Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 554 - NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION › Subchapter X - REQUIREMENTS FOR MEDICAID-CERTIFIED FACILITIES › Section 554.2320 - Medical Transportation

Current through Reg. 49, No. 28; July 12, 2024
(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.