Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Definitions.
For purposes of this part, the following terms have the
meanings given them.
A. "Ancillary
services" means health services, incident to ambulance services, that may be
medically necessary on an individual basis, but are not routinely used, and are
not included in the base rate for ambulance service.
B. "Common carrier transportation" means the
transport of a recipient by a bus, taxicab, or other commercial carrier or by
private automobile.
C. "Ambulance
service" means the transport of a recipient whose medical condition or
diagnosis requires medically necessary services before and during
transport.
D. "Medical
transportation" means the transport of a recipient for the purpose of obtaining
a covered service or transporting the recipient after the service is provided.
The types of medical transportation are common carrier, life support, and
special transportation.
E. "No load
transportation" refers to medical transportation that does not involve
transporting a recipient.
F.
"Special transportation" means the transport of a recipient who, because of a
physical or mental impairment, is unable to use a common carrier and does not
require ambulance service.
For the purposes of item F, "physical or mental impairment"
means a physiological disorder, physical condition, or mental disorder that
prohibits access to or safe use of common carrier transportation.
Subp. 2.
Payment
limitations; general.
To be eligible for medical assistance payment, medical
transportation must be to or from the site of a covered service to a recipient.
Examples of covered services are the services specified in parts
9505.0170 to
9505.0475 and services provided by
a rehabilitation facility or a training and habilitation center.
Subp. 3.
Payment
limitations; transportation between providers of covered services.
Medical transportation of a recipient between providers of
covered services is eligible for medical assistance payment as specified in
items A to C.
A. Except for an
emergency, transportation between two long-term care facilities must be
medically necessary because the health service required by the recipient's plan
of care is not available at the long-term care facility where the recipient
resides.
B. Transportation between
two hospitals must be to obtain a medically necessary service that is not
available at the hospital where the recipient was when the medical necessity
was diagnosed.
C. Claims for
payment for transportation between two long-term care facilities or between two
hospitals must be documented by a statement signed by a member of the nursing
staff at the originating facility that the medically necessary health service
is part of the recipient's plan of care and is not available at the originating
facility.
Subp. 4.
Payment limitation; transportation of deceased person.
Payment for transportation of a deceased person is limited to
the circumstances in items A to C.
A.
If a recipient is pronounced dead by a legally authorized person after medical
transportation is called but before it arrives, service to the point of pickup
is eligible for payment.
B. If
medical transportation is provided to a recipient who is pronounced dead en
route or dead on arrival by a legally authorized person, the medical
transportation is eligible for payment.
C. If a recipient is pronounced dead by a
legally authorized person before medical transportation is called, medical
transportation is not eligible for payment.
Subp. 5.
Excluded costs related to
transportation; general.
The costs of items A to F are not eligible for payment as
medical transportation:
A.
transportation of a recipient to a hospital or other site of health services
for detention that is ordered by a court or law enforcement agency except when
ambulance service is a medical necessity;
B. transportation of a recipient to a
facility for alcohol detoxification that is not a medical necessity;
C. no load transportation except as in
subpart
6, item E;
D. additional charges for luggage, stair
carry of the recipient, and other airport, bus, or railroad terminal
services;
E. airport surcharge;
and
F. federal or state excise or
sales taxes on air ambulance service.
Subp. 6.
Payment limitations; ambulance
service.
To be eligible for the medical assistance payment rate as an
ambulance service, the service must comply with the conditions in items A to
E.
A. The provider must be licensed
under Minnesota Statutes, sections
144E.10
and
144E.16 as
an advanced life support, basic life support, or scheduled ambulance
service.
B. The provider must
identify the level of medically necessary services provided to the recipient in
the claim for payment.
C. The
medical necessity of the ambulance service for a recipient must be documented
by the state report required under Minnesota Statutes, section
144E.17.
D. The recipient's
transportation must be in response to a 911 emergency call, a police or fire
department call, or an emergency call received by the provider. Except as in
item E, an ambulance service that responds to an emergency call but does not
transport a recipient as a result of the call is not eligible for medical
assistance payment.
E. An ambulance
that responds to a medical emergency is eligible for payment for no load
transportation only if the ambulance provided medically necessary treatment to
the recipient at the pickup point of the recipient. The payment is limited to
charges for transportation to the point of pickup and for ancillary
services.
Subp. 7.
Payment limitation; special transportation.
To be eligible for medical assistance payment, a provider of
special transportation, except as specified in Minnesota Statutes, section
174.30,
must be certified by the Department of Transportation under Minnesota Statutes,
sections
174.29
to
174.30.
Payment eligibility of special transportation is subject to the limitations in
items A to C.
A. The special
transportation is provided to a recipient who has been determined eligible for
special transportation by the local agency on the basis of a certification of
need by the recipient's attending physician.
B. Special transportation to reach a health
service destination outside of the recipient's local trade area is ordered by
the recipient's attending physician and the local agency has approved the
service.
C. The cost of special
transportation of a recipient who participates in a training and habilitation
program is not eligible for reimbursement on a separate claim for payment if
transportation expenses are included in the per diem payment to the
intermediate care facility for the developmentally disabled or if the
transportation rate has been established under parts
9525.1200 to
9525.1330.
D. [Repealed,
L
2013 c 81
s
12]
Subp. 8.
Payment limitation; common
carrier transportation.
To be eligible for medical assistance payment, the claim for
payment of common carrier transportation must state the date of service, the
origin and destination of the transportation, and the charge. Claims for
payment must be submitted to the local agency.
Subp. 9.
Payment limitation; air
ambulance.
Transportation by air ambulance shall be eligible for medical
assistance payment if the recipient has a life threatening condition that does
not permit the recipient to use another form of transportation.
Statutory Authority: MS s
256B.04
