Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services
Article 3 - Transportation and Accommodation Services
7 AAC 120.415 - Emergency transportation services

(a) The department will pay for medically necessary emergency air or ground transportation to the nearest facility that provides emergency care. If the recipient is an American Indian or Alaska Native, the department will, at the request of the recipient or a family member, pay for medically necessary emergency transportation to the nearest facility operated by a tribal health program that provides emergency care even though the facility is not the nearest facility that provides emergency care.

(b) A claim submitted to the department for payment of costs for emergency transportation service, including ground ambulance and air ambulance service, must be accompanied by written justification of the medical emergency, including medical documentation. A ground ambulance service's documentation of a recipient's medical status and medical services provided may serve as adequate written justification to support a claim for emergency transportation services by a ground ambulance service.

(c) The department will not pay for

(d) If the department determines that the use of an emergency ground ambulance was not medically justified, a claim for allowable costs will be paid at the nonemergency ground ambulance rate. If the department determines that the recipient's medical condition did not warrant any form of ambulance transportation, the claim will be denied.