26 Tex. Admin. Code § 554.2320 - Medical Transportation
(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.
Notes
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