| (a) The nursing facility is responsible for providing
normal transportation for the recipient to medical services outside
the facility. The attending physician must have ordered the medical
services.
(b) Normal transportation is to and from the medical
care provider of the recipient's choice, who is generally available
and used by recipients of the locality for medical care included under
the Texas Medical Assistance program. If a Title XIX provider is not
in the locality, transportation is to and from the nearest appropriate
Title XIX provider if the recipient so chooses. The term "locality"
means the service area surrounding the nursing facility from which
individuals ordinarily come or are expected to come for inpatient
or outpatient services.
(c) Transportation charges, including non-emergency,
routine ambulance services, involved in the certification or recertification
of a recipient are the responsibility of the nursing facility.
(d) The facility may not charge the state's Medicaid
health insuring agent, the recipient, the family, or responsible party
for normal transportation as defined in this section. Normal transportation
charges are covered in the monthly vendor rate. The facility may not
use the state's Medicaid community-based Title XIX medical transportation
program except to transport recipients for renal dialysis treatments.
(e) Charges for the following medically necessary ambulance
services, when provided by a Medicaid-enrolled provider, are not
the responsibility of the nursing facility, but are payable by the
state's Medicaid health insuring agent as a Medicaid benefit:
(1) emergency transport, which is ambulance service
for a Medicaid recipient with an emergency medical condition. Emergency
medical condition is defined as one which manifests itself by acute
symptoms of sufficient severity such that the absence of immediate
medical attention could result in placing the recipient's health in
serious jeopardy; and
(2) nonemergency transport, under the following conditions:
(A) the recipient is severely disabled, which is defined
as a condition which limits mobility and requires confinement to bed
at all times, prevents sitting unassisted at all times, or requires
the monitoring of life support systems, including oxygen or intravenous
infusion;
(B) the severely disabled recipient cannot be transported
by any means other than an ambulance without endangering the health
or safety of the recipient; and
(C) the nonemergency ambulance transportation of the
severely disabled recipient is to or from a scheduled medical appointment
and authorization has been received from the Texas Department of Health
or its designee. If payment under the medical assistance program is
denied because the facility failed to obtain prior authorization,
the facility must pay for the service if presented a copy of the bill
for which payment was denied.
(f) If ambulance services are reimbursable by the
state's Medicaid health insuring agent, they are not the responsibility
of the recipient, the family, or the responsible party.
(g) Nursing facilities are encouraged to use family,
friends, sponsors, civic groups, or charitable organizations as resources
for transportation services. If normal transportation is not obtainable
from these sources, the facility must provide or purchase the appropriate
services.
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| Source Note: The provisions of this §554.2320 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective June 1, 2004, 29 TexReg 5416; amended to be effective August 31, 2004, 29 TexReg 8141; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
