Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-15 - Medical Transportation Services
Section 5160-15-24 - Transportation: services from an eligible provider: air ambulance services
Universal Citation: OH Admin Code 5160-15-24
Current through all regulations passed and filed through September 16, 2024
(A) Payment may be made for the following air ambulance services:
(1) Ambulance transport,
fixed
wing;
(2) Ambulance transport,
rotary
wing;
(3) Mileage,
fixed
wing ambulance; and
(4) Mileage,
rotary
wing ambulance.
(B) Payment may be made only if all the requirements in this paragraph are met.
(1) The necessity of air ambulance service is
established.
(a) Air ambulance services are
deemed to be necessary when two criteria are met:
(i) Emergency ambulance service is
necessary because the medicaid-eligible individual is
critically ill or has critical injuries ; and
(ii) It is estimated that transporting the
medicaid-eligible individual by ground ambulance to the nearest appropriate
treatment facility will take more than thirty minutes.
(b) The necessity of other air ambulance
services is determined by two criteria:
(i)
The criteria have been met for determining the necessity of transport by ground
ambulance in accordance with rule
5160-15-23 of the Administrative
Code; and
(ii) At least one of the
following conditions applies:
(a) The point of
pick-up is inaccessible by ground ambulance;
(b) The additional time
needed for transport by ground ambulance would
endanger the life or health of the medicaid-eligible individual;
(c) The time saved by air transport would
significantly increase the chances of survival or reduce the risk of further
injury or impairment; or
(d) The
closest appropriate treatment facility is at least one hundred eighty miles
from the point of pick-up.
(2) The transport vehicle is an air
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.
(C) A hospital that is an eligible provider may submit a claim for air ambulance services on behalf of another entity if two conditions apply:
(1) The other entity is
an eligible provider of air ambulance services; and
(2) The hospital and the other entity have
entered into an appropriate agreement or contract.
(D) Separate payment may be made for critical care services, the provision of which is delineated in Chapter 5160-4 of the Administrative Code.
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