	PROGRAM PROFILE Program Name: Title XIX Medical Transportation Program Address: 1105 W. HWY 114 City: Levelland State: Texas Zip Code: 79336 Telephone #: 806/894-3800 Fax: 806/894-2759 800-462-8747 Days Open: Monday - Friday Hours: 8:00 A.M. - 5:00 P.M. Director: Luis Perez Contact Person: Luis Perez Origination Date: 1973 Budget Total: 130,000 Type of Funding: Unit rate Clients Served Annually: 8,000 passenger trips Services Provided: Non-ambulance transportation to Medicaid-allowable medical services for all Medicaid eligible clients. Requirements for Eligibility and Financial Guidelines: Current Medicaid eligible Intake Procedure: Transportation requests are taken at each Multi-Service Center or call 800/462-8747 at least 24 hours in advance Required Documents: Medical care identification card, form 3087, or Medicaid verification letter, form 1027. Fee Structure: None Counties Served: Bailey, Cochran, Garza, Hockely, Lamb, Lynn, Terry, Yoakum Funding Sources: Texas Department of Health Title XIX Federal and State History with SPCAA: The initial contract with DHS was for $19,000. Through an incentive plan that was established in 1987, the agency has been able to increase its reimbursement to the present amount of 130,000.00. Other Comments:
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PROGRAM PROFILE

Program Name: Title XIX Medical Transportation Program

Address: 1105 W. HWY 114

City: Levelland State: Texas Zip Code: 79336

Telephone #: 806/894-3800 Fax: 806/894-2759

800-462-8747

Days Open: Monday - Friday Hours: 8:00 A.M. - 5:00 P.M.

Director: Luis Perez

Contact Person: Luis Perez

Origination Date: 1973

Budget Total: 130,000

Type of Funding: Unit rate

Clients Served Annually: 8,000 passenger trips

Services Provided: Non-ambulance transportation to Medicaid-allowable medical services for all Medicaid eligible clients.

Requirements for Eligibility and Financial Guidelines: Current Medicaid eligible

Intake Procedure: Transportation requests are taken at each Multi-Service Center or call 800/462-8747 at least 24 hours in advance

Required Documents: Medical care identification card, form 3087, or Medicaid verification letter, form 1027.

Fee Structure: None

Counties Served: Bailey, Cochran, Garza, Hockely, Lamb, Lynn, Terry, Yoakum

Funding Sources: Texas Department of Health Title XIX Federal and State

History with SPCAA: The initial contract with DHS was for $19,000. Through an incentive plan that was established in 1987, the agency has been able to increase its reimbursement to the present amount of 130,000.00.

Other Comments:

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