Medical Transportation Program (MTP) services must be prior authorized by Regional MTP staff. MTP services include the following:

1. (1) reasonable transportation of a prior authorized MTP recipient to and/or from a prior authorized health care facility where health care needs will be met , which includes transportation to and from renal dialysis services for recipients enrolled in the medical assistance program who are residing in a nursing facility;

2. (2) special medical transportation to a health care facility when one of the following conditions is met:

   1. (A) the services are allowable and the health care provider will not bill Medicaid or another source for the cost of the services; or
   2. (B) the recipient provides Regional MTP staff with a Health Care Provider's Statement of Need or equivalent for review and the service is determined reasonable.
3. (3) transportation for an attendant(s); if the health care provider documents the need, the recipient is a minor, or a language or other barrier to communication or mobility exists that necessitates such assistance;
4. (4) transportation for a service animal when accompanying a recipient;
5. (5) retroactive reimbursement for up to three months of reasonable transportation, meals and lodging if the recipient is a new recipient to MTP and was eligible under all program requirements. The retroactive reimbursement process will begin on the date of the request for retroactive reimbursement;
6. (6) advance funds for an eligible child and attendant(s) when lack of transportation funds will prevent the child from traveling to receive health care services; and

7. (7) reimbursement or advance funds for an eligible child and attendant(s) for meals and lodging when the health care service requires the child to remain overnight. If the child remains overnight for six consecutive months, the recipient or responsible party must provide proof of residency by providing:

   1. (A) copy of federal or state ID (driver's license or identification card); and
   2. (B) copy of a utility bill under the recipient's or responsible party's (if recipient is a child) name; or
   3. (C) if residing with a family member, written verification that the applicant resides in the household.
8. (8) partial reimbursement or advance funds for a prior authorized MTP recipient and attendant(s) for transportation beyond the approved destination. Partial reimbursement is limited to the amount that would have been paid to the approved destination for transportation permitted under paragraph (1) of this section.

Source Note:The provisions of this §380.203 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.