Client Rights and Responsibilities
- Transportation for a covered non-emergency medical service allowing the client to arrive to the destination on time.
- Courteous trip reservations with respect to privacy, confidentiality, and cultural diversity.
- Instructions on how to use NEMT services offered by MTM and/or its subcontracted transportation providers/coordinators.
- Education on the complaint, grievance, and appeals process.
- Free oral interpretation services for clients with limited-English proficiency (LEP).
- Written information in prevalent languages (subject to contract requirements).
Information in alternate formats for individuals with special needs (i.e. visually or hearing impaired).
- Safe, reliable transportation services in clean, undamaged, and appropriately equipped vehicles operated by trained, professional, and courteous drivers.
- Non-discrimination. 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).
- 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 MTM, the Medical Transportation Program (MTP), or the transportation provider upon arrival at the client’s destination.
- Denial notification. If a service is denied, MTM 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).
- Appeal request. For services that have been denied by MTM, a client may request an internal review of the denied services to be conducted by MTM, MTP, or both. For services that have been denied by MTP, a client may request an administrative review to be conducted by the MTP Program Director. 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.
- When client or responsible adult requests transportation, he/she must provide the following information: client name, address, and telephone number if available; Medicaid ID number or Social Security number and date of birth; name, address, and telephone number of the healthcare provider and/or referring healthcare provider; purpose and date of trip and time of appointment; affirmation that other means of transportation are unavailable; special needs, including wheelchair lift or attendant(s); medical necessity verified by the Healthcare Provider’s Statement of Need, if applicable; and affirmation that advance funds are needed when a lack of transportation funds will prevent the passenger from traveling to a covered healthcare service, if applicable.
- Clients requesting Medicaid transportation under the Indigent Cancer Patients Program or Children with Special Health Care Needs Program must provide a client identification number (if applicable) or Social Security number, and date of birth.
- Clients must schedule transportation services for routine medical appointments with at least two business days advance notice. Long distance trips require five business days advance notice.
- Urgent trips, follow-up appointments, and hospital discharges can be set up with less than the required amount of advance notice.
- If the client calls for urgent/same day trips, MTM is responsible for calling the medical provider to confirm urgency and will schedule transportation according to HHSC’s protocols and guidelines.
- If a client does not need to use scheduled transportation services, the client or responsible adult should contact MTM to cancel the trip at least four hours in advance.
- Clients who live within a ¼ mile of a fixed bus route must use the bus if they are physically and cognitively able to do so. A client is excluded from public transit if they meet the HHSC-approved exclusions.
- Clients must safeguard bus tickets and tokens from loss and theft, and must return unused tokens to MTM.
- Clients who receive bus tickets or tokens must complete a verification forms. Clients must return this form prior to their next request for tickets or tokens. A letter from the healthcare provider verifying delivery of services may be substituted for a verification form. Exceptions may be granted when circumstances are beyond the client’s control.
- Clients will be assigned to the mode of transportation that is most appropriate to their needs in the following order: mass transit, mileage reimbursement, cab, and para-lift/wheelchair lift.
- Clients may not use authorized medical transportation for purposed other than travel to and from healthcare services.
- Clients should attempt to use the closest appropriate medical facility unless a healthcare provider has referred the client outside of the immediate community.
- Return trips will only be provided from the point of drop-off where the client obtained authorized healthcare.
- The transportation provider must pick up clients within one hour from the time the client calls for the return ride or “will call” trip.
- Clients must await pick up in an area designated as a pre-arranged “look-out” position. This is not necessarily outside but rather an area that allows easy and speedy access to the vehicle. The transportation provider’s approved methods for notifying the driver’s arrival include at minimum honking, knocking on the door, inquiring at the reception desk, and calling dispatch to place a call to the client.
- MTM shall authorize out-of-state travel for eligible clients and a travel companion based on physician referral when medically necessary.
- Clients must provide the following when seeking reimbursement for lodging in situations where prior authorization could not be obtained in advance: 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; letter from the client or attendant requesting reimbursement for out-of-pocket expenses; and copies of the client or attendant’s Social Security card and valid state-issued identification.
- Clients who receive advance funds for meals, lodging, and/or travel must return written documentation from the healthcare provider verifying services were provided, prior to receiving future advance funds.
- Clients must cancel requests for advance funds or lodging when not needed and must refund any disbursed funds.
- Clients must reimburse HHSC or MTM for any advance funds, or any portion thereof, that are not used for the specific prior authorized service, or when a verification that client attended the covered healthcare service is not submitted.
- Clients must refrain from verbal and 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.