Texas § IN.1301.00553 - MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE

§ IN.1301.00553. MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE

MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE. (a) In this section, "maximum distance" means the miles calculated to drive by automobile within a service area to a particular type of preferred provider. (b) For purposes of this section, each county in this state is classified as a large metro, metro, micro, or rural county, or a county with extreme access considerations as determined by the federal Centers for Medicare and Medicaid Services by population and density thresholds as of March 1, 2023. (c) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each large metro county are: (1) for the following physicians, as designated by physician specialty: Time Distance Allergy and Immunology 30 15 Cardiology 20 10 Cardiothoracic Surgery 30 15 Dermatology 20 10 Emergency Medicine 20 10 Endocrinology 30 15 Ear, Nose, and Throat/Otolaryngology 30 15 Gastroenterology 20 10 General Surgery 20 10 Gynecology and Obstetrics 10 5 Infectious Diseases 30 15 Nephrology 30 15 Neurology 20 10 Neurosurgery 30 15 Oncology: Medical, Surgical 20 10 Oncology: Radiation 30 15 Ophthalmology 20 10 Orthopedic Surgery 20 10 Physical Medicine and Rehabilitation 30 15 Plastic Surgery 30 15 Primary Care: Adults 10 5 Primary Care: Pediatric 10 5 Psychiatry 20 10 Pulmonology 20 10 Rheumatology 30 15 Urology 20 10 Vascular Surgery 30 15 (2) for health care practitioners in the following disciplines: Time Distance Chiropractic 30 15 Occupational Therapy 20 10 Physical Therapy 20 10 Podiatry 20 10 Speech Therapy 20 10 (3) for the following types of institutional providers: Time Distance Acute Inpatient Hospitals (Emergency Services Available 24/7) 20 10 Cardiac Catheterization Services 30 15 Cardiac Surgery Program 30 15 Critical Care Services: Intensive Care Units 20 10 Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 20 10 Inpatient or Residential Behavioral Health Facility Services 30 15 Mammography 20 10 Outpatient Infusion/Chemotherapy 20 10 Skilled Nursing Facilities 20 10 Surgical Services (Outpatient or Ambulatory Surgical Center) 20 10 (4) for the following settings: Time Distance Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 10 5 Urgent Care 20 10 (d) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each metro county are: (1) for the following physicians, as designated by physician specialty: Time Distance Allergy and Immunology 45 30 Cardiology 30 20 Cardiothoracic Surgery 60 40 Dermatology 45 30 Emergency Medicine 45 30 Endocrinology 60 40 Ear, Nose, and Throat/Otolaryngology 45 30 Gastroenterology 45 30 General Surgery 30 20 Gynecology and Obstetrics 15 10 Infectious Diseases 60 40 Nephrology 45 30 Neurology 45 30 Neurosurgery 60 40 Oncology: Medical, Surgical 45 30 Oncology: Radiation 60 40 Ophthalmology 30 20 Orthopedic Surgery 30 20 Physical Medicine and Rehabilitation 45 30 Plastic Surgery 60 40 Primary Care: Adults 15 10 Primary Care: Pediatric 15 10 Psychiatry 45 30 Pulmonology 45 30 Rheumatology 60 40 Urology 45 30 Vascular Surgery 60 40 (2) for health care practitioners in the following disciplines: Time Distance Chiropractic 45 30 Occupational Therapy 45 30 Physical Therapy 45 30 Podiatry 45 30 Speech Therapy 45 30 (3) for the following types of institutional providers: Time Distance Acute Inpatient Hospitals (Emergency Services Available 24/7) 45 30 Cardiac Catheterization Services 60 40 Cardiac Surgery Program 60 40 Critical Care Services: Intensive Care Units 45 30 Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 45 30 Inpatient or Residential Behavioral Health Facility Services 70 45 Mammography 45 30 Outpatient Infusion/Chemotherapy 45 30 Skilled Nursing Facilities 45 30 Surgical Services (Outpatient or Ambulatory Surgical Center) 45 30 (4) for the following settings: Time Distance Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 15 10 Urgent Care 45 30 (e) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each micro county are: (1) for the following physicians, as designated by physician specialty: Time Distance Allergy and Immunology 80 60 Cardiology 50 35 Cardiothoracic Surgery 100 75 Dermatology 60 45 Emergency Medicine 80 60 Endocrinology 100 75 Ear, Nose, and Throat/Otolaryngology 80 60 Gastroenterology 60 45 General Surgery 50 35 Gynecology and Obstetrics 30 20 Infectious Diseases 100 75 Nephrology 80 60 Neurology 60 45 Neurosurgery 100 75 Oncology: Medical, Surgical 60 45 Oncology: Radiation 100 75 Ophthalmology 50 35 Orthopedic Surgery 50 35 Physical Medicine and Rehabilitation 80 60 Plastic Surgery 100 75 Primary Care: Adults 30 20 Primary Care: Pediatric 30 20 Psychiatry 60 45 Pulmonology 60 45 Rheumatology 100 75 Urology 60 45 Vascular Surgery 100 75 (2) for health care practitioners in the following disciplines: Time Distance Chiropractic 80 60 Occupational Therapy 80 60 Physical Therapy 80 60 Podiatry 60 45 Speech Therapy 80 60 (3) for the following types of institutional providers: Time Distance Acute Inpatient Hospitals (Emergency Services Available 24/7) 80 60 Cardiac Catheterization Services 160 120 Cardiac Surgery Program 160 120 Critical Care Services: Intensive Care Units 160 120 Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 80 60 Inpatient or Residential Behavioral Health Facility Services 100 75 Mammography 80 60 Outpatient Infusion/Chemotherapy 80 60 Skilled Nursing Facilities 80 60 Surgical Services (Outpatient or Ambulatory Surgical Center) 80 60 (4) for the following settings: Time Distance Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 30 20 Urgent Care 80 60 (f) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each rural county are: (1) for the following physicians, as designated by physician specialty: Time Distance Allergy and Immunology 90 75 Cardiology 75 60 Cardiothoracic Surgery 110 90 Dermatology 75 60 Emergency Medicine 75 60 Endocrinology 110 90 Ear, Nose, and Throat/Otolaryngology 90 75 Gastroenterology 75 60 General Surgery 75 60 Gynecology and Obstetrics 40 30 Infectious Diseases 110 90 Nephrology 90 75 Neurology 75 60 Neurosurgery 110 90 Oncology: Medical, Surgical 75 60 Oncology: Radiation 110 90 Ophthalmology 75 60 Orthopedic Surgery 75 60 Physical Medicine and Rehabilitation 90 75 Plastic Surgery 110 90 Primary Care: Adults 40 30 Primary Care: Pediatric 40 30 Psychiatry 75 60 Pulmonology 75 60 Rheumatology 110 90 Urology 75 60 Vascular Surgery 110 90 (2) for health care practitioners in the following disciplines: Time Distance Chiropractic 90 75 Occupational Therapy 75 60 Physical Therapy 75 60 Podiatry 75 60 Speech Therapy 75 60 (3) for the following types of institutional providers: Time Distance Acute Inpatient Hospitals (Emergency Services Available 24/7) 75 60 Cardiac Catheterization Services 145 120 Cardiac Surgery Program 145 120 Critical Care Services: Intensive Care Units 145 120 Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 75 60 Inpatient or Residential Behavioral Health Facility Services 90 75 Mammography 75 60 Outpatient Infusion/Chemotherapy 75 60 Skilled Nursing Facilities 75 60 Surgical Services (Outpatient or Ambulatory Surgical Center) 75 60 (4) for the following settings: Time Distance Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 40 30 Urgent Care 75 60 (g) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each county with extreme access considerations are: (1) for the following physicians, as designated by physician specialty: Time Distance Allergy and Immunology 125 110 Cardiology 95 85 Cardiothoracic Surgery 145 130 Dermatology 110 100 Emergency Medicine 110 100 Endocrinology 145 130 Ear, Nose, and Throat/Otolaryngology 125 110 Gastroenterology 110 100 General Surgery 95 85 Gynecology and Obstetrics 70 60 Infectious Diseases 145 130 Nephrology 125 110 Neurology 110 100 Neurosurgery 145 130 Oncology: Medical, Surgical 110 100 Oncology: Radiation 145 130 Ophthalmology 95 85 Orthopedic Surgery 95 85 Physical Medicine and Rehabilitation 125 110 Plastic Surgery 145 130 Primary Care: Adults 70 60 Primary Care: Pediatric 70 60 Psychiatry 110 100 Pulmonology 110 100 Rheumatology 145 130 Urology 110 100 Vascular Surgery 145 130 (2) for health care practitioners in the following disciplines: Time Distance Chiropractic 125 110 Occupational Therapy 110 100 Physical Therapy 110 100 Podiatry 110 100 Speech Therapy 110 100 (3) for the following institutional providers: Time Distance Acute Inpatient Hospitals (Emergency Services Available 24/7) 110 100 Cardiac Catheterization Services 155 140 Cardiac Surgery Program 155 140 Critical Care Services: Intensive Care Units 155 140 Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) 110 100 Inpatient or Residential Behavioral Health Facility Services 155 140 Mammography 110 100 Outpatient Infusion/Chemotherapy 110 100 Skilled Nursing Facilities 95 85 Surgical Services (Outpatient or Ambulatory Surgical Center) 110 100 (4) for the following settings: Time Distance Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) 70 60 Urgent Care 110 100 Added by Acts 2023, 88th Leg., R.S., Ch. 740 (H.B. 3359 ), Sec. 6, eff. September 1, 2023.