Sec. 533.00257. DELIVERY OF MEDICAL TRANSPORTATION PROGRAM SERVICES. (a) In this section:
(1) "Managed transportation organization" means:
(A) a rural or urban transit district created under Chapter 458, Transportation Code;
(B) a public transportation provider defined by Section 461.002, Transportation Code;
(C) a regional contracted broker defined by Section 531.02414;
(D) a local private transportation provider approved by the commission to provide Medicaid nonemergency medical transportation services; or
(E) any other entity the commission determines meets the requirements of this section.
(2) "Medical transportation program" has the meaning assigned by Section 531.02414.
(3) "Transportation service area provider" means a for-profit or nonprofit entity or political subdivision of this state that provides demand response, curb-to-curb, nonemergency transportation under the medical transportation program.
(b) Subject to Subsection (i), the commission shall provide medical transportation program services on a regional basis through a managed transportation delivery model using managed transportation organizations and providers, as appropriate, that:
(1) operate under a capitated rate system;
(2) assume financial responsibility under a full-risk model;
(3) operate a call center;
(4) use fixed routes when available and appropriate; and
(5) agree to provide data to the commission if the commission determines that the data is required to receive federal matching funds.
(c) The commission shall procure managed transportation organizations under the medical transportation program through a competitive bidding process for each managed transportation region as determined by the commission.
(d) A managed transportation organization that participates in the medical transportation program must attempt to contract with medical transportation providers that:
(1) are considered significant traditional providers, as defined by rule by the executive commissioner;
(2) meet the minimum quality and efficiency measures required under Subsection (g) and other requirements that may be imposed by the managed transportation organization; and
(3) agree to accept the prevailing contract rate of the managed transportation organization.
(e) To the extent allowed under federal law, a managed transportation organization may own, operate, and maintain a fleet of vehicles or contract with an entity that owns, operates, and maintains a fleet of vehicles. The commission shall seek appropriate federal waivers or other authorizations to implement this subsection as necessary.
(f) The commission shall consider the ownership, operation, and maintenance of a fleet of vehicles by a managed transportation organization to be a related-party transaction for purposes of applying experience rebates, administrative costs, and other administrative controls determined by the commission.
(g) The commission shall require that managed transportation organizations and providers participating in the medical transportation program meet minimum quality and efficiency measures as determined by the commission.
(h) Expired.
(i) The commission may delay providing medical transportation program services through a managed transportation delivery model in areas of this state in which the commission on September 1, 2013, is operating a full-risk transportation broker model.
(j) Notwithstanding Subsection (i), the commission may not delay providing medical transportation program services through a managed transportation delivery model in:
(1) a county with a population of 750,000 or more:
(A) in which all or part of a municipality with a population of one million or more is located; and
(B) that is located adjacent to a county with a population of two million or more; or
(2) a county with a population of at least 55,000 but not more than 65,000 that is located adjacent to a county with a population of at least 500,000 but not more than 1.5 million.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1311 (S.B. 8), Sec. 7(a), eff. September 1, 2013.
Section: Previous 533.0025 533.00251 533.00253 533.00254 533.00255 533.002551 533.00256 533.00257 533.0026 533.0027 533.0028 533.00281 533.0029 533.003 533.004 NextLast modified: September 28, 2016