Kentucky Administrative Regulations
Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES
Chapter 1 - Medicaid Services
Section 907 KAR 1:061 - Payments for ambulance transportation
Universal Citation: 907 KY Admin Regs Service 1:061
Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 205.520, 205.8451, 42 C.F.R. 440.170, 447.200 -447.205, 42 U.S.C. 1396, 2005 Acts ch. 173 Parts I., A.22.(i), I., H.3.b.(19)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services has responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed, or opportunity presented, by federal law for the provision of medical assistance to Kentucky's indigent citizenry. This administrative regulation establishes the method for determining amounts payable by the Department for Medicaid Services for ambulance transportation services.
Section 1. Definitions.
(1) "Advanced life support (ALS) emergency
ambulance transportation" means an ambulance service meeting the standards for
advanced life support services established in accordance with
202 KAR
7:501.
(2)
"Advanced Life Support (ALS) Medical First Response Provider" means an
emergency medical professional licensed in accordance with
202 KAR
7:501 to provide ALS care.
(3) "Air ambulance provider" means an air
ambulance service licensed in accordance with
202 KAR
7:510.
(4)
"Appropriate medical facility or provider" means a local medical provider other
than an emergency room of a hospital who can provide necessary emergency care
if a hospital emergency room is not located within a recipient's county of
residence or a contiguous county.
(5) "Basic life support (BLS) emergency
ambulance transportation" means an ambulance service which meets the standards
for basic life support services established in
202 KAR
7:501.
(6)
"Department" means the Department for Medicaid Services or its designated
agent.
(7) "Membership or
subscription fee" means a payment collected from a recipient by a provider
which entitles the recipient to free or discounted ambulance transportation
services.
(8) "Recipient" is
defined in
KRS
205.8451(9).
(9) "Upper limit" means the maximum
reimbursement rate the department shall pay an ambulance transportation
provider for the service provided.
Section 2. Reimbursement for Licensed Ambulance Services.
(1) The department shall
reimburse an ambulance service at the lesser of:
(a) The provider's usual and customary charge
for the service; or
(b) An upper
limit established in this section for the service plus, if applicable, a rate
for oxygen and reimbursement for disposable medical supplies utilized during an
ambulance transportation service.
(2) Except for an air ambulance
transportation service, the upper limit for an ambulance service shall be
calculated by adding a base rate, mileage allowance, and flat rate fees as
follows:
(a) For ALS emergency ambulance
transportation to the emergency room of a hospital:
1. A base rate of 110 dollars;
2. A mileage allowance of four (4) dollars
per mile; and
3. If transported
concurrently, a flat rate of twenty-five (25) dollars for an additional
recipient;
(b) For BLS
emergency ambulance transportation to the emergency room of a hospital:
1. A base rate of eighty-two (82) dollars and
fifty (50) cents;
2. A mileage
allowance of three (3) dollars per mile; and
3. If transported concurrently, a flat rate
of twenty (20) dollars for an additional recipient;
(c) For ALS or BLS emergency ambulance
transportation to an appropriate medical facility or provider:
1. A base rate of sixty (60)
dollars;
2. A mileage allowance of
two (2) dollars and fifty (50) cents per mile; and
3. If transported concurrently, a flat rate
of fifteen (15) dollars for an additional recipient;
(d) For BLS emergency ambulance
transportation to the emergency room of a hospital during which the services of
an ALS Medical First Response provider is required to stabilize the recipient:
1. A base rate of 110 dollars;
2. A mileage allowance of four (4) dollars
per mile; and
3. If transported
concurrently, a flat rate of twenty-five (25) dollars for an additional
recipient;
(e) For BLS
emergency ambulance transportation to an appropriate medical facility or
provider during which the services of an ALS Medical First Response provider
are required:
1. A base rate of sixty (60)
dollars;
2. A mileage allowance of
two (2) dollars and fifty (50) cents per mile; and
3. If transported concurrently, a flat rate
of fifteen (15) dollars for an additional recipient; and
(f) For non emergency ambulance
transportation during which the recipient requires no medical care during
transport:
1. A base rate of fifty-five (55)
dollars; and
2. A mileage allowance
of two (2) dollars per mile.
(3) In addition to the rates specified in
subsection (2) of this section, the department shall reimburse for:
(a) The administration of oxygen during an
ambulance transportation service at a flat rate of ten (10) dollars per one (1)
way trip if medically necessary; and
(b) The cost of disposable supplies actually
utilized during an ambulance transportation service if the provider lists the
supplies used during the service on an invoice. The department shall not
reimburse for a supply item that is not disposable or is not actually used
during the ambulance transportation service.
(4) Reimbursement for air ambulance
transportation shall be an all inclusive rate which shall be the lesser of:
(a) The provider's usual and customary
charge; or
(b) An upper limit of
$3,500 per one (1) way trip.
(5) Payment for a service identified in
subsections (2) through (4) of this section shall be contingent upon a
statement of medical necessity which:
(a)
Shall be maintained in accordance with
907 KAR
1:060, Section 5(2); and
(b) May be requested by the department for
post-payment review.
(6)
If a recipient has paid a membership or subscription fee to a transportation
provider, the provider shall not be eligible for Medicaid reimbursement for
service provided to the recipient.
Section 3. Appeal Rights.
(1) An appeal of a negative action regarding
a Medicaid recipient shall be in accordance with
907
KAR 1:563.
(2) An appeal of a negative action regarding
Medicaid eligibility of an individual shall be in accordance with
907
KAR 1:560.
(3) An appeal of a negative action regarding
a Medicaid provider shall be in accordance with
907
KAR 1:671.
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3)
Disclaimer: These regulations may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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