1. (a) All health maintenance organizations (HMOs) shall provide services and benefits available to Medicaid clients under the Medicaid program, as defined in Chapter 354 of this title, relating to Medicaid Health Services, except services that are excluded from the Medicaid Managed Care Program.
2. (b) The Commission will establish the scope and level of benefits, which all HMOs must agree to provide as a condition for participation. These requirements may exceed the scope and level of covered benefits and services available to fee-for-service Medicaid Clients. These requirements will be contained in all contracts entered into by an HMO and the Commission.
3. (c) HMOs are encouraged to provide any value-added services or benefits beyond the level and scope required as a condition for participation in the competitive procurement process. These services and benefits cannot increase the cost borne or capitation rates paid by the Commission during any current contract term or in any subsequent contract term. These services or benefits cannot violate any other state or federal rule or regulation.

Source Note:The provisions of this §353.409 adopted to be effective December 18, 1996, 21 TexReg 11822; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective August 10, 2005, 30 TexReg 4466.