SECTION 353.413. Managed Care Benefits and Services for Children Under 21 Years of Age

(a) A managed care organization (MCO) must provide comprehensive, timely, and cost-effective diagnostic, screening, and treatment services for the medical, vision, hearing, and dental needs of Medicaid managed care program members under the age of 21, at a level and frequency that meet the requirements of the federal EPSDT program, as determined by the Health and Human Services Commission (HHSC). These requirements will be contained in all contracts, as applicable to each managed care program.

(b) An MCO must make available special training about Texas Health Steps (THSteps) benefits and goals to all providers of health and dental services contracting with the MCO to providers' staffs, and to all employees and contractors of the MCO who will provide oral presentations or marketing to members or prospective members. To fulfill this requirement, the MCO may use the training programs created by HHSC or its contractors, or the MCO may create its own training programs. Any training program created by the MCO under this subsection must meet the requirements of and be approved by HHSC.

(c) An MCO must coordinate and cooperate with HHSC in developing effective outreach, access, and monitoring systems to ensure that all qualified members receive THSteps benefits.

(d) The managed care programs of participating MCOs are intended to complement and enhance the effectiveness and availability of THSteps benefits in the service areas. HHSC will not delegate the responsibility and accountability for monitoring and ensuring that THSteps benefits are available and accessible to all eligible children.

Source Note: The provisions of this §353.413 adopted to be effective December 18, 1996, 21 TexReg 11822; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective August 10, 2005, 30 TexReg 4466; amended to be effective September 1, 2006, 31 TexReg 6629; amended to be effective March 1, 2012, 37 TexReg 1283