Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter A - PURCHASED HEALTH SERVICES
Division 34 - OUT-OF-STATE SERVICES
Section 354.1440 - Medical Care or Services Provided to Medicaid Recipients Outside of Texas

(a) Subject to certain conditions, limitations, and exclusions, the Texas Medicaid program covers medical assistance services provided to an eligible Texas recipient while away from Texas in another state if the recipient does not leave Texas for the purpose of receiving out-of-state medical care that the recipient can receive in Texas. Services provided outside of Texas but within the United States are covered to the same extent they are covered in Texas when:

(b) Except as provided in subsection (a) of this section or otherwise specified by the Texas Health and Human Services Commission (HHSC) or its designee, the Texas Medicaid program does not pay for medical care and services furnished outside Texas unless prior authorization is obtained from HHSC or its designee. Prior authorization is required for utilization control and to ensure the appropriate use of medical resources. Prior authorization may be obtained by submitting medical justification or documentation to HHSC or its designee indicating the reason the recipient must obtain medical care outside Texas. Prior authorization must be obtained before providing the medical care or service.

(c) HHSC or its designee determines the basis and amount of reimbursement for medical services provided outside Texas but within the United States in accordance with Chapter 355 of this title (relating to Reimbursement Rates).