The following words and terms are applicable to this Chapter,
Medical Transportation Program (MTP):
(1) Abuse--The willful infliction of intimidation or
injury resulting in physical harm, pain, or mental anguish.
(2) Accident--An unexpected event or series of events
causing loss or injury to person or property (e.g., automobile).
(3) Adjacent county(ies)--The county or counties that
share a common county line or point with the client's county of residence.
(4) Advance funds--Funds authorized in advance of travel
and provided to the client or attendant to cover authorized transportation
services (e.g., gas money, lodging, and/or meals) for travel to a
covered health care service.
(5) Ambulance service--A service paid through HHSC
or its designee in an emergency, or non-emergency situation in which
transportation in a vehicle other than an ambulance could endanger
the recipient's health.
(6) Attendant--
(A) an adult required to accompany a prior authorized
MTP client under §380.207(4) of this chapter (relating to Program
Limitations);
(B) an adult that accompanies a prior authorized MTP
client to provide necessary mobility, personal or language assistance
to the client during the time that transportation services are provided;
(C) a service animal that accompanies a prior authorized
MTP client to provide necessary mobility or personal assistance to
the client during the time that transportation services are provided;
or
(D) an adult that accompanies a prior authorized MTP
client because a health care provider has submitted a statement of
need that the client requires an attendant.
(7) Certification Period--A period of time for which
a Transportation for Indigent Cancer Patient client is certified for
service.
(8) Children with Special Health Care Needs (CSHCN)
services program--A program funded with general revenue and federal
funds administered by the Department of State Health Services. Services
for eligible children include early identification, diagnosis and
evaluation, resulting in early health care intervention.
(9) Covered health care service--A service included
in the premium of the health care policy paid by or on behalf of an
MTP client.
(10) Demand Response--Transportation that involves
using performing provider dispatched vehicles in response to requests
from clients or shared one-way trips.
(11) Health and Human Services Commission (HHSC)--The
state agency that operates the Medical Transportation Program.
(12) Health Care Provider's Statement of Need--MTP
Form 3113 or equivalent submitted by a health care provider which
documents the client's need for health care services and/or special
transportation accommodations.
(13) Individual Transportation Participant (ITP)--An
individual who has been approved for mileage reimbursement at a rate
prescribed by HHSC to provide transportation for a prior authorized
MTP client to a covered health care service.
(14) Limited Status--A Medicaid client's limitation
to a designated provider, either a primary care provider or primary
care pharmacy, under the lock-in provisions contained in Chapter 354,
Subchapter K of this title (relating to Medicaid Recipient Utilization
Review and Control). Clients are limited for specific periods of time
as outlined in §354.2405(c) of this title (relating to Utilization
Control).
(15) Lodging--A commercial establishment such as a
hotel, motel, charitable home or hospital that provides overnight
lodging.
(16) Long Distance Trip--Transportation beyond a county
adjacent to a client's county of residence or Medicaid managed care
service delivery area for the purpose of receiving a covered health
care service.
(17) Managed Transportation Organization (MTO)--
(A) a rural or urban transit district created under
Chapter 458, Transportation Code;
(B) a public transportation provider defined by §461.002,
Transportation Code;
(C) a regional contracted broker defined by Government
Code §531.02414;
(D) a local private transportation provider approved
by HHSC to provide MTP services; or
(E) any other entity HHSC determines meets the requirements.
(18) Mass transit--Public transportation by bus, rail,
air, ferry, or intra-city bus either publicly or privately owned,
which provides general or special service transportation to the public
on a regular and continuing basis. Mass transit is intercity or intra-city
transportation and also includes the use of commercial air service
to transport clients to an authorized service.
(19) Medicaid--A health care program provided to eligible
individuals under 42 U.S.C. §1396a et
seq.; 42 C.F.R. §431.53; Texas Human Resources Code, Chapters
22 and 32.
(20) Medically necessary--Services that are:
(A) reasonably necessary to: prevent illness(es) or
medical condition(s); maintain function or to slow further functional
deterioration; provide early screening, intervention, care, and/or
provide care or treatment for eligible clients who have medical condition(s)
that cause suffering or pain, physical deformity or limitations in
function, or that threaten to cause or worsen a disability, illness
or infirmity, or endanger life;
(B) provided at appropriate locations and at the appropriate
levels of care for the treatment of the medical condition(s);
(C) consistent with health care practice guidelines
and standards endorsed by professionally recognized health care organizations
or governmental agencies;
(D) consistent with the diagnosis(es) of the condition(s);
(E) no more intrusive or restrictive than necessary
to provide a proper balance of safety, effectiveness, and efficiency;
(F) not experimental or investigative; and
(G) not primarily for the convenience of the client.
(21) Medical Transportation Program (MTP)--The program
that provides prior authorized nonemergency transportation services
to and from covered health care services, based on medical necessity,
for categorically eligible Medicaid clients enrolled in Medicaid,
and eligible clients enrolled in CSHCN services program, or the Transportation
for Indigent Cancer Patients program who have no other means of transportation.
(22) Minor--An individual under 18 years of age who
has never been married or emancipated by court ruling.
(23) Passenger assistance--Transportation from curb
at origin to curb at destination, including providing assistance,
as required, to clients entering and exiting the vehicle.
(24) Performing provider--An entity that arranges or
provides transportation services to a prior authorized MTP client,
including subcontractors, independent contractors, lodging and meal
vendors, and intercity or intra-city bus services.
(25) Prior authorization--Authorization or approval
for the provision of transportation services obtained from MTP or
a transportation provider before the services are rendered.
(26) Prior authorized MTP client--A client authorized
by HHSC as eligible for Medicaid services under a specific category,
or identified by either the CSHCN service program or the TICP program
as eligible for program services, who has no other means of transportation
to covered health care services.
(27) Reasonable transportation--Transportation using
the most cost-effective transportation that meets the client's medical
needs:
(A) within a client's local community, county of residence,
or county adjacent to a client's county of residence where the client
wishes to maintain an ongoing relationship or establish a relationship
with a health care provider of his or her choice; or
(B) to a provider or facility within a designated Medicaid
managed care service delivery area.
(28) Regional contracted broker--An entity that contracts
with HHSC to provide or arrange for the provision of nonemergency
transportation services under the MTP, including a full risk broker
as referenced in 42 C.F.R. §440.170(a)(4) (relating to nonemergency
medical transportation brokerage program).
(29) Routine medical transportation--Prior authorized
medical transportation trips, other than long distance trips, to and/or
from a facility where covered health care services will be provided.
(30) Service animal--A trained guide dog, signal dog,
or other animal to provide assistance to a specified MTP client with
a disability.
(31) Sexual harassment--Unwelcome sexual advances,
requests for sexual favors, or other unwanted verbal or physical conduct
of a sexual nature directed toward an individual by another individual
during the provision of transportation services.
(32) Significant traditional provider--An individual
or entity that has a documented record of providing transportation
services for a minimum of two years.
(33) Special needs--A transportation service that requires
the use of a vehicle equipped with a ramp or a mechanical lift to
provide the client with a means of accessing the vehicle.
(34) Transportation provider--A regional contracted
broker or an MTO.
(35) Transportation for Indigent Cancer Patients (TICP)
Program--A state-funded program that provides medical transportation
services to individuals diagnosed with cancer or a cancer-related
illness and who meet residency and financial criteria.
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| Source Note: The provisions of this §380.101 adopted to be effective April 10, 2001, 26 TexReg 2720; amended to be effective May 11, 2003, 28 TexReg 3722; transferred effective March 1, 2004, as published in the Texas Register April 30, 2004, 29 TexReg 4267; amended to be effective August 6, 2013, 38 TexReg 4888; amended to be effective September 1, 2014, 39 TexReg 5731 |
