TITLE 1.ADMINISTRATION

Part 15. TEXAS HEALTH AND HUMAN SERVICES COMMISSION

Chapter 353. MEDICAID MANAGED CARE

Subchapter C. MEMBER BILL OF RIGHTS AND RESPONSIBILITIES

1 TAC §353.202

The Health and Human Services Commission (HHSC), proposes to amend 1 TAC §353.202, concerning Member Bill of Rights. The amendment gives Medicaid managed care members an additional right concerning how they are treated. Federal Medicaid managed care regulation 42 C.F.R. §438.100(b)(2)(v) requires that enrollees be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. The amendment adds that right, which will be published in the managed care Member Bill of Rights. The Member Bill of Rights is published in the Member Handbook and a copy is given to each Medicaid managed care member. The purpose of the proposed amendment is to bring HHSC into compliance with 42 C.F.R. §438.100(b)(2)(v). Medicaid managed care health plans will be required to revise member materials to include this change.

The proposed amendment has been written in easily understood language, as required by 42 C.F.R. §438.10(d)(i).

Tom Suehs, Deputy Commissioner for Financial Services, has determined that for the first five years the proposed amendment is in effect, there will be no fiscal implications for the state or local government as a result of enforcing or administering the amended rule.

Mr. Suehs also has determined that during the first five years the proposed amendment is in effect, the public's benefit as a result of enforcing the proposed amendment is to inform Medicaid managed care enrollees of the rights granted to them under federal regulations. There is no anticipated impact on small businesses and micro-businesses to comply with the amended rule as proposed, as they will not be required to modify business practices. There are no anticipated economic costs to persons who are required to comply with the proposed rule. There is no anticipated impact on local employment.

HHSC has determined that the proposed amendment is not a "major environmental rule" as defined by §2001.0225 of the Texas Government Code. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect in a material way the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. The proposed amendment is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.

HHSC has determined that the proposed amendment does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of governmental action and, therefore, does not constitute a taking under §2007.043, Government Code.

Written comments on the proposed amended rule may be submitted to Ms. Dee Sportsman, Medicaid/CHIP Division, Texas Health and Human Services Commission, 1100 West 49th Street, Austin, Texas 78756, within 30 days of publication of this proposal in the Texas Register .

A public hearing is scheduled for June 25, 2003, from 1:00 p.m. to 3:00 p.m. The hearing will be held in the Public Hearing Room, 12555 Riata Vista Circle, Bldg. 3, Austin, Texas, 78727.

The amendment is proposed under the Texas Government Code, §531.033, which provides the Commissioner of HHSC with broad rulemaking authority; Human Resources Code, §32.021, and the Texas Government Code, §531.021(a), which provide HHSC with the authority to administer the federal medical assistance program (Medicaid) in Texas.

No other statutes, articles, or codes are affected by the proposed amendment.

§353.202.Member Bill of Rights.

Each managed care organization participating in the state's Medicaid program shall provide to each member an easy-to-read, written document stating:

Figure: 1 TAC §353.202

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on May 27, 2003.

TRD-200303248

Steve Aragón

General Counsel

Texas Health and Human Services Commission

Earliest possible date of adoption: July 13, 2003

For further information, please call: (512) 424-6576