| (a) If a consumer or the consumer's LAR contacts OMCAT
seeking information or wishing to complain about an HHS program other
than Medicaid, the consumer or the consumer's LAR is transferred to
OO staff that handle complaints regarding those programs. OMCAT staff
inform the consumer or the consumer's LAR of this referral and document
it in the HEART system.
(b) In accordance with the requirement at 42 CFR §438.408(f)(1)
that a fair hearing related to managed care is only available after
an MCO appeal, a request for a fair hearing is referred to the consumer's
MCO so it can be submitted to HHSC Appeals Division staff. A request
for an appeal of a decision by an MCO is referred to that MCO. OMCAT
staff inform the consumer or the consumer's LAR of these referrals
and document them in the HEART system.
(c) A request from a Medicaid health care provider
that does not relate to a consumer's Medicaid case is referred to
the HHSC office designated to receive these complaints, in accordance
with the Texas Medicaid Provider Procedures Manual maintained by HHSC
Medicaid program staff and available on the HHS web site. OMCAT staff
inform the health care provider of this referral and document it in
the HEART system.
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