Texas § GV.523.0359 - OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE

§ GV.523.0359. OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE

OMBUDSMAN FOR BEHAVIORAL HEALTH ACCESS TO CARE. (a) The commission shall establish an ombudsman program to provide support and information services to a consumer enrolled in or applying for a behavioral health program. (b) The commission may use an alternate title for the ombudsman in consumer-facing materials if the commission determines that an alternate title would be beneficial to consumer understanding or access. (c) An ombudsman serves as an impartial party to help consumers, including consumers who are uninsured or have public or private health benefit coverage, and behavioral health care providers navigate and resolve issues related to consumer access to behavioral health care, including care for mental health conditions and substance use disorders. (d) An ombudsman shall: (1) interact with consumers and behavioral health care providers regarding concerns or complaints to help the consumers and providers resolve behavioral health care access issues; (2) identify, track, and help report potential violations of state or federal rules, regulations, or statutes concerning the availability of, and terms and conditions of, benefits for mental health conditions or substance use disorders, including potential violations related to quantitative and nonquantitative treatment limitations; (3) report concerns, complaints, and potential violations described by Subdivision (2) to the appropriate regulatory or oversight agency; (4) receive and report concerns and complaints relating to inappropriate care or mental health commitment; (5) provide appropriate information to help consumers obtain behavioral health care; (6) develop appropriate points of contact for referrals to other state and federal agencies; and (7) provide appropriate information to help consumers or providers file appeals or complaints with the appropriate entities, including insurers and other state and federal agencies. (e) The Texas Department of Insurance shall appoint a liaison to an ombudsman to receive reports of concerns, complaints, and potential violations described by Subsection (d)(2) from an ombudsman, consumers, or behavioral health care providers. Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10 ), Sec. 1, eff. September 1, 2017. Transferred, redesignated and amended from Government Code, Section 531.02251 by Acts 2023, 88th Leg., R.S., Ch. 741 (H.B. 3462 ), Sec. 11, eff. June 12, 2023. Transferred, redesignated and amended from Government Code, Subchapter Y, Chapter 531 by Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620 ), Sec. 8.019(a), eff. September 1, 2025.