Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 4 - AMBULANCE SERVICES
Section 471-4-004 - SERVICE REQUIREMENTS
Universal Citation: 471 NE Admin Rules and Regs ch 4 ยง 004
Current through September 17, 2024
004.01 GENERAL REQUIREMENTS.
004.01(A)
MEDICAL NECESSITY OF
THE SERVICE. Medical necessity is established when the client's
condition is such that use of any other method of transportation is
contraindicated. In any case in which some means of transportation other than
an ambulance could be used without endangering the client's health, whether or
not such other transportation is actually available, Medicaid will not make
payment for ambulance service. Claims for ambulance services must include
adequate documentation for determination of medical necessary.
004.01(B)
SERVICES PROVIDED FOR
CLIENTS ENROLLED IN NEBRASKA MEDICAID MANAGED CARE. See 471 NAC
1.
004.01(C)
HEALTH
CHECK SERVICES. See 471 NAC 33.
004.02 COVERED SERVICES. Medicaid covers medically necessary and reasonable ambulance services required to transport a client to obtain, or after receiving, a Medicaid covered service.
004.02(A)
GROUND AMBULANCE
SERVICES.
004.02(A)(i)
BASIC LIFE SUPPORT (BLS) SERVICES. Medicaid covers
basic life support (BLS) ambulance services.
004.02(A)(ii)
ADVANCED LIFE
SUPPORT (ALS) SERVICES. Medicaid covers advanced life support
(ALS) ambulance services if:
(1) Ambulance
personnel perform advanced life support (ALS) services during the
transport;
(2) Advanced life
support (ALS) personnel monitor the condition of a client during the transport,
even if no advanced life support (ALS) services are provided during the
transport; or
(3) Any ambulance
service not covered under 004.02(A)(ii)(1) or 004.02(A)(ii)(2) covered as a
basic life support (BLS) service.
004.02(A)(iii)
MILEAGE. Loaded mileage is covered for total distances
in excess of five loaded miles. Unloaded mileage, and the initial five loaded
miles when the total distance is not in excess of five loaded miles, is covered
as a part of the base rate.
004.02(A)(iv)
WAITING OR STANDBY
TIME. Waiting or standby time under normal circumstances is
covered as a part of the base rate. Waiting or standby time, in excess of
thirty minutes, but less than two hours, is covered only when necessary to
stabilize a client's condition. Waiting or standby time in excess of two hours
is not covered.
004.02(B)
AIR
AMBULANCE. Medicaid covers medically necessary air ambulance
services only when transportation by ground ambulance is contraindicated and:
(i) Great distances or other obstacles are
involved in getting the client to the destination;
(ii) Immediate and rapid admission is
essential; or
(iii) The point of
pickup is inaccessible by land vehicle.
004.02(C)
NON-EMERGENCY
TRANSPORTS. Any ambulance transport that does not meet the
definition of an emergency transport will be covered as a non-emergency
transport, regardless of point of origin and destination. Sufficient
documentation is required to support the medical necessity of a non-emergency
transport.
004.02(C)(i)
TRANSPORTS TO THE FACILITY WHICH MEETS THE NEEDS OF THE
CLIENT. Medicaid covers services provided by the most appropriate
ambulance and practitioner type that meets the needs of the client including:
(1) Medical care in a facility;
(2) Support from the client's community;
or
(3) Care from the client's own
physician or practitioner or a qualified physician, practitioner, or
specialist.
004.02(C)(ii)
TRANSPORTS TO A
PHYSICIAN'S OFFICE. Non-emergency ambulance transports to a
physician or practitioner's office, clinic or therapy center are covered when:
(1) The client is bed confined before,
during, and after transport; and
(2) The services cannot or cannot reasonably
be expected to be provided at the client's residence.
004.02(D)
ROUND TRIP
TRANSPORTS FOR HOSPITAL INPATIENTS. Ambulance services provided to
a client receiving inpatient hospital services, where the client is transported
to a separate facility for services, and the client is returned to the
originating hospital for continuation of inpatient care, are covered as an
ambulance service as opposed to a hospital service outlined in 471 NAC
10.
004.02(E)
TRANSPORT
OF MORE THAN ONE CLIENT. When more than one client is transported
during a single trip, a base rate is covered for each client transported. The
number of loaded miles and mileage charges must be prorated among the number of
clients being billed.
004.02(F)
TRANSPORT OF MEDICAL TEAMS. Transportation of a
medical team resulting in an ambulance transport of the client, is covered as a
part of the base rate. Transportation of a medical team without the client
being in the ambulance is not covered.
004.02(G)
TRANSPORT OF DECEASED
CLIENTS. Ambulance services are covered if the client is
pronounced dead while en route to or upon arrival at the hospital. Ambulance
services are not covered if a client is pronounced dead before the client is
transported.
004.02(H)
HOSPITAL-BASED AMBULANCE SERVICE. Hospital-based
ambulance services are regulated in 471 NAC 10.
Disclaimer: These regulations may not be the most recent version. Nebraska 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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