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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 380MEDICAL TRANSPORTATION PROGRAM
SUBCHAPTER BELIGIBILITY, PROGRAM SERVICES, PROCESSES, ADDITIONAL TRANSPORTATION CONNECTED WITH AN AUTHORIZED TRIP, LIMITATIONS, AND EXCLUSIONS
RULE §380.207Program Limitations

Recipients are not eligible to receive medical transportation services under the following circumstances:

  (1) to and from a day activity, a personal care home or state institution, or a facility participating in another Title XIX program for which the reimbursement rate structure includes transportation funds, except as specified in §380.203(1) of this subchapter (relating to Program Services);

  (2) the intended destination is a nursing facility;

  (3) the recipient is an inpatient in a health care facility, except as specified in §380.203(1) of this subchapter;

  (4) the recipient is under 15 years of age and:

    (A) the recipient's parent, guardian, or another adult authorized by the parent or guardian does not accompany the recipient as required by §354.1133 of this title (relating to Parental Accompaniment Requirement); and

    (B) the parent or guardian, if authorizing another adult to accompany the recipient, has not provided written authorization on a form prescribed by the Health and Human Services Commission, which will allow for the designation of one authorized adult and one alternate authorized adult;

  (5) the recipient is 15 through 17 years of age and not accompanied, unless one of the following conditions exists:

    (A) the recipient presents the parent's or legal guardian's signed, written consent for the transportation services to the Regional MTP office or the transportation contractor; and/or

    (B) the treatment to which the minor is being transported is such that the law extends confidentiality to the minor for this treatment;

  (6) the recipient or another person or entity providing care for the recipient receives direct payment of worker's compensation benefits, U.S. Department of Veterans Affairs benefits, or other third-party resources for transportation to health care services on the recipient's behalf;

  (7) the recipient is on limited status, unless the provider has made the referral or the recipient requests family planning services;

  (8) TICP diagnostic visits and/or cancer or cancer-related treatments that are provided out-of-state;

  (9) the recipient and/or attendant intentionally, knowingly, or recklessly boards the vehicle carrying an illegal knife, a club, handgun or other weapon, as defined in Penal Code, §46.01, on or about his or her person;

  (10) a third-party, such as a lodging establishment, provides transportation, meals, and/or lodging at no charge for a recipient and attendant, for a particular appointment; or

  (11) an attendant does not accompany the recipient on the MTP-requested trip when a Health Care Provider's Statement of Need, Form 3113 or equivalent, is on file stating the recipient requires an attendant(s).


Source Note: The provisions of this §380.207 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; amended to be effective September 13, 2004, 29 TexReg 8796; amended to be effective January 1, 2013, 37 TexReg 10192

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