| (a) OMCAT coordinates a network of entities to provide
support and information services to persons enrolled in or applying
for Medicaid who experience barriers to receiving health care services,
in accordance with Texas Government Code §531.0213.
(b) As a part of the support and information services,
OMCAT is responsible for operating a statewide toll-free assistance
telephone number and for intervening promptly with HHSC Medicaid program
staff, MCOs, health care providers, and any other appropriate entity
on behalf of a person who has an urgent need for medical services.
(c) OMCAT is responsible for assisting persons who
are experiencing barriers in the Medicaid application and enrollment
process and educating them so that they understand the concept of
managed care; understand their rights under Medicaid, including grievance
and appeal procedures; and are able to advocate for themselves.
(d) In accordance with Texas Government Code §531.0213(e),
OMCAT is sufficiently independent from other aspects of Medicaid managed
care to represent the best interests of consumers in complaint resolution.
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