Current through Vol. 42, No. 1, September 16, 2024
(a)
Continuous or round trip transport.
(1) If a member is transported to a
destination and returned to their original point of pickup, coverage includes
payment for the primary transport and the return transport.
(2) If the provider is required to remain and
attend the member between transports, the provider may claim waiting
time.
(b)
Nursing
facility.
(1) Ambulance or stretcher
transportation from nursing home to nursing home (skilled or intermediate care)
is covered if the discharging institution is not certified and the admitting
nursing home is certified.
(2)
Nursing home to nursing home transports are covered if the member requires care
not available at the discharging facility, and the member's medical status
requires ambulance transport.
(c)
Multiple members per
transport.
(1) When more than one
eligible member is transported at the same time, the only acceptable
duplication of charges is half the base rate.
(2) Separate claims must be submitted for
each member.
(3) No mileage or
waiting time is to be charged for additional members. These services are
included in the reimbursement of the first claim.
(d)
Multiple transports per
member. More than one transport per member on the same date of service
is covered when the member received a different level of service on each
transport (e.g., Advanced Life Support 1 and Basic Life Support). When more
than one transport with the same level of care occurs on the same day medical
necessity must be documented.
(e)
Multiple arrivals. When multiple units respond to a call for
services, only the entity that actually provides services for the member may
bill and be paid for the services by the OHCA. The entity that rendered
service/care bills for all services furnished.
(f)
No transport. If member
refuses treatment after immediate aid has been provided the ambulance may bill
the base rate for the level of service and waiting time.
(g)
Pronouncement of death.
(1) If the member dies before dispatch, no
payment is available.
(2) If the
member dies after dispatch, but before the member is loaded, payment is allowed
for the base rate but no mileage.
(3) If the member dies after pickup, payment
is available for the base rate and mileage.
(4) Time of death is the point at which the
member is pronounced dead by an individual authorized by the state to make such
pronouncements.
(h)
Out of state transports.
(1) Out
of state, non-emergency transports require prior authorization.
(2) The ambulance provider, home health
agency, hospital, nursing facility, physician, case manager or social worker
may request this authorization. The ambulance provider must retain the
physician's order of medical necessity in the member's file to support the need
for ambulance transportation.
(3)
When a member is transported by ground ambulance to or from an air ambulance
for out-of-state services, the ground and air ambulance providers providing the
transports must bill OHCA independently. When the OHCA is unable to contract
for the out-of-state ground transport, the ground and air ambulance charges
(air service, medical team, ground transportation) may be consolidated and
billed when the following conditions apply.
(A) The air ambulance provider furnishing air
transportation (hereafter referred to as "the entity") arranges for ground
transportation services and has a contract on file with the OHCA to subcontract
for ground ambulance;
(B) The
contract includes the requirement that the entity certifies that the ground
transportation provider meets the minimum state licensure requirements in the
state in which the service is provided;
(C) The entity certifies that the payment
will be made to the ground provider;
(i)
Neonatal transports.
(1) Coverage of neonatal transport includes
neonatal base rate, loaded mileage, transfer isolette, and waiting
time.
(2) The intensive care
transport of critically ill neonate(s) (i.e. newborns to approved, designated
neonatal intensive care units) is a covered service.
(3) When a trained hospital medical team from
the receiving or transferring hospital accompanies a newborn on the transport
ambulance services, the primary care of the newborn is the hospital team's
responsibility, reimbursement for the hospital team is made to the hospital as
part of the hospital rate.
Added at 24 Ok Reg
601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, eff
5-11-07
