Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-15 - Medical Transportation Services
Section 5160-15-23 - Transportation: services from an eligible provider: ground ambulance services
Universal Citation: OH Admin Code 5160-15-23
Current through all regulations passed and filed through September 16, 2024
(A) Payment may be made for the following ground ambulance services:
(1) Basic life support, provided in a
non-emergency (BLS non-emergency);
(2) Basic life support, provided in an
emergency (BLS emergency);
(3)
Advanced life support, level 1, provided in a non-emergency (ALS1
nonemergency);
(4) Advanced life
support, level 1, provided in an emergency (ALS1 emergency);
(5) Advanced life support, level 2
(ALS2);
(6) Specialty care
transport (SCT);
(7) Mileage,
ground ambulance; and
(8) Attendant
services, ground ambulance.
(B) Payment may be made only if all the requirements in this paragraph are met.
(1)
The necessity of ground ambulance service is established.
(a) Emergency ground ambulance services are
deemed to be necessary. BLS emergency, ALS1 emergency, and associated loaded
mileage are emergency services by definition. ALS2, specialty care transport,
and associated loaded mileage are treated as emergency services.
(b) The non-emergency transfer by ground
ambulance of a medicaid-eligible individual from one hospital to a second
hospital is deemed to be necessary if two conditions apply:
(i) At least one of the criteria listed in
paragraph (B)(1)(c) of this rule is met; and
(ii) The services provided at the second
hospital are coverable by medicaid.
(c)
Any other non-emergency
ground ambulance service is determined to be necessary if the individual needs
at least one of the following services during transport:
(i)
Medical treatment or
continuous supervision by an EMT ;
(ii)
The administration or regulation of oxygen by
another person ;
or
(iii)
Supervised protective restraint
.
(2) The transport vehicle is a
ground ambulance.
(3) The
medicaid-eligible individual is transported either to or from a
medicaid-coverable service.
(4) The
medicaid-eligible individual is transported both to and from a recognized or
approved point of transport.
(5)
The services of an additional attendant are used only when such services are
necessary for the safe transport of a medicaid-eligible individual,
and the transportation provider
maintains documentation of such necessity.
(C) A hospital that is an eligible provider may submit a claim for ground ambulance services on behalf of another entity if two conditions apply:
(1) The other
entity is an eligible provider of ground ambulance services; and
(2) The hospital and the other entity have
entered into an appropriate agreement or contract.
Disclaimer: These regulations may not be the most recent version. Ohio 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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