Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 40. MEDICAL TRANSPORTATION

The Texas Department of Health (department) proposes amendments to §§40.1, 40.101-40.103, 40.105-40.106, and 40.201, repeal of §§40.104, 40.301-40.304, 40.401-40.405, 40.501-40.502, 40.601-40.603 and new §40.301 concerning the Medical Transportation Program (MTP).

Specifically, the amendments, repeals and new section are required to add new definitions, correct terms, clarify language and delete references to information already contained in contract documents.

An amendment to §40.1 changes the term client(s) to recipient(s), eligible MTP client to prior authorized MTP recipient and individual contractor to individual volunteer contractor, changes references to the Chronically Ill and Disabled Children (CIDC) program to the Children with Special Health Care Needs (CSHCN) program, adds additional definitions, expands on definitions and deletes definitions contained in contract documents.

The amendments to §§40.101-40.103, and 40.105 expands on language, changes the term client(s) to recipient(s) and changes references to the Chronically Ill and Disabled Children (CIDC) program to the Children with Special Health Care Needs (CSHCN) program, adds language pertaining to partial reimbursement or advance funds and clarifies services to nursing facilities.

An amendment to §40.106 changes the term client to recipient, changes references to the Chronically Ill and Disabled Children (CIDC) program to the Children with Special Health Care Needs (CSHCN) program, and adds additional requirements not covered by the MTP.

An amendment to §40.201 changes the term client(s) to recipient(s), changes references to the Chronically Ill and Disabled Children (CIDC) program to the Children with Special Health Care Needs (CSHCN) program, clarifies language in that if a service is denied, then the recipient shall be notified in accordance with Medicaid Uniform Fair Hearings Procedures by the MTP and adds an additional requirement to the recipients responsibilities.

New §40.301 pertains to individual volunteer contractors participation requirements and includes language from repealed §40.301.

Linda M. Altenhoff, D.D.S., Director, Texas Health Steps and Medical Transportation Division, has determined that for each year of the first five years the sections are in effect, there will be no fiscal implication to state or local government as a result of enforcing or administering the sections as proposed.

Dr. Altenhoff has also determined that for each year of the first five years the sections are in effect, the public benefits anticipated as a result of enforcing or administering the sections will be improved compliance with the policies and procedures related to the provision of medical transportation services. There will be no effect or implications on micro businesses or small businesses. This was determined by the conclusion that the end process for obtaining and receiving services remains the same. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated impact on local employment.

Comments on the proposal may be submitted to David Autry, Director, Medical Transportation Program, Texas Department of Health, 1100 West 49th Street, Austin, Texas, 78756, (512) 458-7519. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

Subchapter A. PROGRAM OVERVIEW

25 TAC §40.1

The amendment is proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The amendment affects the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.1.Definitions of Terms.

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) (No change.)

(2) Adjacent county(ies) -- The county or counties that share a common county line or point with [ next to ] the recipient's [ client's ] county of residence.

(3) Advance funds -- Funds authorized by Regional MTP staff in advance of travel and provided to a recipient [ client ] or attendant for a medically-necessary health care service.

(4) Ambulance service -- A service paid through the Texas Medicaid Program's Claims Administrator in an emergency, or non-emergency situation in which transportation in a vehicle other than an ambulance could endanger the recipient's health.

(5) [ (4) ] Attendant -- An individual, translator, other assistant 18 years of age or older or service animal that accompanies a prior authorized MTP recipient to provide necessary assistance to and from the vehicle and the specified medical facility [ an eligible client ].

(6) [ (5) ] Batch -- A group of mass-transit tickets or tokens with one unique confirmation number.

(7) [ (6) ] Cancellation -- Verbal or written notification from a recipient [ client, ] or a recipient's [ client ] advocate [ , or contractor ] prior to the scheduled medical transportation service which indicates that the particular service is not needed.

(8) [ (7) ] Certification Period -- A period of time for which the recipient [ service ] is certified for service .

(9) [ (8) ] Children with Special Health Care Needs (CSHCN) [ -Chronically Ill and Disabled Children (CSHCN-CIDC) ] -- A department program funded with general revenue and federal funds. Services for eligible children include early identification, diagnosis and evaluation, resulting in early health care intervention.

(10) [ (9) ] Contractor -- A [ An individual, a ] for-profit business, a non-profit organization, or a governmental unit that has entered into a legally binding contract with the department to provide authorized MTP transportation services, advance funds, meals and/or lodging to prior authorized MTP recipients [ eligible clients ].

(11) [ (10) ] Curb-to-curb service -- Transportation from curb at origin to curb at destination. This service includes providing assistance, as required, to passengers entering and exiting the vehicle.

(12) Demand-response -- Transportation that involves using dispatched vehicles in response to requests for individual or shared one-way trips.

(13) [ (11) ] Department -- Texas Department of Health. The State agency that operates the Medical Transportation Program [ under Title XIX of the Social Security Act ].

(14) [ (12) ] Dependent care -- Necessary care for a child or disabled adult.

(15) [ (13) ] Destination -- The place or point to which a recipient [ client ] has been authorized by MTP to travel.

(16) [ (14) ] 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.

[(15) Eligible MTP client -- A person enrolled in Medicaid, Children with Special Health Needs (CSHCN-CIDC), or the Transportation for Indigent Cancer Patients (TICP) programs.]

(17) [ (16) ] 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.

(18) [ (17) ] Health [ - ] Care Provider's Statement of Need -- MTP Form 3113 or equivalent [ A written statement or MTP form ] submitted by a health care provider which documents the recipient's [ client's ] need for health care services and/or special transportation accommodations .

[(18) Hotel -- An establishment that provides overnight lodging.]

(19) Individual Volunteer Contractor (IVC) [ contractor (IC) ] -- An individual [ A person ] who has an approved service agreement [ contracts ] with the department for mileage reimbursement at a prescribed rate to provide transportation for a prior authorized MTP recipient [ an eligible client ] to a prior authorized [ covered ] health care service.

(20) Limited [ Lock-in ] -- An action taken by the Texas Department of Human Services (TDHS) [ department ] to limit a Medicaid recipient's [ restrict the individual's ] choice of providers.

(21) Lodging establishment -- An establishment such as a hotel, motel, charitable home or hospital that provides overnight lodging.

(22) [ (21) ] Mass transit -- Transportation that is subsidized by sales taxes or Federal Transit Administration funds and provided to the general public within a specified [ predetermined ] local area.

(23) [ (22) ] Medicaid -- A health care program provided to eligible individuals under 42 U.S.C. §1396a et seq .; 42 C.F.R. 431.53; [ Title XIX of the federal Social Security Act and the ] Texas Human Resources Code, Chapters 22 and [ Chapter ] 32.

(24) [ (23) ] Medicaid-allowable service -- A service covered under the State's Medicaid Plan [ for which a client is eligible ]. This includes health care services that are provided to the recipient [ client ] 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.

(25) [ (24) ] Medically-necessary -- Services [ services ] that are:

(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;

(B) provided at appropriate locations and at the appropriate levels of care for the treatment of the medical condition(s);

(C) consistent with health care practice guidelines and standards endorsed by professionally recognized health care organizations or governmental agencies;

(D) consistent with the diagnosis(es) of the condition(s); and

(E) no more intrusive or restrictive than necessary to provide a proper balance of safety, effectiveness, and efficiency.

(26) [ (25) ] Medical Transportation Program (MTP) -- A program which provides prior authorization for non-emergency transportation services for recipients to and from health care services for categorically eligible Medicaid recipients [ persons ] enrolled in Medicaid, CSHCN[ -CIDC ], or TICP who have no other means of transportation to a prior authorized [ the ] health care service.

(27) [ (26) ] Minor -- An individual under 18 years of age who has never been married or emancipated by court ruling.

(28) [ (27) ] No show --

(A) a recipient [ client ] who does not respond within ten minutes of the time the contractor arrives at the designated pick-up point and scheduled time and announces its presence; or

(B) a contractor who fails to arrive at the designated pick-up point and time.

(29) [ (28) ] One-way trip -- Transportation of a passenger from point-of-origin to destination.

[(29) On-time -- Contractor arrives at the health care facility no more than one hour prior to the MTP client's scheduled medical appointment time and returns for pick up no later than one hour after the scheduled return trip time.]

(30) Origin -- The location at which the contractor is authorized to pick up the recipient [ client ].

[(31) Overnight stay -- A service enabling a client to remain beyond the date of MTP transportation at a health care facility located outside the client's city of residence.]

(31) [ (32) ] Passenger assistance -- Assistance which enables a recipient [ client ] to walk, enter or exit a vehicle, or transfer from a wheelchair. This does not include lifting or carrying a person.

(32) [ (33) ] Prior authorization -- Authorization or approval for the delivery of transportation [ certain ] services obtained from the department [ or its designee ] before the services are rendered. [ Prior authorized services may be limited in duration, scope, and amount. Services provided beyond those authorized are not reimbursable by MTP. If a prior authorization is limited in duration, scope or amount, a separate request must be submitted and approved for any additional services. ]

(33) Prior authorized MTP recipient -- A recipient, as authorized by the department, who has been identified by the Texas Department of Human Services (TDHS) as eligible for Medicaid services under a specific category, Children with Special Health Care Needs (CSHCN) or the Transportation for Indigent Cancer Patients (TICP) program, who have no other means of transportation to health care services.

(34) Priority Trips -- Prior-authorized trips that must be provided on the original authorized date and time.

(35) [ (34) ] Reasonable transportation -- Transportation [ within a client's county of residence, or to an adjacent county, ] using the most cost-effective transportation that meets the recipient's [ client's ] medical needs : [ . ]

(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;

(B) to and from a county beyond the county adjacent to the recipient's county of residence when determined by the department 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

(C) to a provider or facility within a designated Medicaid managed care service delivery area.

(36) [ (35) ] Rescheduled authorized trips -- Prior-authorized [ Authorized ] trips postponed by a contractor because of scheduling conflicts , inclement weather conditions [ and/ ] or seating capacity limitations.

(37) [ (36) ] Retroactive authorizations [ payments ] -- Authorizations provided [ Payments made to a contractor ] for eligible services which would have been authorized had they been requested prior to the service.

(38) [ (37) ] Routine medical transportation -- Prior-authorized [ Authorized ] medical transportation trips that do not have priority status [ of eligible clients ] to and/or from the nearest facility where health care needs will be met.

(39) [ (38) ] Same-day service -- An urgent request prior authorized by MTP staff.

[(39) Sanctions -- Disciplinary action against an MTP contractor for validated infractions of program rules, policies, or contract terms.]

[(40) Scheduling -- Authorized medical transportation arranged for clients by contractors to ensure the client's timely arrival at health care services on or before the scheduled medical appointment.]

(40) [ (41) ] Service animal -- A guide dog , [ or a ] signal dog , or other animal individually trained to provide assistance to an individual with a disability.

(41) [ (42) ] Sexual harassment -- Unwelcome sexual advances, requests for sexual favors, or other unwanted verbal or physical conduct of a sexual nature directed toward an individual [ a person ] by another individual during the provision of MTP services.

(42) [ (43) ] Special medical transportation -- Medical transportation to and/or from a recipient's county of residence to a health care facility beyond the adjacent county where health care needs will be met and the appropriate prior authorized service(s) are not available locally [ adjacent to the client's county of residence ].

(43) Special needs -- A transportation service request 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.

[(44) Subcontractor -- An individual, for-profit business, non-profit organization, or governmental unit that has entered into a legal contract with the department's MTP contractor to provide transportation services, advance funds, meals, and/or lodging to eligible clients authorized by Regional MTP staff.]

(44) [ (45) ] Transportation for Indigent Cancer Patients (TICP) Program -- A state-funded program that provides medical transportation services to recipients [ clients ] diagnosed with cancer or a cancer-related illness and who meet certain residency and financial criteria.

[(46) Urgent -- A request for same-day transportation service.]

[(47) Usual and customary charge -- The fee a contractor customarily charges the general public for a service.]

[(48) Workday -- Normal department operating hours from 8:00 a.m. - 5:00 p.m. Monday through Friday with the exception of state and federal holidays.]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207271

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §§40.101- 40.103, 40.105, 40.106

The amendments are proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The amendments affect the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.101.Eligibility.

(a) The following prior authorized MTP recipients are eligible to receive reasonable [ medical ] transportation to medical services if no other means of transportation are available , the mode of transportation is the most cost-effective mode available that does not endanger the recipient's health and the facility is reasonably close to the prior authorized health care service that meets the recipient's medical needs :

(1) Current Medicaid recipients authorized by the department and identified by the Texas Department of Human Services (TDHS) as eligible for Medicaid services under a specific category [ clients who are enrolled in Medicaid ];

(2) CSHCN[ -CIDC ] recipients [ clients ]; and

(3) TICP recipients [ clients ].

(b) Transportation for Indigent Cancer Patients (TICP) - To be [ determined ] eligible [ by the department ] for participation in the TICP Program, the recipient [ client ]:

(1) - (8) (No change.)

(9) has zero income and shall therefore submit written verification [ letters ] from two family members or individuals who can [ that ] attest that the household receives no monthly earned or unearned income [ to the applicant's current financial status ] . Unearned income refers to monetary assistance provided by family, friends, charitable organizations, and such given to the recipient for household expenses ;

(10) - (11) (No change.)

§40.102.Program Services.

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

(1) reasonable transportation of an prior authorized MTP recipient [ eligible client ] to and/or from a prior authorized [ covered ] health care facility where health care needs will be met [ service ];

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

(A) (No change.)

(B) the recipient [ client ] provides Regional MTP staff with a Health Care Provider's Statement of Need and the Health Care Provider's Statement of Need or equivalent is reviewed and the service is determined reasonable. [ ; ]

(3) transportation for an attendant(s); if the health [ - ] care provider documents the need, the recipient [ client ] is a minor, or a language or other barrier to communication or mobility exists that necessitates such assistance;

(4) transportation for a service animal when accompanying a recipient [ client ];

(5) retroactive reimbursement for up to three months of reasonable transportation, meals and lodging if the recipient [ client ] is a new recipient to MTP and is eligible under all program [ health-eligibility ] requirements. Retroactive reimbursement will begin on the date of the request for retroactive reimbursement;

(6) (No change.)

(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 [ . After six months ], the recipient [ client ] or responsible party must provide proof of residency by providing:

(A) (No change.)

(B) copy of a utility bill under the recipient's [ client's ] or responsible party's (if recipient [ client ] is a child) name; or

(C) (No change.)

(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.

§40.103.Program Processes.

To ensure transportation for prior authorized MTP recipients [ eligible clients ] to a health care facility where health care needs will be met :

(1) a request for routine medical transportation must be received by the Regional MTP staff at least two working days [ workdays ] in advance of the recipient's prior authorized [ client's ] health care service appointment;

(2) a request for special medical transportation must be received by the Regional MTP staff at least five working days [ workdays ] in advance of the recipient's prior authorized [ client's ] health care service appointment;

(3) exceptions to paragraphs (1) and (2) of this section may be granted by the Regional MTP manager or designee when the circumstances have been determined by the Regional MTP manager or designee to be beyond the recipient's [ client's ] control. The exception will be documented in the recipient's [ client's ] record;

(4) recipients with [ clients with a chronic health condition, which requires ] recurring visits to a health care provider[ , ] may receive multiple mass transit tickets or may have more than one transportation appointment authorized in advance ;

(5) an individual volunteer contractor(s) may receive reimbursement that exceeds the amount paid to other transportation contractors in their area for transportation to a similar facility when the facility is the recipient's [ client's ] choice and/or the facility is prior authorized [ deemed ] by the department as [ to be ] appropriate for the prior authorized health care service required;

(6) - (7) (No change.)

§40.105.Program Limitations.

Recipients [ Clients ] are not eligible to receive medical transportation services under the following circumstances:

(1) to and from a day activity [ the intended destination is a nursing facility ], a personal care home or state institution, or a facility participating in another Title XIX program for which [ and ] the reimbursement rate structure [ of that program ] includes transportation funds;

(2) the intended destination is a nursing facility;

(3) [ (2) ] the recipient [ client ] is an inpatient in a health care facility;

(4) [ (3) ] the recipient [ client ] is under 18 years of age and not accompanied by a parent or legal guardian, unless one of the following conditions exists:

(A) the recipient [ client ] is aged 15 through 17 years of age and presents the parent's or legal guardian's signed, written consent for the transportation services to the Regional MTP office or the transportation contractor; or

(B) the treatment to which the minor is being transported is such that the law extends confidentiality to the minor for this treatment;

(5) [ (4) ] the recipient [ client ] or another person or entity providing care for the recipient [ client ] receives direct payment of worker's compensation benefits, U. S. Department of Veterans Affairs benefits, or other third-party resources for transportation to prior authorized [ covered ] services on the recipient's [ client's ] behalf;

(6) [ (5) ] the recipient [ client ] is on limited [ lock-in ] status [ and is limited to a specific health care provider ], unless the [ lock-in ] provider has made the referral or the recipient [ client ] requests family planning services;

(7) [ (6) ] TICP diagnostic visits and/or cancer or cancer-related treatments that are provided out-of-state;

(8) [ (7) ] the recipient [ client ] and/or attendant intentionally, knowingly, or recklessly boards the vehicle carrying an illegal knife, a club, handgun or other weapon, as defined in Penal Code , §46.01, on or about his or her person;

(9) [ (8) ] a third-party, such as a hospital or hotel, provides transportation, meals, and/or lodging at no charge for a recipient [ client ] and attendant, for a particular appointment; or

(10) [ (9) ] an attendant does not accompany the recipient [ client ] on the MTP-requested trip when a Health [ - ] Care Provider's Statement of Need, Form 3113 or equivalent , is on file stating the recipient [ client ] requires an attendant(s).

§40.106.Program Exclusions.

The following transportation services are not covered by the Medical Transportation Program:

(1) transportation of deceased recipients [ clients ];

(2) transportation of individuals who do not qualify for a state or federal medical assistance program served by the MTP program;

(3) transportation of individuals to services which are not covered by the applicable state or federal medical assistance program under which the recipient qualifies;

(4) [ (2) ] advance funds, meals, and/or lodging services to a recipient [ client ] 21 years of age or older, unless the individual is a CSHCN [ -CIDC ] recipient [ client ] diagnosed with cystic fibrosis;

(5) [ (3) ] reimbursement for additional travel costs when a recipient [ client ] elects to seek care at a more remote facility that is not supported on a Health Care Provider's Statement of Need, Form 3113 or equivalent and prior [ than the one ] authorized by Regional MTP staff;

(6) [ (4) ] medical care while recipients [ clients ] are being transported;

(7) [ (5) ] emergency or non-emergency ambulance service;

(8) [ (6) ] passenger assistance beyond that which is necessary to ensure that recipients [ clients ] enter and leave vehicles safely, unless the contractor's contract states that door-to-door service is provided;

(9) [ (7) ] reimbursement for transportation services provided by an individual volunteer contractor before the date that Regional MTP staff approved the initial request to provide services from the individual volunteer contractor, unless an exception for retroactive reimbursement has been made and is documented by the Regional MTP staff; and

(10) [ (8) ] transportation services for family members not previously authorized for the specific trip by Regional MTP staff.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207272

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §40.104

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeal is proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The repeal affects the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.104.Additional Transportation Connected with an Authorized Trip.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207273

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §40.201

The amendment is proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The amendment affects the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.201. Recipient [ Client ] Rights and Responsibilities.

(a) Recipient [ Client ] Rights.

(1) Nondiscrimination. The recipient [ client ] has a right to receive services in compliance with Title VI of the Civil Rights Act of 1964, 42 U.S.C.A. §§2000d, et seq.; §504 of the Rehabilitation Act of 1973, 29 U.S.C.A. §794; the Americans with Disabilities Act of 1990, 42 U.S.C.A. §12101, et seq. ; and all amendments to each, and all requirements imposed by the regulations issued pursuant to these Acts, in particular 45 CFR Part 80 (relating to race, color, national origin), 45 CFR Part 84 (relating to handicap), 45 CFR Part 86 (relating to sex), and 45 CFR Part 91 (relating to age).

(2) Abuse report. Recipients [ Clients ] should report verbal or physical abuse or sexual harassment committed by other recipients [ clients ] or passengers, contractor employees, or department staff to Regional MTP staff or Regional Management staff upon arrival at the recipient's [ client's ] destination.

(3) Denial notification. If a service is [ services are ] denied, Regional MTP staff shall notify the recipient in accordance with Chapter 1 [ client verbally and in writing no less than 30 days before the department intends to terminate services. This notification must contain information listed in Chapter 36 ], Subchapter C, §1.41 [ §36.21 ] of this title (relating to Medicaid Uniform [ Recipient Notice and ] Fair Hearings Procedures [ Request ]). This recipient notification does not apply to transportation services not covered [ clients ] under §40.106 of this title [ chapter ] (relating to Program Exclusions).

(4) Appeal request. A recipient [ client ] whose services have been denied may request an administrative review by the Regional MTP Manager . A second administrative review may be conducted by the MTP Program Director. If the recipient is still dissatisfied, the recipient [ or ] may appeal the administrative review decision or the service denial by requesting a fair [ formal ] hearing. A [ Unless otherwise specified, a ] request for a fair [ formal ] hearing must [ should ] be in writing and mailed or hand-delivered to the appropriate Regional MTP office.

(b) Recipient [ Client ] Responsibilities.

(1) When a recipient [ client ] or responsible adult requests transportation, he/she must provide Regional MTP staff with the following information:

(A) recipient [ client ] name, address, and, if available, the telephone number;

(B) Medicaid, TICP or CSHCN[ -CIDC ] recipient [ client ] identification number (if applicable) or [ , ] Social Security number, and date of birth;

(C) - (G) (No change.)

(H) affirmation that advance funds are needed in order for the recipient [ client ] to access [ travel to a ] health care services [ facility, if applicable ];

(I) recipient must reimburse the department for any advance funds, and any portion thereof, that are not used for the specific prior authorized service.

(2) Recipients [ Clients ] must refrain from verbal and/or physical abuse or sexual harassment toward another recipient [ client ] or passenger, contractor's employees, or department employees while requesting or receiving medical transportation services.

(3) Recipients [ Clients ] must safeguard all bus tickets and/or tokens from loss and theft and must return unused tickets or tokens to the Regional MTP office issuing the tickets or tokens.

(4) Recipients [ Clients ] who receive mass-transit bus tickets or tokens must complete the department's Verification of Travel to Health Care Services by Mass Transit , Form 3111 [ verification form ]. Recipients [ Clients ] must return this verification form prior to their next request for tickets or tokens. A letter from the health care provider verifying delivery of services may be substituted for the disbursement of mass transit tickets or tokens verification form. Exceptions to this documentation may be granted by a Regional MTP Manager or [ MTP-designated ] supervisor when circumstances occur that are beyond the recipient's [ client's ] control. Exceptions will be documented in the recipient's [ client's ] record.

(5) Recipients [ Clients ] must not use authorized medical transportation for purposes other than travel to and from prior authorized [ covered ] health care services.

(6) If the recipient [ client ] does not need to use the authorized transportation services, the recipient [ client ] or the responsible adult should contact the Regional MTP staff to cancel the particular trip no less than four hours [ within 48 hours ] prior to the time of the authorized trip.

(7) Recipients [ Clients ] who receive advance funds for meals, lodging, and/or travel must return a completed Individual Volunteer Contractor (IVC) [ (IC) ] Service Record verifying services were provided, prior to receiving future advance funds or reimbursements. [ A letter from the health care provider verifying services were provided may be substituted for the IC service record. Exceptions to this documentation may be granted by a Regional MTP manager when circumstances occur that are beyond the client's control. Exceptions will be documented in the client's record. ]

(8) Recipients [ Clients ] must cancel requests for advance funds or lodging when not needed and must refund any disbursed advance funds to the department .

(9) Recipients [ Clients ] must provide appropriate receipts when seeking reimbursement for lodging.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207274

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §§40.301 - 40.304

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The repeals affect the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.301.Transportation Contractor Participation Requirements.

§40.302.Subcontractors.

§40.303.Contractor Accident Reports.

§40.304.Contractor Reporting Abuse.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207275

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

40 TAC §40.301

The new section is proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The new section affects the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.301.Individual Volunteer Contractor Participation Requirements.

(a) To participate in MTP, all individual volunteer contractors must:

(1) sign an Individual Volunteer Contractor Agreement with the department to acquire participation status; and

(2) have and maintain a current driver's license, current vehicle insurance, current vehicle inspection sticker and current vehicle license tags and meet all requirements of the individual volunteer contractor agreement to participate as an individual volunteer contractor.

(b) The department may reject any request for participation in MTP and cancel any existing agreement at the department's discretion.

(c) The Individual Volunteer Contractor must refund to the department any funds to which the IVC is not entitled to for any reason.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207276

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §§40.401 - 40.405

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The repeals affect the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.401.Contractor Billing.

§40.402.Gifts and Contractor Additional Charges.

§40.403.Contractor Recordkeeping and Accounting Records.

§40.404.Confidentiality of Records.

§40.405.Audits.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207277

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §40.501, §40.502

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The repeals affect the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.501.Monitoring and Evaluation of Contractors.

§40.502.Contractor Compliance.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207278

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

25 TAC §§40.601 - 40.603

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The repeals are proposed under the Human Resources Code, Chapter 22 and Chapter 32; and Health and Safety Code §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

The repeals affect the Human Resources Code, Chapters 22 and 32; and Government Code, Chapter 531.

§40.601.Expiration or Termination of Contract.

§40.602.Sanctions on Contractor.

§40.603.Contractor Rights.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207279

Susan Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 458-7236

Chapter 411. STATE AUTHORITY RESPONSIBILITIES

Subchapter B. INTERAGENCY AGREEMENTS

25 TAC §411.56

(Editor's note: The text of the following section proposed for repeal will not be published. The section may be examined in the offices of the Texas Department of Mental Health and Mental Retardation or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes the repeal of §411.56, governing memorandum of understanding (MOU) on coordinated services to children and youths of Chapter 411, Subchapter B, concerning interagency agreements.

Senate Bill 1468 (77th Legislative Session) repealed Family Code, §264.003, which required TDMHMR and seven other health and human services agencies to adopt by rule the Memorandum of Understanding for Coordinated Services to Children and Youths. In §411.56, TDMHMR adopted by reference a rule of the Texas Department of Protective and Regulatory Services (TDPRS), 40 TAC §736.701 (relating to Memorandum of Understanding for Coordinated Services to Children and Youths). The MOU remained in effect until the new MOU required by the Government Code, §531.055, (relating to Memorandum of Understanding on Services for Persons Needing Multiagency Services) was signed by the final party in early March 2002.

Cindy Brown, chief financial officer, has determined that for each year of the first five year period the proposed repeals are in effect, enforcing or administering the sections do not have foreseeable economic implications relating to cost or revenue of the state or local government because the repeals don't impose measurable costs on any person or entity.

David Rollins, acting director, Long Term Services and Supports, has determined that for each year of the first five-year period the repeals are in effect, the public benefit expected is compliance with current law which repeals the statutory provision that required the old MOU be adopted by rule and replaces it with a statutory provision in the Government Code which requires a similar MOU but does not require that it be adopted by rule. It is not anticipated that the repeal will have an adverse economic effect on small business or micro-business because they do not impose any measurable costs on any person or entity. It is not anticipated that there will be an economic cost to persons required to comply with the repealed sections. It is not anticipated that the repealed sections will affect a local economy.

Written comments on the proposal may be sent to Linda Logan, director, Policy Development, Texas Department of Mental Health and Mental Retardation, P.O. Box 12669, Austin, Texas 78711-2668, within 30 days of publication.

The existing sections are proposed for repeal under the Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority and Senate Bill 1468 (77th Legislative Session) that repealed Family Code, §264.003. The provision required TDMHMR to adopt the MOU by rule.

The repealed section affects the Family Code, §264.003.

§411.401.Memorandum of Understanding (MOU) on Coordinated Services to Children and Youths.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on November 7, 2002.

TRD-200207261

Andrew Hardin

Chairman, Texas Mental Health and Mental Retardation Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: December 22, 2002

For further information, please call: (512) 206-4516