Read 2010_Texas_Medicaid_Provider_Procedures_Manual.book(Vol1_D_Medical_Transportation.fm) text version

TE X A S M E D I C A I D P R O V I D E R P R O C E D U R E S M A N U A L : V O L . 1

APPENDIX D: MEDICAL TRANSPORTATION

D.1 Medical Transportation Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2 D.1.1 MTP Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-2 D.1.2 Program Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-2 D.1.3 Program Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-2 D.1.3.1 Verification of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-2 D.1.3.2 Form H3113, Health Care Provider Statement of Medical Need. . . . . . . . . . . . . . . . . .D-3 D.1.4 Contacting MTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-3 D.1.5 MTP Program Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-3

D-1 CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.

TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

D.1 Medical Transportation Program

The Medical Transportation Program (MTP) is funded with federal and state dollars to arrange nonemergency transportation to medical or dental appointments for eligible clients and their attendants. When eligible clients and their attendants have no other means of transportation, HHSC MTP arranges the most cost-effective mode of transportation that meet the client's transportation needs.

D.1.1 MTP Eligibility

Texas Medicaid, Medicaid managed care, and Children with Special Health Care Needs (CSHCN) Services Program clients and their attendants are eligible to receive MTP services. To be eligible for MTP services, clients must have no other means of transportation. For Medicaid clients (20 years of age or younger) and CSHCN Services Program clients, MTP advances clients funds for travel. Additionally, when health-care services require an eligible client to remain overnight, MTP advances funds for meals and lodging for the eligible client and attendant. CSHCN clients who are 21 years of age or older and diagnosed with cystic fibrosis may also qualify for these services.

D.1.2 Program Services

MTP provides for the following general services: · Mass transit (intercity and intracity)--Passes or tickets for client transport within a city and from city to city. Air travel is also an allowable service. · Demand response transportation--Common carriers such as taxi, wheelchair van, and other transportation according to contractual requirements. · Mileage reimbursement (through the individual transportation provider)--Mileage reimbursement for enrolled provider. Enrolled individual transportation provider can be the responsible party, family member, friend, neighbor, or client. · Meals--Contracted vendors (e.g., hospital cafeteria.) · Lodging--Contracted hotels and motels. · Advanced funds--Financial services contractor. · Attendant--Responsible party, parent/guardian, etc. who accompanies the client to a health-care service.

D.1.3 Program Requirements

D.1.3.1 Verification of Service

Medicaid federal regulations require that MTP verify that eligible clients are transported to an enrolled Medicaid provider for the purpose of receiving a covered Medicaid service. To continue to receive transportation services, Medicaid clients request their health-care providers to sign verification of receipt of services forms or to provide a statement on official letterhead attesting that the client received services on a specific date of service. It is the responsibility of the client to request verification of service. To verify MTP, mass transit, and advanced funds transportation services, clients submit the following forms for signature: · Form H3103, Individual Transportation Provider Service Record · Form H3111, Verification of Travel to Healthcare Service by Mass Transit · Form H3131, Authorization and Request for Advance Funds--Travel The Medicaid-enrolled health-care provider must complete and sign these forms upon the client's request. The health-care provider's signature attests to the accuracy and authenticity of the information included on the form or in the statement.

D-2 CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.

APPENDIX E: MEDICAL TRANSPORTATION

D.1.3.2 Form H3113, Health Care Provider Statement of Medical Need

In some cases, the client's attending provider is asked to complete Form H3113, Health Care Provider Statement of Need. Form H3113 is required to determine appropriate mode of transportation, need for special accommodation (e.g., attendant), or necessity of long distance travel to a provider outside of the client's residential transportation area. Medicaid health-care providers completing Form H3113 must complete the form based on the client's medical need, not the client's preferences.

D.1.4 Contacting MTP

If health-care providers have MTP-eligible patients who express difficulty accessing health-care services, advise the clients or their advocates to call the statewide MTP toll-free number (1-877-633-8747) to request transportation services. For transportation services within the county where the client lives, clients or their advocates must call the MTP office at least 2 business days before the scheduled appointment. For clients who need to travel beyond the county where they live, clients or their advocates must call the MTP office at least 5 business days before the scheduled appointment. The client must provide the following information to the intake operator at the time of the call: · Medicaid number, CSHCN number, or Social Security number (SSN) · Name and address · Telephone number, if available · Name, address, and telephone number of the health-care provider · Purpose of the trip · Affirmation that no other means of transportation is available · Special needs, wheelchair lift, or attendant need

D.1.5 MTP Program Limitations

Clients and their attendants are not eligible to receive medical transportation services under the following circumstances (this list is not all-inclusive): · Transportation for children who are 17 years of age or younger and not accompanied by a parent or legal guardian, unless one of the following conditions exists: · Emergency transportation or nonemergency ambulance services · Transportation to or from a day activity health services facility, personal care home, state institution, nursing facility (unless the client requires dialysis treatment), or facility participating in another Title XIX Program for which the reimbursement rate structure includes transportation funds · Transportation when the client or another person or entity providing care for the client receives direct payment of workers' compensation benefits, U.S. Department of Veterans Affairs benefits, or other third-party resources for transportation to health-care services on the client's behalf · Transportation when the client is an inpatient in a health-care facility · Transportation of deceased clients · Transportation passenger assistance beyond that which is necessary to ensure that clients enter and exit vehicles safely Refer to: Title 1, Part 15, Chapter 380 of the Texas Administrative Code (TAC) for more information.

D-3 CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.

Information

2010_Texas_Medicaid_Provider_Procedures_Manual.book(Vol1_D_Medical_Transportation.fm)

4 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

35574