| (a) Applicability. This section applies to integrated
eligibility services call centers established by the Health and Human
Services Commission ("HHSC") after June 1, 2004.
(b) Definitions. The following words and phrases, when
used in this section, have the following meanings, unless the context
clearly indicates otherwise:
(1) "Applicant" means a person who asks HHSC to determine,
certify, or recertify his or her eligibility for a service.
(2) "Call center" means a place where HHSC or an HHSC
contractor receives and responds to applicants' telephone inquiries
and processes information in order to assist HHSC to determine, certify,
or recertify an applicant's eligibility for a service.
(3) "Contractor" means a public or private entity that
is awarded a contract to provide call center services under this section.
(4) "Service" means a benefit or assistance provided
under any of the following programs:
(A) the Children's Health Insurance Program ("CHIP")
established under Chapter 62, Health and Safety Code;
(B) the Temporary Assistance to Needy Families ("TANF")
program established under Chapter 31, Human Resources Code;
(C) the Medicaid program established under Chapter
32, Human Resources Code;
(D) the nutritional assistance programs established
under Chapter 33, Human Resources Code, including the Food Stamp Program;
(E) long-term care services, as defined by Section
22.0011, Human Resources Code;
(F) community-based support services identified or
provided in accordance with Section 531.02481, Government Code; and
(G) any other health and human services program that
HHSC determines is appropriate to include as part of a call center
service.
(c) Establishment and number of call centers.
(1) HHSC must establish at least one but not more than
four call centers if HHSC determines that it is cost-effective to
establish such call centers subject to subsections (c)(2) through
(c)(4) of this section.
(2) Subject to subsection (d), HHSC must contract with
at least one but not more than four private entities for the operation
of call centers identified in subsection (c)(1) of this section, unless
HHSC determines that contracting is not cost effective.
(3) HHSC must operate any call center identified under
subsection (c)(1) of this section that it determines is not cost effective
to contract with a private entity to operate.
(4) All eligibility calls, including overflow calls,
will be processed through call centers located in Texas.
(5) Each call center established under this section
must provide translation and interpretation services as required by
federal law.
(6) HHSC will conduct one or more public hearings around
the state before it establishes any call center under this section.
(d) Contracting requirements.
(1) Any contract for call center services will be competitively
procured in compliance with Section 2155.144, Government Code; HHSC
administrative rules codified at 1 TAC chapter 391; and applicable
federal laws and regulations.
(2) Any contract for call center services that HHSC
awards under this section must include, at a minimum:
(A) Performance requirements that describe the specific
services to be performed by a contractor;
(B) Terms and conditions that are expressly required
by state or federal laws, rules or regulations; and
(C) Any other provision that HHSC determines is necessary
or beneficial to the State of Texas including, but not limited to,
HHSC's Uniform Contract Terms and Conditions published on the HHSC
Internet web site.
(e) Performance standards and measurement.
(1) HHSC must develop performance standards to govern
the operation of each call center that address, at a minimum:
(A) The call center's ability to serve consumers in
a timely manner;
(B) Quality and accuracy of eligibility determinations
conducted through the call center;
(C) Courtesy, friendliness, training, and knowledge
of call center staff;
(D) The call center's management of consumer and public
complaints;
(E) Consumer satisfaction with the call center's services;
(F) The accessibility and usability of eligibility
call center web sites, including compliance with 1 TAC §206.2,
Accessibility and Usability of State Web Sites, and Government Code §531.0162,
Use of Technology; and
(G) Any other standard that HHSC determines is necessary
to ensure the desired or expected levels and quality of call center
services.
(2) HHSC must develop mechanisms for measuring the
operation of each call center and to evaluate call centers' compliance
with all performance standards.
(3) HHSC may establish performance standards and measurements
for a contracted call center under a competitive procurement
(4) HHSC will publish all call center performance standards
and measures.
(f) Establishment of eligibility by personal appearance.
(1) This subsection does not apply to an applicant
whose eligibility must be established or who must be certified or
recertified through a face-to-face interview under federal law or
to an applicant for CHIP services.
(2) An applicant may request the opportunity to appear
in person to establish initial eligibility for a service or for certification
or recertification purposes.
(3) If an applicant wishes to appear personally to
assist HHSC to determine, certify, or recertify his or her eligibility
for a service, the applicant must notify HHSC or the health and human
services agency that administers the program. An applicant may provide
notice in any of the following ways:
(A) In person at an office of the health and human
services agency that administers the program;
(B) In writing by using materials that HHSC provides
for this purpose or by any other written method;
(C) By telephone using a toll-free number that HHSC
acquires for this purpose; or
(D) By an electronic method that HHSC creates for this
purpose, including facsimile and electronic mail.
(4) HHSC or its contractor will schedule a personal
appearance upon request unless HHSC can establish the applicant's
eligibility without a personal appearance. The personal appearance
will be scheduled at a time and location that reasonably accommodates
the applicant's schedule, location, and circumstances.
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