Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 380 - MEDICAL TRANSPORTATION PROGRAM
Subchapter B - ELIGIBILITY, PROGRAM SERVICES, PROCESSES, ADDITIONAL TRANSPORTATION CONNECTED WITH AN AUTHORIZED TRIP, LIMITATIONS, AND EXCLUSIONS
Section 380.201 - Eligibility

Universal Citation: 1 TX Admin Code § 380.201

Current through Reg. 49, No. 38; September 20, 2024

(a) The following prior authorized Medical Transportation Program (MTP) clients are eligible to receive reasonable transportation to covered health care services if no other means of transportation are available, the mode of transportation is the most cost-effective mode available, and the facility is reasonably close and meets the client's health care needs:

(1) current Medicaid clients authorized and identified by the Health and Human Services Commission (HHSC) as eligible for Medicaid services under a specific category;

(2) Children with Special Health Care Needs (CSHCN) services program clients; and

(3) Transportation for Indigent Cancer Patients (TICP) Program clients.

(b) Eligibility for participation in the TICP Program must be determined by HHSC. The individual:

(1) must reside in Webb, Zapata, Starr, Jim Hogg, Hidalgo, Cameron, Willacy, or Nueces County and provide a copy of a federal or state ID (driver's license or identification card) and one of the following as proof of residency:

(A) a copy of a utility bill under the applicant's name; or

(B) if residing with a family member, a written verification from that family member stating that the applicant resides in the household and proof that the household is in an eligible county;

(2) must not be eligible for Medicaid;

(3) must not be eligible for CSHCN services program;

(4) must be at or below 100% of federal poverty guidelines. Before program services are provided, the monthly household gross income shall be verified by:

(A) financial information obtained through HHSC;

(B) check stub or other written verification for each person in the household who is employed. This form must contain the name, address of employer, income and dates covered for each pay period; or

(C) award letter or other written verification of unearned income (such as Social Security, Worker's Compensation, Unemployment or Veteran's Administration benefits);

(5) is permitted the following allowable deductions from the total monthly household gross income:

(A) $120 standard deduction per person in household who is employed (the standard deduction per person will be the rate set by HHSC); and

(B) dependent care:

(i) up to $200 per child under two years of age; or

(ii) up to $175 per child two years of age and older;

(6) is not permitted to take deductions on unearned income;

(7) if over the age of 18 and residing with a family member, the family member's household income is not considered. The applicant's gross income, less standard deductions, is used to determine the applicant's eligibility;

(8) has zero income and shall therefore submit written verification from two family members or individuals who can attest that the household receives no monthly earned or unearned income. Unearned income refers to monetary assistance provided by family, friends, charitable organizations, and such given to the client for household expenses;

(9) must provide initial confirmation of cancer or cancer-related diagnosis by a licensed medical physician to HHSC. The following restrictions apply:

(A) the applicant is eligible for up to four diagnostic visits to a licensed medical physician to determine cancer or cancer-related diagnosis if HHSC is provided written verification that diagnostic visits are to rule out the possibility of cancer or cancer-related illness; and

(B) confirmation of cancer or cancer-related diagnosis must be provided on or following the last diagnostic visit for transportation services to continue; and

(10) must be accepted for evaluation or treatment by a medical institution in Texas capable of providing quality cancer services. §380.202.Program Services.

Transportation services prior authorized by the Medical Transportation Program (MTP) or transportation providers include:

(1) Demand response transportation services provided when fixed route services are either unavailable or do not meet the health care needs of clients. Services must be timely and provided by qualified, courteous, knowledgeable, and trained personnel;

(2) Mass transit tickets when determined to be the appropriate mode of transportation for the client, ensuring the client does not live more than a quarter (1/4) mile from a public fixed route stop, the appointment is not more than a quarter (1/4) mile from a public fixed route stop, and that mass transit tickets are received by the client before the client's appointment;

(3) Individual transportation participant services provided by volunteers who enter into an agreement and are reimbursed for mileage if they are prior authorized to drive a client to a covered health care service in a personal car;

(4) Meal and lodging services for clients and an attendant when a covered health care service requires an overnight stay outside the client's county of residence or beyond adjacent counties. Clients and attendants must receive the same quality of services provided to other guests and the lodging services must be equivalent or better than those listed in the Office of the Texas Comptroller's State Travel Management Program;

(5) Transportation to and from renal dialysis services for clients enrolled in the Medicaid program who are residing in a nursing facility, as required by the Human Resources Code;

(6) Advance funds disbursed before the covered health care service to clients when a lack of transportation funds will prevent a child from traveling to the service. Advance funds are for clients through age 20 and Children with Special Health Care Needs services program clients 21 and over who have been diagnosed with cystic fibrosis. Advanced funds may be issued to cover meals, lodging, and/or mileage;

(7) Out-of-state transport to contiguous counties or bordering counties in adjoining states (Louisiana, Arkansas, Oklahoma, and New Mexico) that are within 50 miles of the Texas border, if services are medically necessary and it is the customary or general practice of clients in a particular locality within Texas to obtain services from an out-of-state provider that is enrolled as a Texas Medicaid provider;

(8) Commercial airline transportation services for a client and attendant to a covered health care service, when it is the most cost effective option or when necessary to meet the client's medical needs; and

(9) Nonemergency ambulance transportation services, including a driver and an assistant, for clients who are in excess of 600 pounds, reclining position, or are non-ambulatory and cannot be transported in a taxicab or wheelchair van.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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