SECTION 354.1452. Provider Marketing

(a) Prohibited marketing activities. A provider participating in the Medicaid or child health plan program, including a provider participating in the network of a managed care organization that contracts with the Health and Human Services Commission to provide services under the Medicaid or child health plan program, may not engage in any marketing activity, including any dissemination of material or other attempt to communicate, that:

(1) Involves unsolicited personal contact, including by door-to-door solicitation, solicitation at a child care facility or other type of facility, direct mail, or telephone, with a Medicaid client or a parent whose child is enrolled in the Medicaid or child health plan program;

(2) Is directed at the client or parent solely because the client or the parent's child is receiving benefits under the Medicaid or child health plan program; and

(3) Is intended to influence the client's or parent's choice of provider.

(b) Permissible marketing activities by providers participating in Medicaid or child health plan programs. Nothing in this rule prohibits a provider participating in the Medicaid or child health plan program from:

(1) Engaging in a marketing activity, including any dissemination of material or other attempt to communicate, that is intended to influence the choice of provider by a Medicaid client or a parent whose child is enrolled in the Medicaid program, if the marketing activity:

(A) Is conducted at a community-sponsored educational event, health fair, outreach activity, or other similar community or nonprofit event in which the provider participates and does not involve unsolicited personal contact or promotion of the provider's practice that is not used as part of health education; or

(B) Involves only the general dissemination of information, including by television, radio, newspaper, or billboard advertisement, and does not involve unsolicited personal contact;

(2) As permitted under the provider's contract, engaging in the dissemination of material or another attempt to communicate with a Medicaid client or a parent whose child is enrolled in the Medicaid program or child health plan program, including communication in person or by direct mail or telephone, for the purpose of:

(A) Providing an appointment reminder;

(B) Distributing promotional health materials;

(C) Providing information about the types of services offered by the provider; or

(D) Coordinating patient care; or

(3) Engaging in a marketing activity that has been submitted for review and obtained a notice of prior authorization from the Health and Human Services Commission under subsection (c) of this section.

(c) Review and prior authorization. At the provider's option, a provider participating in the Medicaid program may submit proposed marketing materials to the Health and Human Services Commission for review and prior authorization to ensure that the materials are in compliance with this rule. The Commission may grant or deny a provider's request for prior authorization.

Source Note: The provisions of this §354.1452 adopted to be effective July 6, 2014, 39 TexReg 4952