Texas Health and Human Services System

Change font size:
Regular | Larger

Find Services | News & Information | Rules & Statutes | Business Information 
Content
Transformation - Projects - Integrated Eligibility

Transformation - Projects Integrated Eligibility (IE)

Title 1. Administration
Part 15. Health and Human Services Commission
Chapter 351 Coordinated Planning and Delivery of Health and Human Services
Rule 351.751 Integrated eligibility services call centers


Preamble

The Texas Health and Human Services Commission ("HHSC") proposes new section 351.751, entitled "Integrated eligibility services call centers," to implement the requirement in section 531.063(a), Government Code, that HHSC establish at least one but not more than four call centers "by rule."

Background and Factual Basis for the Rule

Section 531.063, Government Code (as added by Acts 2003, 78th Leg., ch. 198, §2.06), requires the Health and Human Services Commission to establish one or more call centers for the purpose of determining, certifying, or recertifying a person's eligibility and need for services provided by certain programs assigned to HHSC's eligibility services division under section 531.008(c), Government Code. These programs include the Children's Health Insurance Program, Texas Medicaid program, Temporary Assistance to Needy Families program, Food Stamps, long-term care and community-based support services programs, and other health and human services programs as HHSC determines are appropriate.

The statute requires HHSC to establish at least one but not more than four such call centers if HHSC determines it is cost-effective to do so. It also requires such centers to be located in Texas, except that overflow calls may be directed to call centers located outside of Texas. The statute also directs HHSC to establish consumer service and performance standards to govern the operation of call centers by either HHSC or a contracted service provider.

On March 25, 2004, HHSC published a Business Case Analysis document that proposes a call center model for public consideration. The proposed model will be addressed at the public hearings discussed below. Business, employment and fiscal impacts of this rule are based on the proposed model. A description and details about the proposed model is available on HHSC's web site.

Section-by-Section Explanation

Subsection (a) of the proposed rule describes the applicability of the proposed rule. Subsection (b) defines certain terms used in the proposed rule. Subsection (c) generally describes how HHSC will establish call centers in Texas, while subsection (d) describes the minimum required content of any contract HHSC may award for call center services. Subsection (e) prescribes HHSC's policy and process for providing an applicant for services an opportunity to request to appear in person to facilitate eligibility determination and the circumstances under which HHSC will provide such opportunity. Subsection (e) does not apply to a service for which federal law currently requires a face-to-face interview to be conducted for eligibility determination (such as the Food Stamp program) or for the CHIP program, which currently determines eligibility using a streamlined process that does not require a personal appearance by the applicant.

Public Benefit

Gregg Phillips, Deputy Executive Commissioner for Program Services, has determined that applicants and clients of programs that are included within the scope of a call center operation and the public will benefit from the implementation of the rule in several ways. First, implementation of call centers will improve access to program services and benefits for applicants and clients by (1) reducing the amount of time and personal expense required to apply for and receive services, (2) facilitating the implementation of streamlined and simplified eligibility processes, and (3) enhancing the accuracy of eligibility determination, certification, and recertification. The taxpayers will benefit from administrative cost savings that may be achieved from the successful implementation of call centers, improved public confidence in the accuracy and efficiency of public programs resulting from business and process improvements, and an improved return on the investment of tax dollars in eligibility determination services.

Fiscal Note

Tom Suehs, Deputy Executive Commissioner for Financial Services, has determined that for the first five years the proposed rule is in effect, there will be no significant negative fiscal impact on state or local government. However, the establishment of call centers pursuant to the proposed rule will generate estimated savings to the State of Texas for State Fiscal Year 2004 of up to $71,593; for State Fiscal Year 2005 of up to $14,433,188; for State Fiscal Year 2006 of up to $50,390,047; for State Fiscal Year 2007 of up to $52,189,387; and for State Fiscal Year 2008 of up to $61,786,270.

Small and Micro-Business Impact Analysis

Because the proposed rule does not specify or require HHSC to establish any new call centers, HHSC does not believe the rule itself has any adverse impact on small or micro-businesses. However, HHSC understands that its establishment of call centers under the authority provided in section 531.063, Government Code, and the proposed rule may have some potentially adverse impact on some small or micro-businesses in Texas.

HHSC and other health and human services agencies lease office space for, among other purposes, performing eligibility determination for the programs currently included within the scope of the proposed rule. Some of this space may be leased from small and micro-businesses. HHSC anticipates that the establishment of call centers will reduce the need for office space for eligibility determination purposes. The precise impact of call centers on these businesses cannot be determined because neither the number of call centers nor the number or location of vacated leases was determined as of the date the proposed rule. Further, the impact of call centers on owners of leased office locations will be contingent on several factors beyond HHSC's control-e.g., the availability of replacement tenants, the marketability and marketing of specific vacated office locations, and local market conditions. Accordingly, HHSC is unable to estimate the impact on small and micro-businesses.

HHSC's Business Case Analysis indicates that state employment related to eligibility determination functions will remain constant in State Fiscal Year 2004, decline by 3,471 positions in State Fiscal Year 2005, and decline by another 1,016 positions in State Fiscal Year 2006. After these declines, employment is expected to remain stable, but at the reduced level, through State Fiscal Year 2008.

The employment effect on particular local areas cannot be estimated at this time because the call center model may change and HHSC has not identified the specific geographic areas that may be affected. Statewide, the proposed integrated eligibility call center model would have a positive impact on local employment productivity as people in the local workforce who are applicants, recipients, or assisting people to apply for benefits and services would not have to take off from work to apply in person at an office, but would be offered the option of more flexible means of accessing services.

Regulatory Analysis

The Health and Human Services Commission has determined that the proposed rule is not a "major environmental rule" as defined by section 2001.0225, Government Code. The proposed rule is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.

Takings Impact Assessment

The Health and Human Services Commission has determined that the proposed rule does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of governmental action and therefore this action does not constitute a taking under Texas Government Code, section 2007,043. The proposed rule primarily is administrative and does not impose any new regulatory requirements that affect property. The proposed rule is reasonably taken to fulfill the requirements of state law.

Public Comment

Public comment may be submitted in writing to Angie Nelson-Wernli, Health and Human Services Commission, by mail addressed to P.O. Box 13247, Austin, Texas 78711, by facsimile to (512) 424-6669, or by electronic mail at:
   angie.nelson-wernli@hhsc.state.tx.us. 

Comments must be submitted by 5:00 p.m., May 16, 2004. Further information may be obtained by calling Angie Nelson-Wernli at (512) 424-6931.

Public Hearing

HHSC will conduct public hearings during the public comment period for the proposed rule in multiple health and human services regions on the proposed rule in conjunction with public hearings required under section 531.063, Government Code, concerning the establishment of call centers. The dates, times, and locations of such public hearings will be posted on the Secretary of State's Open Meetings web site (http://www.sos.state.tx.us/open/index/.html) and the HHSC web site.

Statutory Authority

The new rule is proposed pursuant to the authority granted to HHSC under section 531.033, Government Code, and is required under section 531.063, Government Code, (as added by Acts 2003, 78th Leg., ch. 198, §2.06).

The proposed rule affects section 531.0653, Government Code, Chapters 31, 32, and 33, Human Resources Code, and Chapter 62, Health and Safety Code.

The agency hereby certifies that this proposal has been reviewed and approved by legal counsel and found to be within the agency's legal authority to adopt.


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
  1. Applicability. This section applies to integrated eligibility services call centers by the Health and Human Services Commission ("HHSC") established after June 1, 2004.
  2. 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:
    1. the Children's Health Insurance Program ("CHIP") established under Chapter 62, Health and Safety Code;
    2. the Temporary Assistance to Needy Families ("TANF") program established under Chapter 31, Human Resources Code;
    3. the Medicaid program established under Chapter 32, Human Resources Code;
    4. the nutritional assistance programs established under Chapter 33, Human Resources Code, including the Food Stamp Program;
    5. long-term care services, as defined by Section 22.0011, Human Resources Code;
    6. community-based support services identified or provided in accordance with Section 531.02481, Government Code; and
    7. any other health and human services program that HHSC determines is appropriate to include as part of a call center service.
  3. 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. Each call center established under this section will be located in Texas, but overflow calls from a call center located in Texas may be processed at a call center located outside of Texas.
    5. Each call center established under this section must provide translation 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.
  4. 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 T.A.C. 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:
      1. Performance requirements that describe the specific services to be performed by a contractor;
      2. Terms and conditions that are expressly required by state or federal laws, rules or regulations; and
      3. 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.
  5. Performance standards and measurement.
    1. HHSC must develop performance standards to govern the operation of each call center that address, at a minimum:
      1. The call center's ability to serve consumers in a timely manner;
      2. Quality and accuracy of eligibility determinations conducted through the call center;
      3. Courtesy, friendliness, training, and knowledge of call center staff;
      4. The call center's management of consumer and public complaints;
      5. Consumer satisfaction with the call center's services; and
      6. 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.
  6. 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:
      1. In person at an office of the health and human services agency that administers the program;
      2. In writing by using materials that HHSC provides for this purpose or by any other written method;
      3. By telephone using a toll-free number that HHSC acquires for this purpose; or
      4. 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.