| (a) Recipient Rights.
(1) Nondiscrimination. The recipient has a right to
receive services in compliance with Title VI of the Civil Rights Act
of 1964, 42 U.S.C.A. §§2000d, et seq.; §504
of the Rehabilitation Act of 1973, 29 U.S.C.A. §794; the Americans
with Disabilities Act of 1990, 42 U.S.C.A. §12101, et seq.;
and all amendments to each, and all requirements imposed by the regulations
issued pursuant to these Acts, in particular 45 CFR Part 80 (relating
to race, color, national origin), 45 CFR Part 84 (relating to handicap),
45 CFR Part 86 (relating to sex), and 45 CFR Part 91 (relating to
age).
(2) Abuse report. Recipients should report verbal or
physical abuse or sexual harassment committed by other recipients
or passengers, contractor employees, or department staff to Regional
MTP staff or Regional Management staff upon arrival at the recipient's
destination.
(3) Denial notification. If a service is denied, Regional
MTP staff shall notify the recipient in accordance with Chapter 1,
Subchapter C, §1.41 of this title (relating to Medicaid Uniform
Fair Hearings Procedures). This recipient notification does not apply
to transportation services under §40.106 of this title (relating
to Program Exclusions).
(4) Appeal request. A recipient whose services have
been denied may request an administrative review by the Regional MTP
Manager. A second administrative review may be conducted by the MTP
Program Director. If the recipient is still dissatisfied, the recipient
may appeal the administrative review decision or the service denial
by requesting a fair hearing. A request for a fair hearing must be
in writing and mailed or hand-delivered to the appropriate Regional
MTP office.
(b) Recipient Responsibilities.
(1) When a recipient or responsible adult requests
transportation, he/she must provide Regional MTP staff with the following
information:
(A) recipient name, address, and, if available, the
telephone number;
(B) Medicaid, TICP or CSHCN recipient identification
number (if applicable) or Social Security number, and date of birth;
(C) name, address, and telephone number of health
care provider and/or referring health-care provider;
(D) purpose and date of trip and time of appointment;
(E) affirmation that other means of transportation
are unavailable;
(F) special needs, including wheelchair lift or attendant(s);
(G) medical necessity verified by the Health Care Provider's
Statement of Need, if applicable; and
(H) affirmation that advance funds are needed in order
for the recipient to access health care services;
(I) recipient must reimburse the department for any
advance funds, and any portion thereof, that are not used for the
specific prior authorized service.
(2) Recipients must refrain from verbal and/or physical
abuse or sexual harassment toward another recipient or passenger,
contractor's employees, or department employees while requesting or
receiving medical transportation services.
(3) Recipients must safeguard all bus tickets and/or
tokens from loss and theft and must return unused tickets or tokens
to the Regional MTP office issuing the tickets or tokens.
(4) Recipients who receive mass-transit bus tickets
or tokens must complete the department's Verification of Travel to
Health Care Services by Mass Transit, Form 3111. Recipients must return
this verification form prior to their next request for tickets or
tokens. A letter from the health care provider verifying delivery
of services may be substituted for the disbursement of mass transit
tickets or tokens verification form. Exceptions to this documentation
may be granted by a Regional MTP Manager or supervisor when circumstances
occur that are beyond the recipient's control. Exceptions will be
documented in the recipient's record.
(5) Recipients must not use authorized medical transportation
for purposes other than travel to and from health care services.
(6) If the recipient does not need to use the authorized
transportation services, the recipient or the responsible adult should
contact the Regional MTP staff to cancel the particular trip no less
than four hours prior to the time of the authorized trip.
(7) Recipients who receive advance funds for meals,
lodging, and/or travel must return a completed Individual Volunteer
Contractor (IVC) Service Record verifying services were provided,
prior to receiving future advance funds or reimbursements.
(8) Recipients must cancel requests for advance funds
or lodging when not needed and must refund any disbursed advance funds
to the department.
(9) Recipients must provide appropriate receipts when
seeking reimbursement for lodging.
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| Source Note: The provisions of this §380.301 adopted to be effective April 10, 2001, 26 TexReg 2720; amended to be effective May 11, 2003, 28 TexReg 3722; transferred effective March 1, 2004, as published in the Texas Register April 30, 2004, 29 TexReg 4267 |
