SECTION 87.203. Creation of the Program and Populations Served

(a) 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, in accordance with Texas Government Code §531.0213.

(b) As a part of the support and information services, OMCAT is responsible for operating a statewide toll-free assistance telephone number and for intervening promptly with HHSC Medicaid program staff, MCOs, health care providers, and any other appropriate entity on behalf of a person who has an urgent need for medical services.

(c) 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; and are able to advocate for themselves.

(d) In accordance with Texas Government Code §531.0213(e), OMCAT is sufficiently independent from other aspects of Medicaid managed care to represent the best interests of consumers in complaint resolution.

Source Note: The provisions of this §87.203 adopted to be effective January 10, 2019, 44 TexReg 252