The purpose of this communication is to inform providers of new state requirements under House Bill (H.B.) 44 (88th Legislature, Regular Session, 2023). Effective April 29, 2025, the Texas Health and Human Services Commission (HHSC) adopted new rules that prohibit Medicaid and CHIP providers from refusing to provide covered services to members based solely on a member’s refusal or failure to obtain a vaccine or immunization.
These requirements are outlined in Texas Government Code §545.0205 and are now reflected in the Texas Medicaid Provider Procedures Manual (TMPPM), Section 1.7 – Provider Responsibilities, which will read:
“In accordance with H.B. 44, Medicaid providers are prohibited from refusing to provide health care services to any Medicaid client based solely on the client’s refusal or failure to obtain a vaccine or immunization for a particular infectious or communicable disease unless excepted by Texas Government Code §531.02119.”
What Providers Need to Know:
- Providers must not deny services to a Medicaid or CHIP member solely based on their vaccination status.
- Violations of this requirement may result in payment denials, including the use of Payment Denial Code (PDC) 59 – Vaccine status discrimination non-compliance. Payment will resume only after corrective actions are taken.
- Providers have the right to request an administrative appeal and, if necessary, a judicial review of any decision related to payment denials.
- These rules apply to all Medicaid and CHIP providers and aim to ensure members maintain access to care regardless of vaccination decisions.
You can review the full HHSC communication and additional implementation details here:
Reminder: No Discrimination Based on Client’s Vaccination Status
How to Report Non-Compliance:
Allegations of provider discrimination based on vaccine status are handled directly by HHSC and not by Community First Health Plans. Allegations may be submitted to the HHS Office of Ombudsman in the following ways:
- Phone: 1-866-566-8989 (Managed Care Assistance Team)
- TTY: 7-1-1 or 800-735-2989
- Email: Managed_Care_Initiatives@hhs.texas.gov
- Online: https://hhs.texas.gov/omcat
- Fax: 888-780-8099
- Mail:
Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, Texas 78711-3247
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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