SECTION 380.301. Client Rights and Responsibilities

(a) Client Rights.

(1) Nondiscrimination. The 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 C.F.R. Part 80 (relating to race, color, national origin), 45 C.F.R. Part 84 (relating to handicap), 45 C.F.R. Part 86 (relating to sex), and 45 C.F.R. Part 91 (relating to age).

(2) Abuse report. Clients should report verbal or physical abuse or sexual harassment committed by other clients, passengers, a transportation provider's employees, or Health and Human Services Commission (HHSC) staff to the Medical Transportation Program (MTP) or the transportation provider upon arrival at the client's destination.

(3) Denial notification. If a service is denied, MTP or the transportation provider shall notify the client in accordance with Chapter 357, Subchapter A of this title (relating to Uniform Fair Hearing Rules). This client notification does not apply to transportation services under §380.209 of this title (relating to Program Exclusions).

(4) Appeal request.

(A) For services that have been denied by a transportation provider, a client may request an internal review of the denied services to be conducted by the transportation provider, MTP, or both.

(B) For services that have been denied by MTP, a client may request an administrative review to be conducted by the MTP Program Director.

(C) At any time, a client may request a fair hearing for review of a service denial by an HHSC hearings officer. A request for a fair hearing must be in writing and mailed or hand-delivered to the MTP office in Austin.

(b) Client Responsibilities.

(1) When a client or responsible adult requests transportation, he/she must provide the following information:

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

(B) Medicaid, Transportation for Indigent Cancer Patients Program or Children with Special Health Care Needs services program client identification number (if applicable) or Social Security number, and date of birth;

(C) name, address, and telephone number of health care provider and/or referring health-care provider;

(D) purpose and date of trip and time of appointment;

(E) affirmation that other means of transportation are unavailable;

(F) special needs, including wheelchair lift or attendant(s);

(G) medical necessity verified by the Health Care Provider's Statement of Need, if applicable; and

(H) affirmation that advance funds are needed when a lack of transportation funds will prevent the child from traveling to a covered health care service, if applicable.

(2) Clients must reimburse HHSC or its designee for any advance funds, and any portion thereof, that:

(A) are not used for the specific prior authorized service; or

(B) when a verification that client attended the covered health services is not submitted.

(3) Clients must refrain from verbal and/or physical abuse or sexual harassment toward another client or passenger, transportation provider or performing provider employees, or HHSC employees while requesting or receiving medical transportation services.

(4) Clients must safeguard all bus tickets and/or tokens from loss and theft and must return unused tickets or tokens to the MTP or the transportation provider issuing the tickets or tokens.

(5) Clients who receive mass transit bus tickets or tokens must complete a verification form. 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 when circumstances occur that are beyond the client's control. Exceptions will be documented in the client's record.

(6) Clients must not use authorized medical transportation for purposes other than travel to and from health care services.

(7) If the client does not need to use the authorized transportation services, the client or the responsible adult should contact MTP or the transportation provider to cancel the particular trip no less than four hours prior to the time of the authorized trip.

(8) Clients who receive advance funds for meals, lodging, and/or travel must return written documentation from the health care provider verifying services were provided, prior to receiving future advance funds.

(9) Clients must cancel requests for advance funds or lodging when not needed and must refund any disbursed advance funds to HHSC.

(10) Clients must provide the following when seeking reimbursement for lodging in situations where prior authorization could not be obtained in advance:

(A) original receipt from the lodging establishment showing its name and address, the client's name as an occupant, and specific services for which the occupant was charged (e.g., room rent, tax);

(B) letter from the client or attendant requesting reimbursement for out-of-pocket expenses; and

(C) copies of the client or attendant's Social Security card and valid state-issued identification.

Source Note: The provisions of this §380.301 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; amended to be effective September 1, 2014, 39 TexReg 5731