Government Code § 540.0054

Sec. 540.0054. PROVIDER AND RECIPIENT EDUCATION PROGRAMS. (a) In adopting rules to implement a Medicaid managed care program, the executive commissioner shall establish guidelines for, and require Medicaid managed care organizations to provide, education programs for providers and recipients using a variety of techniques and media. (b) A provider education program must include information on: (1) Medicaid policies, procedures, eligibility standards, and benefits; (2) recipients' specific problems and needs; and (3) recipients' rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 532.0301. (c) A recipient education program must present information in a manner that is easy to understand. A program must include information on: (1) a recipient's rights and responsibilities under the bill of rights and the bill of responsibilities prescribed by Section 532.0301; (2) how to access health care services; (3) how to access complaint procedures and the recipient's right to bypass the Medicaid managed care organization's internal complaint system and use the notice and appeal procedures otherwise required by Medicaid; (4) Medicaid policies, procedures, eligibility standards, and benefits; (5) the Medicaid managed care organization's policies and procedures; and (6) the importance of prevention, early intervention, and appropriate use of services. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.