Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-546 - Transportation services
GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT)
Section 182-546-1500 - Ambulance transportation-Nonemergency air-Payment

(1) The medicaid agency pays for a nonemergency air ambulance transport only when the transport is prior authorized by the agency.

(2) The agency authorizes a nonemergency air ambulance transport only when the following conditions are met:

(3) The agency requires providers to thoroughly document the circumstances requiring a nonemer-gency air ambulance transport. The medical necessity justification and all supporting documentation must be received, evaluated, and approved by the agency before the air ambulance transport takes place.

(4) The agency pays a negotiated rate for a medically necessary nonemergency interstate air ambulance transportation that the agency has prior authorized. The air ambulance provider is responsible for ensuring that all medical services necessary for the client's health and safety during the transport are available on board the vehicle or aircraft.

(5) Unless otherwise specified in the agency's authorization letter, the contractual amount for a nonemergency air ambulance transport includes:

(6) Payment for nonemergency air ambulance transportation clients may not exceed published fee schedule amounts, except when the agency expressly allows payment of a negotiated rate for a prior authorized nonemergency transport.

(7) Billing documentation must include a copy of the agency's authorization letter, adequate descriptions of the severity and complexity of the transport, and the medical interventions provided in transit.