULE §353.104	Member Education Program

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.

Source Note: The provisions of this §353.104 adopted to be effective February 28, 1997, 22 TexReg 1799; amended to be effective August 10, 2005, 30 TexReg 4466; amended to be effective March 1, 2012, 37 TexReg 1283

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