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December 2016 Texas Medicaid Provider Procedures Manual

Medicaid Managed Care Handbook : 2 Overview of Medicaid Managed Care : 2.3 General Information About Client Enrollment in Managed Care : 2.3.3 Client Rights

2.3.3
In Texas, Medicaid managed care clients have defined rights and responsibilities. Each health plan and PCP share the responsibility to ensure and protect client rights and to assist clients in understanding and fulfilling their responsibilities as plan clients.
Medicaid managed care clients have the right to:
A reasonable opportunity to choose a health-care plan and PCP (the doctor or health-care provider they will see most of the time and who will coordinate their care) and to change to another plan or provider in a reasonably easy manner. These opportunities include the right to:
Know that doctors, hospitals, and others who provider care can advise clients about their health status, medical care, and treatment. The health plan cannot prevent them from giving clients this information, even if the care or treatment is not a covered service.”
Know that clients are not responsible for paying for covered services. Doctors, hospitals, and others cannot require clients to pay copayments or any other amounts for covered services.
Utilize each available complaint and appeal process through the MCO and through Medicaid, receive a timely response to complaints, appeals, and fair hearings. These processes include the right to:
Have telephone access to a medical professional 24 hours a day, 7 days a week in order to obtain any needed emergency or urgent care.
Be able to get in and out of a health-care provider’s office, including barrier free access for persons with disabilities or other conditions limiting mobility, in accordance with the Americans with Disabilities Act.
Have interpreters, if needed, during appointments with their providers and when talking to their health plan. Interpreters include people who can speak in their native language, assist with a disability, or help them understand the information.

Texas Medicaid & Healthcare Partnership
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