The following words and terms, when used in the Medical Transportation Program (MTP) rules, shall have the following meanings, unless the content clearly indicates otherwise.

1. (1) Abuse--The willful infliction of intimidation or injury resulting in physical harm, pain, or mental anguish.
2. (2) Adjacent county(ies)--The county or counties that share a common county line or point with the recipient's county of residence.
3. (3) Advance funds--Funds authorized by the Health and Human Services Commission (HHSC) in advance of travel and provided to a recipient or attendant for a medically-necessary health care service.
4. (4) Ambulance service--A service paid through HHSC or its designee in an emergency, or non-emergency situation in which transportation in a vehicle other than an ambulance could endanger the recipient's health.
5. (5) Attendant--An adult required to accompany a prior authorized MTP recipient under §380.207(4) of this chapter (relating to Program Limitations) or an adult or service animal that accompanies a prior authorized MTP recipient to provide necessary mobility, personal or language assistance to the recipient during the time that transportation and health care services are provided.
6. (6) Certification Period--A period of time for which the recipient is certified for service.
7. (7) Children with Special Health Care Needs (CSHCN)--A program funded with general revenue and federal funds. Services for eligible children include early identification, diagnosis and evaluation, resulting in early health care intervention.
8. (8) Contractor--A for-profit business, a non-profit organization, or a governmental unit, including a regional contracted broker, that has entered into a legally binding contract with HHSC to provide authorized MTP transportation services, advance funds, meals and/or lodging to prior authorized MTP recipients.
9. (9) Dependent care--Necessary care for a child or an adult with a disability.
10. (10) Destination--The place or point to which a recipient has been authorized by MTP to travel.
11. (11) Door-to-door service--Transportation from the door of the trip origin to the door of the trip destination as authorized by Regional MTP staff. This service includes providing assistance, as required, to passengers entering and exiting the vehicle.
12. (12) Fraud--Deliberate misrepresentation or intentional concealment of information in order to obtain services or payment for services to which a person or contractor is not entitled.
13. (13) Health and Human Services Commission (HHSC)--The state agency that operates the Medical Transportation Program.
14. (14) Health Care Provider's Statement of Need--MTP Form 3113 or equivalent submitted by a health care provider which documents the recipient's need for health care services and/or special transportation accommodations.
15. (15) Individual Transportation Participant (ITP)--An individual who has been approved by HHSC for mileage reimbursement at a prescribed rate to provide transportation for a prior authorized MTP recipient to a prior authorized health care service.
16. (16) Limited Status--A Medicaid recipient's limitation to a designated provider, either a primary care provider or primary care pharmacy, under the lock-in provisions contained in Chapter 354, Subchapter K of this title (relating to Medicaid Recipient Utilization Review and Control). Recipients are limited for specific periods of time as outlined in §354.2405(c) of this title (relating to Utilization Control).
17. (17) Lodging establishment--An establishment such as a hotel, motel, charitable home or hospital that provides overnight lodging.
18. (18) Mass transit--Transportation that is subsidized by sales taxes or Federal Transit Administration funds and provided to the general public within a specified local area.
19. (19) Medicaid--A health care program provided to eligible individuals under 42 U.S.C. §1396a et seq.; 42 C.F.R. §431.53; Texas Human Resources Code, Chapters 22 and 32.
20. (20) Medicaid-allowable service--A service covered under the State's Medicaid Plan or a Medicaid waiver. This includes health care services that are provided to the recipient by a charitable organization but not billed to Medicaid as well as value-added services provided by a Medicaid managed care plan to a Medicaid-enrolled member.

21. (21) Medically-necessary--Services that are:

    1. (A) reasonably necessary to: prevent illness(es) or medical condition(s); maintain function or to slow further functional deterioration; provide early screening, intervention, care, and/or provide care or treatment for eligible recipients who have medical condition(s) that cause suffering or pain, physical deformity or limitations in function, or that threaten to cause or worsen a disability, illness or infirmity, or endanger life;
    2. (B) provided at appropriate locations and at the appropriate levels of care for the treatment of the medical condition(s);
    3. (C) consistent with health care practice guidelines and standards endorsed by professionally recognized health care organizations or governmental agencies;
    4. (D) consistent with the diagnosis(es) of the condition(s); and
    5. (E) no more intrusive or restrictive than necessary to provide a proper balance of safety, effectiveness, and efficiency.
22. (22) Medical Transportation Program (MTP)--A program which provides prior authorized non-emergency transportation services to and from covered health care services, based on medical necessity, for categorically eligible Medicaid recipients enrolled in Medicaid, and eligible recipients enrolled in CSHCN, or the Transportation for Indigent Cancer Patients (TICP) program who have no other means of transportation.
23. (23) Minor--An individual under 18 years of age who has never been married or emancipated by court ruling.
24. (24) Passenger assistance--Assistance which enables a recipient to walk, enter or exit a vehicle, or transfer from a wheelchair. This does not include lifting or carrying a person.
25. (25) Prior authorization--Authorization or approval for the provision of transportation, attendant, advance funds and meals and/or lodging services obtained from Regional MTP staff before the services are rendered.
26. (26) Prior authorized MTP recipient--A recipient authorized by HHSC as eligible for Medicaid services under a specific category, or identified by either the CSHCN or the TICP program as eligible for program services, who has no other means of transportation to health care services.

27. (27) Reasonable transportation--Transportation using the most cost-effective transportation that meets the recipient's medical needs:

    1. (A) within a recipient's local community, county of residence, or county adjacent to a recipient's county of residence where the recipient wishes to maintain an ongoing relationship or establish a relationship with a health care provider of his or her choice;
    2. (B) to and from a county beyond the county adjacent to the recipient's county of residence when determined by HHSC to be reasonably close to obtain medically necessary, health program allowable services from a specialist when appropriate medical services are not available as specified in subparagraph (A) of this paragraph; or
    3. (C) to a provider or facility within a designated Medicaid managed care service delivery area.
28. (28) Regional contracted broker--An entity that contracts with HHSC to provide or arrange for the provision of nonemergency transportation services under the MTP.
29. (29) Routine medical transportation--Prior authorized medical transportation trips that do not have priority status to and/or from a facility where health care needs will be met.
30. (30) Service animal--A trained guide dog, signal dog, or other animal to provide assistance to a specified MTP recipient with a disability.
31. (31) Sexual harassment--Unwelcome sexual advances, requests for sexual favors, or other unwanted verbal or physical conduct of a sexual nature directed toward an individual by another individual during the provision of MTP services.
32. (32) Special medical transportation--Medical transportation to and/or from a recipient's county of residence and beyond the adjacent county, where health care needs will be met and the appropriate health care service(s) are not available locally.
33. (33) Special needs--A transportation service that requires the use of a vehicle equipped with a ramp or a mechanical lift to provide the recipient with a means of accessing the vehicle.
34. (34) Transportation for Indigent Cancer Patients (TICP) Program--A state-funded program that provides medical transportation services to individuals diagnosed with cancer or a cancer-related illness and who meet TICP residency and financial criteria.

Source Note:The provisions of this §380.101 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 August 6, 2013, 38 TexReg 4888.