| (2) More than 50 miles from the Texas border. The
manager of the department unit having responsibility for oversight
of the program may approve coverage of services that are within the
scope of the program and provided by health care providers located
within the United States and more than 50 miles from the Texas border
in unique circumstances in which the program participating physician(s),
the client, parent or guardian, and the program medical director or
assistant medical director agree that:
(A) an out-of-state provider is the provider of choice
for quality care;
(B) the medical literature indicates that the out-of-state
treatment is accepted medical practice and is anticipated to improve
the client's quality of life;
(C) the same treatment or another treatment of equal
benefit or cost is not available from Texas program providers; and
(D) the out-of-state treatment should result in a decrease
in the total projected program cost of the client's treatment.
(3) The limitations of this paragraph do not apply
to coverage for or payment to program providers of selected products
or devices including, but not limited to, medical foods or hearing
amplification devices which either are always less costly or are only
available from out-of-state sources.
(4) For program reimbursement, all program policies
and procedures will apply including the requirement that all providers
be program providers as defined by this section.
(5) The program may cover costs of transportation and
associated meals and lodging for a client and, if necessary, a responsible
adult for travel to and from the location of out-of-state services
that meet the program approval parameters in this subsection. Travel
costs will be negotiated with approval of specific travel options
based on overall cost effectiveness.
|
| Source Note: The provisions of this §351.6 adopted to be effective July 1, 2001, 26 TexReg 2979; amended to be effective June 1, 2006, 31 TexReg 4200; amended to be effective October 3, 2010, 35 TexReg 8921; amended to be effective April 21, 2013, 38 TexReg 2362; transferred effective March 15, 2022, as published in the February 25, 2022 issue of the Texas Register, 47 TexReg 982 |
