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Texas Administrative Code

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TITLE 1	ADMINISTRATION
PART 15	TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 351	COORDINATED PLANNING AND DELIVERY OF HEALTH AND HUMAN SERVICES
RULE §351.751	Integrated eligibility services call centers

(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.

Source Note: The provisions of this §351.751 adopted to be effective August 8, 2004, 29 TexReg 7297

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