| (a) Managed care organizations (MCOs) must submit a
marketing plan and all marketing materials to the Health and Human
Services Commission (HHSC) for prior written approval.
(b) MCOs may present their marketing materials to eligible
Medicaid clients through any method or media determined to be acceptable
by HHSC. The media may include: written materials, such as brochures,
posters, or fliers, which can be mailed directly to the client or
left at HHSC eligibility offices; enrollment events; and public service
announcements on radio.
(c) MCO enrollment or marketing representatives are
required to complete HHSC's marketing orientation and training program
prior to engaging in marketing activities on behalf of the MCO.
(d) Prohibited marketing practices.
(1) MCOs and providers must not conduct any direct
contact marketing except through enrollment events or when assisting
the MCO's current members with reapplication.
(2) MCOs and providers must not make any written or
oral statement containing material misrepresentations of fact or law
relating to their plan or the Medicaid managed care program.
(3) MCOs and providers must not make false, misleading
or inaccurate statements relating to services or benefits, providers,
or potential providers through their plan.
(4) MCOs and providers must not offer Medicaid recipients
material or financial gain as an inducement for enrollment, unless
an exception is made by HHSC.
(5) Marketing or enrollment practices of MCOs and providers
must not discriminate against a client because of a client's race,
creed, age, color, religion, national origin, ancestry, marital status,
sexual orientation, physical or mental disability, health status,
or existing need for medical care.
(e) MCO network providers must comply with the standards
described in §354.1452 of this title (relating to Provider Marketing).
(f) Nothing in this section prohibits a provider participating
in the STAR+PLUS program from, as permitted under the provider's contract,
engaging in a marketing activity, including any dissemination of material
or other attempt to communicate, that is intended to educate a Medicaid
client about available long-term care services and supports.
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| Source Note: The provisions of this §353.405 adopted to be effective December 18, 1996, 21 TexReg 11822; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective August 10, 2005, 30 TexReg 4466; amended to be effective September 1, 2006, 31 TexReg 6629; amended to be effective March 1, 2012, 37 TexReg 1283; amended to be effective July 6, 2014, 39 TexReg 4951 |
