Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency pays for two levels
of service for ground ambulance transportation: Basic life support (BLS) and
advanced life support (ALS):
(a) A BLS
ambulance trip is one in which the client receives basic, noninvasive medical
services at the scene , point-of-pickup, or in transit to a hospital or other
appropriate treatment facility.
(b)
An ALS ambulance trip is one in which the client requires more complex
life-saving services at the scene , point-of-pickup, or in transit to a
hospital or other appropriate treatment facility. To qualify for payment at the
ALS level, certified paramedics or other ALS-qualified personnel must provide
the advanced medical services on board a properly equipped vehicle as defined
by chapter 18.73 RCW. Examples of complex medical services or ALS procedures
include, but are not limited to, the following:
(i) Administration of medication by
intravenous push/bolus or by continuous infusion;
(ii) Airway intubation;
(iii) Cardiac pacing;
(iv) Chemical restraint;
(v) Chest decompression;
(vi) Creation of surgical airway;
(vii) Initiation of intravenous
therapy;
(viii) Manual
defibrillation/cardioversion;
(ix)
Placement of central venous line; and
(x) Placement of intraosseous
line.
(2) The
agency pays for ambulance services (BLS or ALS) based on the client's medical
condition and the medical services provided immediately prior to or during the
trip.
(a) Local ordinances or standing orders
that require all ambulance vehicles be ALS-equipped do not qualify an ambulance
trip for the agency's payment at the ALS level of service unless ALS services
were provided on-scene or in transit to the treatment facility.
(b) A ground ambulance trip is classified and
paid at a BLS level, even if certified paramedics or ALS-qualified personnel
are on board the ambulance, if no ALS-type interventions were provided on-scene
or in transit to the treatment facility.
(c) An ALS assessment does not qualify as an
ALS transport if no ALS-type interventions were provided to the client in
transit to the treatment facility.
(3) An assessment and other intervention
performed on-scene with no resulting transport does not qualify for payment
from the agency, except when the client dies after treatment but before
transport as provided in WAC
182-546-0500(2).
(4) The agency pays ground ambulance
providers for mileage as follows:
(a) Loaded
mileage only.
(b) Actual mileage
incurred for covered trips (i.e., from the point-of-pickup to the destination)
based on trip odometer readings.
(i) The
agency uses the Washington state department of transportation's (WSDOT) mileage
chart. The WSDOT mileage chart indicates shortest distance between points,
including the use of the ferry system.
(ii) The agency uses alternative sources to
calculate distance traveling when the origin or destination points are not
listed in the WSDOT's mileage chart.
(iii) If the ferry system is the normal route
for travel but is not used, the reason must be documented on the claim form
when billing the agency. In this case, normal means the shortest
route.
(iv) Miles traveled by the
ferry. To be paid, providers must report by statute miles using the Washington
state department of transportation (WSDOT) ferry route mileage chart located on
the WSDOT website. Providers must thoroughly document the ferry route used,
including a copy of the ferry ticket.
(5) The agency's base rate includes:
(a) Necessary personnel and
services;
(b) Oxygen and oxygen
administration; and
(c) Intravenous
supplies and intravenous administration reusable supplies, disposable supplies,
required equipment, and waiting time.
(6) The agency pays ground ambulance
providers the same rate for mileage, regardless of the level of service (ALS or
BLS). An odometer reading showing a fraction of a mile (partial mile) at the
conclusion of a transport must be rounded up to the next whole unit (one mile).
The agency pays for mileage when the client is transported to and from medical
services within the local community only, unless necessary medical care is not
available locally. The provider must fully document in the client's record the
circumstances that make medical care outside of the client's local community
necessary.
(7) The agency pays for
extra mileage when sufficient justification is documented in the client's
record and the ambulance trip report. All records are subject to agency review.
Acceptable reasons for allowable extra mileage include, but are not limited to:
(a) The initial destination hospital was on
"divert" status and not accepting patients; or
(b) A road construction project or other
major obstacle caused a detour, or had to be avoided to save time.
(8) When multiple ambulance
providers respond to an emergency call, the agency pays only the ambulance
provider who actually provides the transportation.
(9) The agency pays for an extra attendant
when the ground ambulance provider documents in the client's file the
justification for the extra attendant and the extra attendant is on board for
the trip because of one or more of the following:
(a) The client weighs three hundred pounds or
more;
(b) The client is violent or
difficult to move safely;
(c) The
client is being transported for ITA purposes and the client must be restrained
during the trip; or
(d) More than
one client is being transported, and each requires medical attention or close
monitoring.
(10) The
agency pays ambulance providers "by report" for ferry and bridge tolls incurred
when transporting clients. Receipts must be attached to the claim submission
for reimbursement. All ferry and bridge toll documentation must be kept in the
client's file and made available to the agency for six years from the date of
service in accordance with WAC
182-502-0020.
11-14-075, recodified as §182-546-0450, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.04.057,
74.08.090, and
74.09.510. 04-17-118, §
388-546-0450, 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, §
388-546-0450, filed 1/16/01, effective
2/16/01.
