Tex. Gov't Code Section 533.00257
Delivery of Medical Transportation Program Services Through Managed Transportation Organization


(a)

In this section:

(1)

“Managed transportation organization” means:

(A)

a rural or urban transit district created under Chapter 458 (Rural and Urban Transit Districts), Transportation Code;

(B)

a public transportation provider defined by Section 461.002 (Definitions), Transportation Code;

(C)

a regional contracted broker defined by Section 531.02414 (Nonemergency Transportation Services Under Medical Transportation Program);

(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 (Nonemergency Transportation Services Under Medical Transportation Program).

(2-a)

“Transportation network company” has the meaning assigned by Section 2402.001 (Definitions), Occupations Code.

(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)

The commission may 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)

Except as provided by Subsections (k) and (m), 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)

Except as provided by Subsections (k) and (m), 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)

Repealed by Acts 2019, 86th Leg., R.S., Ch. 1235 (H.B. 1576), Sec. 9, eff. June 14, 2019.

(j)

The commission may not delay providing medical transportation program services through a managed transportation delivery model in:

(1)

a county with a population of one million 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 2.5 million or more; or

(2)

a county with a population of at least 60,000 but not more than 70,000 that is located adjacent to a county with a population of at least 500,000 but not more than 1.5 million.

(k)

A managed transportation organization may subcontract with a transportation network company to provide services under this section. A rule or other requirement adopted by the executive commissioner under this section or Section 531.02414 (Nonemergency Transportation Services Under Medical Transportation Program) does not apply to the subcontracted transportation network company or a motor vehicle operator who is part of the company’s network. The commission or the managed transportation organization may not require a motor vehicle operator who is part of the subcontracted transportation network company’s network to enroll as a Medicaid provider to provide services under this section.

(l)

The commission or a managed transportation organization that subcontracts with a transportation network company under Subsection (k) may require the transportation network company or a motor vehicle operator who provides services under this section to be periodically screened against the list of excluded individuals and entities maintained by the Office of Inspector General of the United States Department of Health and Human Services.

(m)

Notwithstanding any other law, a motor vehicle operator who is part of the network of a transportation network company that subcontracts with a managed transportation organization under Subsection (k) and who satisfies the driver requirements in Section 2402.107 (Driver Requirements), Occupations Code, is qualified to provide services under this section. The commission and the managed transportation organization may not impose any additional requirements on a motor vehicle operator who satisfies the driver requirements in Section 2402.107 (Driver Requirements), Occupations Code, to provide services under this section.

(n)

For purposes of this section and notwithstanding Section 2402.111 (Vehicle Requirements)(a)(2)(A), Occupations Code, a motor vehicle operator who provides services under this section may use a wheelchair-accessible vehicle equipped with a lift or ramp that is capable of transporting passengers using a fixed-frame wheelchair in the cabin of the vehicle if the vehicle otherwise meets the requirements of Section 2402.111 (Vehicle Requirements), Occupations Code.
Added by Acts 2013, 83rd Leg., R.S., Ch. 1311 (S.B. 8), Sec. 7(a), eff. September 1, 2013.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1235 (H.B. 1576), Sec. 5, eff. June 14, 2019.
Acts 2019, 86th Leg., R.S., Ch. 1235 (H.B. 1576), Sec. 6, eff. June 14, 2019.
Acts 2019, 86th Leg., R.S., Ch. 1235 (H.B. 1576), Sec. 7, eff. June 14, 2019.
Acts 2019, 86th Leg., R.S., Ch. 1235 (H.B. 1576), Sec. 9, eff. June 14, 2019.
Acts 2023, 88th Leg., R.S., Ch. 644 (H.B. 4559), Sec. 45, eff. September 1, 2023.
Repealed by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 3.01(3), eff. April 1, 2025.

Source: Section 533.00257 — Delivery of Medical Transportation Program Services Through Managed Transportation Organization, https://statutes.­capitol.­texas.­gov/Docs/GV/htm/GV.­533.­htm#533.­00257 (accessed Jun. 5, 2024).

521
General Provisions
522
Provisions Applicable to All Health and Human Services Agencies and Certain Other State Entities
523
Health and Human Services Commission
524
Authority over Health and Human Services System
525
General Powers and Duties of Commission and Executive Commissioner
526
Additional Powers and Duties of Commission and Executive Commissioner
531
Health and Human Services Commission
532
Medicaid Administration and Operation in General
533.001
Definitions
533.002
Purpose
533.003
Considerations in Awarding Contracts
533.004
Mandatory Contracts
533.005
Required Contract Provisions
533.006
Provider Networks
533.007
Contract Compliance
533.008
Marketing Guidelines
533.009
Special Disease Management
533.010
Special Protocols
533.011
Public Notice
533.012
Information for Fraud Control
533.013
Premium Payment Rate Determination
533.014
Profit Sharing
533.015
Coordination of External Oversight Activities
533.016
Provider Reporting of Encounter Data
533.017
Qualifications of Certifier of Encounter Data
533.018
Certification of Encounter Data
533.019
Value-added Services
533.020
Managed Care Organizations: Fiscal Solvency and Complaint System Guidelines
533.021
Community Health Workers
533.0025
Delivery of Services
533.0026
Direct Access to Eye Health Care Services Under Medicaid Managed Care Model or Arrangement
533.0027
Procedures to Ensure Certain Recipients Are Enrolled in Same Managed Care Plan
533.0029
Promotion and Principles of Patient-centered Medical Homes for Recipients
533.0031
Medicaid Managed Care Plan Accreditation
533.0035
Certification by Commission
533.038
Coordination of Benefits
533.039
Delivery of Benefits Using Telecommunications and Information Technology
533.0051
Performance Measures and Incentives for Value-based Contracts
533.051
Definitions
533.0052
Star Health Program: Trauma-informed Care Training
533.052
Applicability and Construction of Subchapter
533.0053
Compliance with Texas Health Steps
533.053
Overall Strategy for Managing Audit Resources
533.0054
Health Screening Requirements for Enrollee Under Star Health Program
533.054
Performance Audit Selection Process and Follow-up
533.0055
Provider Protection Plan
533.055
Agreed-upon Procedures Engagements and Corrective Action Plans
533.0056
Star Health Program: Notification of Placement Change
533.056
Audits of Pharmacy Benefit Managers
533.057
Collection of Costs for Audit-related Services
533.058
Collection Activities Related to Profit Sharing
533.059
Use of Information from External Quality Reviews
533.060
Security and Processing Controls over Information Technology Systems
533.0061
Provider Access Standards
533.0062
Penalties and Other Remedies for Failure to Comply with Provider Access Standards
533.0063
Provider Network Directories
533.0064
Expedited Credentialing Process for Certain Providers
533.0065
Frequency of Provider Credentialing
533.0066
Provider Incentives
533.0067
Eye Health Care Service Providers
533.0071
Administration of Contracts
533.071
Preferred Drug List Exceptions
533.0072
Internet Posting of Sanctions Imposed for Contractual Violations
533.0073
Medical Director Qualifications
533.0075
Recipient Enrollment
533.0076
Limitations on Recipient Disenrollment
533.0077
Statewide Effort to Promote Maintenance of Eligibility
533.083
Assessment and Implementation of Pilot Program Findings
533.0091
Sickle Cell Disease Treatment
533.0131
Use of Encounter Data in Determining Premium Payment Rates
533.0132
State Taxes
533.0161
Monitoring of Psychotropic Drug Prescriptions for Certain Children
533.00253
Star Kids Medicaid Managed Care Program
533.00254
Star Kids Managed Care Advisory Committee
533.00255
Behavioral Health and Physical Health Services Network
533.00256
Managed Care Clinical Improvement Program
533.00257
Delivery of Medical Transportation Program Services Through Managed Transportation Organization
533.00258
Nonmedical Transportation Services Under Medicaid Managed Care Program
533.00282
Utilization Review and Prior Authorization Procedures
533.00283
Annual Review of Prior Authorization Requirements
533.00284
Reconsideration Following Adverse Determinations on Certain Prior Authorization Requests
533.00511
Quality-based Enrollment Incentive Program for Managed Care Organizations
533.00515
Medication Therapy Management
533.00521
Star Health Program: Health Care for Foster Children
533.00522
Star Health Program: Mental Health Providers
533.00531
Medicaid Benefits for Certain Children Formerly in Foster Care
533.00751
Recipient Directory
533.01315
Reimbursement for Services Provided Outside of Regular Business Hours
533.002551
Monitoring of Compliance with Behavioral Health Integration
533.002552
Targeted Case Management and Psychiatric Rehabilitative Services for Children, Adolescents, and Families
533.002553
Behavioral Health Services Provided Through Third Party or Subsidiary
533.002555
Transition of Case Management for Children and Pregnant Women Program Recipients to Managed Care Program
533.002571
Delivery of Nonemergency Transportation Services to Certain Medicaid Recipients Through Medicaid Managed Care Organization
533.002581
Delivery of Nonmedical Transportation Services Under Medicaid Managed Care Program
533.002821
Prior Authorization Procedures for Hospitalized Recipient
533.002841
Maximum Period for Prior Authorization Decision
534
System Redesign for Delivery of Medicaid Acute Care Services and Long-term Services and Supports to Persons with an Intellectual or Developmental Disability
535
Provision of Human Services and Other
536
Medicaid and the Child Health Plan Program: Quality-based Outcomes and Payments
537
Medicaid Reform Waiver
538
Medicaid Quality Improvement Process for Clinical Initiatives
539.001
Definition
539.002
Grants for Establishment and Expansion of Community Collaboratives
539.003
Acceptable Uses of Grant Money
539.004
Elements of Community Collaboratives
539.005
Outcome Measures for Community Collaboratives
539.006
Annual Review of Outcome Measures
539.007
Reduction and Cessation of Funding
539.008
Rules
539.009
Administrative Costs
539.010
Biennial Report
539.0051
Plan Required for Certain Community Collaboratives
540
Medicaid Managed Care Program
540A
Medicaid Managed Transportation Services
541
Pediatric Tele-connectivity Resource Program for Rural Texas
542
System Redesign for Delivery of Medicaid Acute Care Services and Long-term Services and Supports to Individuals with an Intellectual or Developmental Disability
543
Clinical Initiatives to Improve Medicaid Quality of Care and Cost-effectiveness
543A
Quality-based Outcomes and Payments Under Medicaid and Child Health Plan Program
544
Fraud, Waste, Abuse, and Overcharges Relating to Health and Human Services
545
Certain Public Assistance Benefits
546
Long-term Care and Support Options for Individuals with Disabilities and Elderly Individuals
547
Mental Health and Substance Use Services
547A
Community Collaboratives
548
Health Care Services Provided Through Tele-connective Means
549
Provision of Drugs and Drug Information
550
Human Services and Other Social Services Provided Through Faith- and Community-based Organizations

Accessed:
Jun. 5, 2024

§ 533.00257’s source at texas​.gov