Tex.
Gov't Code Section 531.02115
Marketing Activities by Providers Participating in Medicaid or Child Health Plan Program
(a)
A provider participating in Medicaid or the child health plan program, including a provider participating in the network of a managed care organization that contracts with the commission to provide services under Medicaid or the child health plan program, may not engage in any marketing activity, including any dissemination of material or other attempt to communicate, that:(1)
involves unsolicited personal contact, including by door-to-door solicitation, solicitation at a child-care facility or other type of facility, direct mail, or telephone, with a Medicaid client or a parent whose child is enrolled in Medicaid or the child health plan program;(2)
is directed at the client or parent solely because the client or the parent’s child is receiving benefits under Medicaid or the child health plan program; and(3)
is intended to influence the client’s or parent’s choice of provider.(b)
In addition to the requirements of Subsection (a), a provider participating in the network of a managed care organization described by that subsection must comply with the marketing guidelines established by the commission under Section 533.008 (Marketing Guidelines).(c)
Nothing in this section prohibits:(1)
a provider participating in Medicaid or the child health plan program from:(A)
engaging in a marketing activity, including any dissemination of material or other attempt to communicate, that is intended to influence the choice of provider by a Medicaid client or a parent whose child is enrolled in Medicaid or the child health plan program, if the marketing activity:(i)
is conducted at a community-sponsored educational event, health fair, outreach activity, or other similar community or nonprofit event in which the provider participates and does not involve unsolicited personal contact or promotion of the provider’s practice; or(ii)
involves only the general dissemination of information, including by television, radio, newspaper, or billboard advertisement, and does not involve unsolicited personal contact;(B)
as permitted under the provider’s contract, engaging in the dissemination of material or another attempt to communicate with a Medicaid client or a parent whose child is enrolled in Medicaid or the child health plan program, including communication in person or by direct mail or telephone, for the purpose of:(i)
providing an appointment reminder;(ii)
distributing promotional health materials;(iii)
providing information about the types of services offered by the provider; or(iv)
coordinating patient care; or(C)
engaging in a marketing activity that has been submitted for review and obtained a notice of prior authorization from the commission under Subsection (d); or(2)
a provider participating in the STAR + PLUS Medicaid managed care 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.(d)
The commission shall establish a process by which providers may submit proposed marketing activities for review and prior authorization to ensure that providers are in compliance with the requirements of this section and, if applicable, Section 533.008 (Marketing Guidelines), or to determine whether the providers are exempt from a requirement of this section and, if applicable, Section 533.008 (Marketing Guidelines). The commission may grant or deny a provider’s request for authorization to engage in a proposed marketing activity.(e)
The executive commissioner shall adopt rules as necessary to implement this section, including rules relating to provider marketing activities that are exempt from the requirements of this section and, if applicable, Section 533.008 (Marketing Guidelines).
Source:
Section 531.02115 — Marketing Activities by Providers Participating in Medicaid or Child Health Plan Program, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.531.htm#531.02115 (accessed Jun. 5, 2024).
