Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency pays for air
ambulance transportation for clients only when all of the following conditions
are met:
(a) The client's medical condition
requires immediate and rapid transportation beyond what ground ambulance can
provide;
(b) The client's
destination is an acute care hospital or appropriate trauma designated
facility; and
(c) The vehicle and
crew meet the requirements in WAC
182-502-0016
and this chapter.
(2)
Other factors the agency may consider in payment decisions for air ambulance
include:
(a) The point-of-pickup is not
accessible by ground ambulance (e.g., mountain rescue);
(b) The necessary medical care is not
available locally and time is of the essence; and
(c) The use of other means of air travel
(e.g., commercial flight) is medically contraindicated.
(3)
Lift-off fee. The agency
pays a lift-off fee for each client being transported by air ambulance to an
acute care facility for medical treatment.
(a) When more than one client is transported
in the same ambulance at the same time, each client must meet medical necessity
criteria for the provider to receive a lift-off fee for each client
transported.
(b) The agency does
not pay a lift-off fee:
(i) For a client
onboard an air ambulance when the client is not being transported for medical
treatment (e.g., a mother accompanying a child to the hospital).
(ii) When the air ambulance is dispatched in
response to a call but the client is not transported by the aircraft.
(4)
Statute
miles. The agency pays an air ambulance provider for statute miles
incurred for covered trips by paying from the client's point-of-pickup to the
point of destination.
(a) When more than one
client requiring medical treatment is transported in the same air ambulance at
the same time, the ambulance provider must divide the statute miles traveled by
the number of clients being transported for medical treatment and bill the
agency the mileage portion attributable to each client.
(b) The agency does not pay for mileage for a
client who is traveling in an air ambulance but is not being transported for
medical treatment (e.g., a mother accompanying a child to the hospital). Only
the statute miles directly associated with the client transported for treatment
may be billed to the agency.
(5)
Extra mileage. The agency
does not pay for extra mileage incurred during an air ambulance transport,
except in an unusual circumstance. The unusual circumstance must be clearly
described and documented in the ambulance trip report and the client's file.
The exception for an unusual circumstance does not apply to nonemergency air
transports that are prior authorized by the agency. Unusual circumstances for
incurring additional air miles include, but are not limited to:
(a) Having to avoid a no fly zone;
(b) Being forced to land at an alternate
destination due to severe weather; and
(c) Being diverted to another designated
trauma facility.
(6)
Lift-off fee plus mileage. The agency's payment for an air
ambulance transport (lift-off fee plus mileage) includes all necessary
personnel, services, supplies, and equipment. The agency does not make separate
payment to air ambulance providers for unbundled services (e.g., pediatric
ventilators).
(7)
More than
one travel segment. When an ambulance transport requires more than one
travel segment (leg) to complete, the agency limits its payment for the
transport as follows:
(a) If a fixed-wing
aircraft is used and the transport involves more than one lift-off for the same
client on the same trip (e.g., transportation from Spokane to Portland, but the
aircraft makes a stop in the Tri-Cities), the agency pays the air ambulance
provider for one lift-off fee for the client and the total air miles.
(b) For nonemergency air ambulance transports
that are prior authorized by the agency, the negotiated rate includes both air
and ground ambulance services, unless the agency's authorization letter
specifically allows for ground ambulance services to be billed
separately.
(8)
Nonemergency air transportation - Prior authorization and negotiated
rate. Nonemergency air ambulance transportation must be prior authorized
by the agency.
(a) Nonemergency air ambulance
transportation includes scheduled transports to or from out-of-state treatment
facilities (see WAC
182-546-1500
).
(b) Nonemergency air ambulance
transportation that is prior authorized by the agency are paid a negotiated
rate. The negotiated rate is an all-inclusive rate and may include
transportation for a legally responsible family member or legal guardian
accompanying the client being transported for medical treatment.
(9) The agency does not pay:
(a) For food, lodging, and other expenses of
air ambulance personnel when a scheduled transport is delayed because of
changes in the medical status of the client to be transported, weather
conditions, or other factors;
(b)
For fuel, maintenance and other aircraft-related expenses resulting from
transportation delays because of changes in the medical status of the client to
be transported, weather conditions, or other factors;
(c) Separately for ground ambulance services
to and from airports and treatment facilities when these transportation
services are specifically included in the negotiated air ambulance rate;
and
(d) For canceled air ambulance
transports, for any reason.
(10) The agency does not pay private
organizations for volunteer medical air ambulance transportation services
unless no other air ambulance option is available. The use of private,
volunteer air transportation must be prior authorized by the agency to be
payable. If authorized by the agency, the agency's payment for the transport is
the lesser of:
(a) The provider's actual
incurred and documented cost (e.g., fuel); or
(b) The agency's established rate (fee
schedule).
(11) If the
agency determines, upon review, that an air ambulance transport was not:
(a) Medically necessary, the agency may deny,
recoup, or limit its payment to the amount the agency would have paid to a
ground ambulance provider for the same distance traveled; or
(b) To the closest, most appropriate
agency-contracted hospital, the agency may deny, recoup, or limit its payment
to the maximum amount it would have paid an air ambulance provider for a
transport to the nearest, most appropriate agency-contracted
facility.
(12) The
agency uses commercial airline companies whenever the client's medical
condition permits the client to be transported safely by nonmedical or
scheduled carriers.
11-14-075, recodified as §182-546-0700, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.04.057,
74.08.090, and
74.09.510. 04-17-118, §
388-546-0700, filed 8/17/04, effective 9/17/04. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.04.050,
74.04.055, and
74.04.057. 01-03-084, §
388-546-0700, filed 1/16/01, effective
2/16/01.
