The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise.

1. (1) Ambulance service--A service paid through the Texas Department of Health's (department's) health insuring agent only in an emergency or when transportation in any other vehicle could endanger the patient's health.
2. (2) Ambulatory clients--Clients who are mobile without assistance from a person, animal, and/or an object such as a walker or wheelchair.
3. (3) Attendant--A person who accompanies a Medicaid client to provide necessary assistance to and from the vehicle and the specified medical facility, is the responsible adult for a minor, or is a translator for the client.
4. (4) Cancellation--Notification by a client or designee to Medical Transportation Program (MTP) staff that medical transportation is no longer needed, in time to allow MTP staff to contact the provider to cancel the trip(s).
5. (5) Common carrier--Regularly scheduled intercity transportation by air, rail, or bus for the general public.
6. (6) Contract period--The term of the contract agreement.
7. (7) Curb-to-curb service--Transportation from curb at origin to curb at destination. Curb-to-curb service also includes passenger assistance into and out of the vehicle by the driver and/or attendant.
8. (8) Demand-responsive--Transportation that involves using dispatched vehicles in response to requests for one-way trips. The transportation provides shared occupancy or personalized transportation on demand.
9. (9) Destination--The location of the nearest regular passenger disembarkation point to the medical facility to which the provider is authorized to take the client.
10. (10) Door-to-door service--Transportation from the door of the trip origin to the door of the trip destination as specified by the client or attendant and authorized by the MTP staff. Door-to-door service also includes passenger assistance by the driver and/or attendant.
11. (11) Family health services registered nurses--Department staff who educate Medicaid clients and families on the proper use of Medicaid services.
12. (12) Fiscal year--The 12-month period used for budget purposes (state fiscal year is September 1 through August 31, federal fiscal year is October 1 through September 30).
13. (13) Fixed route--A predetermined, scheduled transportation service with no deviation from the prescribed route.
14. (14) Fraud--Deliberate misrepresentation or intentional concealment of information to obtain or be paid for services to which a person or provider is not entitled.
15. (15) Individual provider--A volunteer with a written agreement with the department to transport clients to medical services authorized by MTP staff at a prescribed mileage reimbursement rate. The individual providers are reimbursed for mileage only.
16. (16) Lock-in--The Medicaid client is limited or locked into a designated physician or pharmacy.
17. (17) Mass transit--Urban transportation subsidized by sales taxes or Federal Transit Administration funds and provided to the general public within a predetermined local area.
18. (18) Medicaid--A state-administered program (Title XIX of the Social Security Act) that provides certain health care services to eligible individuals.
19. (19) Medicaid-allowable medical service--A service covered under the Medicaid state plan for which the individual is eligible. This includes services for which the recipient is eligible, even if the services are not billed to Medicaid, so long as the service does not exceed the amount, duration, and scope specified in the department's Medicaid Provider Procedures Manual.
20. (20) Medical necessity--The need for medical services, according to accepted standards of medical practice, in the amount and frequency sufficient to preserve health and life and to prevent future impairment.
21. (21) Minor--An individual under 18 years of age who has never been married or emancipated by court ruling.
22. (22) Nonambulatory clients--Clients who are mobility impaired and must depend on a person, animal, and/or an object such as a walker or wheelchair.
23. (23) No show--A client who does not respond within five minutes of the time the provider announces his arrival at trip origin.
24. (24) One-way trip--Transportation of a passenger from point of origin to destination.
25. (25) Origin--The location at which the provider is authorized to pick up the client, as specified by MTP staff and local laws and/or medical provider traffic rules.
26. (26) Passenger assistance--Help provided to a person to walk or be pushed in a wheelchair. This does not include the lifting or carrying of the person.
27. (27) Physical abuse--The willful infliction of intimidation or injury resulting in physical harm, pain, or mental anguish.
28. (28) Primary providers--Persons, business entities, and governmental entities who have entered into a legal contract with the department for the purpose of providing MTP-authorized transportation for eligible clients.
29. (29) Priority trips--Trips that the contractor must provide on the original authorized appointment date.
30. (30) Reasonable transportation--Normally refers to transportation within a client's local community, within a client's county of residence, or to and from a county adjacent to a client's county of residence where the client wishes to maintain or obtain an ongoing relationship with a health care provider of his or her choice. Reasonable transportation also includes travel by a client for long distances to obtain medically necessary, Medicaid-allowable services from a specialist when appropriate medical services are not available locally. In all cases, reasonable transportation will be the most cost effective transportation that meets the client's medical needs.
31. (31) Rejection of authorized routine trips--Authorized routine trips refused by primary providers because of scheduling and/or space limitations.
32. (32) Routine medical transportation--Authorized medical transportation of eligible clients to and from the nearest Medicaid services where medical needs will be met.
33. (33) Routine trips--Trips that do not have priority status.
34. (34) Sanctions--Disciplinary action taken by the department for breach of contract which could lead to contract termination.
35. (35) Scheduling--Authorized medical transportation on specific vehicles arranged for clients by primary providers to ensure the client's arrival at medical services prior to appointment times on the appointment date.
36. (36) Semi-fixed route--A predetermined, scheduled transportation route with allowable deviations.
37. (37) Sexual harassment--Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature directed toward a person by another person during a trip authorized by MTP staff.
38. (38) Subcontractors--Persons, business entities, and governmental entities who have entered into a legal contract with a primary provider for the purpose of providing authorized medical transportation for eligible clients.
39. (39) Unit of service--That unit (one-way trip) specified by the contract, upon which the unit rate is based.
40. (40) Usual and customary charge (U&C)--The amount the provider customarily charges the general public for the same service. If special charges are applicable based on special characteristics of the individuals or services provided, the U&C may be specified for those individuals or services.
41. (41) Validated incident--An allegation of an incident substantiated by the department's records, transportation or medical provider records, and/or witnesses of the incident to the satisfaction of department staff.
42. (42) Volunteer--A person who provides services without being paid for involvement of time (see definition of individual provider in this section).

Source Note:The provisions of this §40.1 adopted to be effective November 15, 1992, 17 TexReg 7460; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; amended to be effective December 7, 1995, 20 TexReg 9852.