25 Tex. Admin. Code § 37.201 - Transportation of an Infant to a Hospital's Level III Neonatal Intensive Care Unit

(a) Definitions. The following words and terms, when used in this section, shall have the following meaning unless the context clearly indicates otherwise:

(1) Act-House Bill 893, 68th Legislature, 1983, covering transportation of an infant to a hospital's level III neonatal intensive care unit.

(2) Department-Texas Department of Health.

(3) Infant-For the purposes of this rule, infant means the neonatal period, i.e., through the first 28 days of life.

(b) Hospitals which may participate. A hospital qualifies for possible reimbursement under the Act if it furnishes to the department's Bureau of Crippled Children's Services written documentation that the hospital has a level III neonatal intensive care unit which complies with current American Academy of Pediatrics' standards. This documentation must be furnished by the hospital to the department annually.

(c) Reimbursement procedures.

(1) All requests for payment from a qualifying hospital shall be sent to the Bureau of Crippled Children's Services, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756.

(2) A request for payment from a qualifying hospital must be accompanied by a statement signed by the administrator certifying that the cost, or portion thereof, for which the department is being billed cannot be borne by a member of the infant's immediate family or other person legally liable for the infant's support by personal means, through insurance or through any other benefit system that pays for medical transportation. The request for payment must identify the transported infant by name, date of birth, diagnosis, parent's name, address, and social security number and must provide a detailed list of billed charges and the date on which the transport occurred.

(3) Charges submitted must be actual cost usually and customarily paid by the hospital to a provider of transportation or, if provided by the hospital, costs not greater than the facility's usual and customary charges for transportation services. Charges must be submitted within 60 days of the service provision. Charges received later than 60 days after the provision of the service will not be considered for payment.

(4) Payment by the department is subject to the availability of funds designated to the department under provision of the Act. Charges will be processed for payment in order they are received, and if charges are received after designated available funds are depleted during a fiscal year, no payment will be made for these charges by the department. Further, the charges received by the department after funds for a fiscal year are depleted cannot be considered for payment from possible future funding.

Notes

25 Tex. Admin. Code § 37.201

The provisions of this §37.201 adopted to be effective December 31, 1983, 8 TexReg 4748.