Cal. Code Regs. Tit. 22, § 51323 - Medical Transportation Services
(a) Ambulance, litter van and wheelchair van
medical transportation services are covered when the beneficiary's medical and
physical condition is such that transport by ordinary means of public or
private conveyance is medically contraindicated, and transportation is required
for the purpose of obtaining needed medical care.
(1) Ambulance services are covered when the
patient's medical condition contraindicates the use of other forms of medical
transportation.
(2) Litter van
services are covered when the patient's medical and physical condition:
(A)
1.
Requires that the patient be transported in a prone or supine position, because
the patient is incapable of sitting for the period of time needed to
transport.
2. LEA specialized
medical transportation services shall not be subject to subsection
(a)(2)(A)1.
(B) Requires
specialized safety equipment over and above that normally available in
passenger cars, taxicabs or other forms of public conveyance.
(C) Does not require the specialized
services, equipment and personnel provided in an ambulance because the patient
is in stable condition and does not need constant
observation.
(3)
Wheelchair van services are covered when the patient's medical and physical
condition:
(A) Renders the patient incapable
of sitting in a private vehicle, taxi or other form of public transportation
for the period of time needed to transport.
(B)
1.
Requires that the patient be transported in a wheelchair or assisted to and
from residence, vehicle and place of treatment because of a disabling physical
or mental limitation.
2. LEA
specialized medical transportation services shall not be subject to subsection
(a)(3)(B)1.
(C) Requires
specialized safety equipment over and above that normally available in
passenger cars, taxicabs or other forms of public conveyance.
(D) Does not require the specialized
services, equipment and personnel provided in an ambulance, because the patient
is in stable condition and does not need constant
observation.
(b) Authorization shall be granted or
Medi-Cal reimbursement shall be approved only for the lowest cost type of
medical transportation that is adequate for the patient's medical needs, and is
available at the time transportation is required.
(1) Emergency medical transportation is
covered, without prior authorization, to the nearest facility capable of
meeting the medical needs of the patient. Each claim for program reimbursement
of emergency medical transportation shall be accompanied by a written statement
which will support a finding that an emergency existed. Notwithstanding Section
51056(b), the
statement may be made by the provider of the emergency transportation,
describing the circumstances necessitating the emergency service. The statement
shall include the name of the person or agency requesting the service, the
nature and time of the emergency, the facility to which the patient was
transported, relevant clinical information about the patient's condition, why
the emergency services rendered were considered to be immediately necessary and
the name of the physician accepting responsibility for the patient at the
facility.
(2) All nonemergency
medical transportation, necessary to obtain program covered services, requires
a physician's, dentist's or podiatrist's prescription and prior authorization
except as provided in (C).
(A) When the
service needed is of such an urgent nature that written authorization could not
have reasonably been submitted beforehand, the medical transportation provider
may request prior authorization by telephone. Such telephone authorization
shall be valid only if confirmed by a written request for
authorization.
(B) Transportation
shall be authorized only to the nearest facility capable of meeting the
patient's medical needs.
(C)
Nonemergency transportation services are exempt from prior authorization when
provided to a patient being transferred from an acute care hospital immediately
following a stay as an inpatient at the acute level of care to a skilled
nursing facility or an intermediate care facility licensed pursuant to Section
1250
of the Health and Safety Code.
(c) Medical transportation by air is covered
under the following conditions:
(1) For
emergencies, only when such transportation is medically necessary as
demonstrated by compliance with paragraph (b) (1) and either of the following
apply:
(A) The medical condition of the
patient precludes other means of medical transportation as indicated in the
statement submitted in accordance with paragraph (b) (1).
(B) The patient or the nearest hospital
capable of meeting the medical needs of the patient is inaccessible to ground
medical transportation, as indicated in the statement submitted in accordance
with paragraph (b) (1).
(2) For nonemergencies, only when
transportation by air is necessary because of the medical condition of the
patient or practical considerations render ground transportation not feasible.
The necessity for transportation by air shall be substantiated by content of a
written order of a physician, podiatrist or dentist.
Notes
2. Certificate of Compliance as to 7-6-82 order transmitted to OAL 11-3-82 and filed 12-3-82 (Register 82, No. 49).
3. Amendment of subsection (b) filed 4-11-84; effective thirtieth day thereafter (Register 84, No. 15).
4. Repealer of subsection (d) filed 8-9-85; effective thirtieth day thereafter (Register 85, No. 32).
5. Amendment of subsection (b)(2)(C), designation of portion of subsection (b)(2)(C) as new subsection (b)(2)(C)1. and amendment thereof, new subsections (b)(2)(C)2.-3., and amendment of NOTE filed 4-1-96 as an emergency; operative 4-1-96 (Register 96, No. 14). A Certificate of Compliance must be transmitted to OAL by 9-30-96 pursuant to Welfare and Institutions Code section 14132.22 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction of HISTORY 5 (Register 96, No. 35).
7. Amendment of subsection (b)(2)(C), designation of portion of subsection (b)(2)(C) as new subsection (b)(2)(C)1. and amendment thereof, new subsections (b)(2)(C)2.-3., and amendment of NOTE refiled 8-28-96 as an emergency; operative 9-30-96 (Register 96, No. 35). A Certificate of Compliance must be transmitted to OAL by 1-28-97 or emergency language will be repealed by operation of law on the following day.
8. Editorial correction of subsection (b)(2)(C)3. (Register 97, No. 11).
9. Certificate of Compliance as to 8-28-96 order transmitted to OAL 1-23-97 and filed 3-10-97 (Register 97, No. 11).
10. Change without regulatory effect amending subsection (b)(2)(C), repealing subsections (b)(2)(C)1.-3. and amending NOTE filed 6-12-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 24).
11. Redesignation of former subsection (a)(2)(A) as new subsection (a)(2)(A)1., new subsection (a)(2)(A)2., redesignation of former subsection (a)(3)(B) as new subsection (a)(3)(B)1., new subsection (a)(3)(B)2. and amendment of NOTE filed 12-10-2015; operative 4-1-2016 (Register 2015, No. 50).
Note: Authority cited: Section 20, Health and Safety Code; and Sections 10725, 14115.8, 14124.5 and 14132.06, Welfare and Institutions Code. Reference: Sections 14115.8, 14132, 14132.06 and 14136.3, Welfare and Institutions Code.
2. Certificate of Compliance as to 7-6-82 order transmitted to OAL 11-3-82 and filed 12-3-82 (Register 82, No. 49).
3. Amendment of subsection (b) filed 4-11-84; effective thirtieth day thereafter (Register 84, No. 15).
4. Repealer of subsection (d) filed 8-9-85; effective thirtieth day thereafter (Register 85, No. 32).
5. Amendment of subsection (b)(2)(C), designation of portion of subsection (b)(2)(C) as new subsection (b)(2)(C)1. and amendment thereof, new subsections (b)(2)(C)2.-3., and amendment of Note filed 4-1-96 as an emergency; operative 4-1-96 (Register 96, No. 14). A Certificate of Compliance must be transmitted to OAL by 9-30-96 pursuant to Welfare and Institutions Code section 14132.22 or emergency language will be repealed by operation of law on the following day.
6. Editorial correction of History 5 (Register 96, No. 35).
7. Amendment of subsection (b)(2)(C), designation of portion of subsection (b)(2)(C) as new subsection (b)(2)(C)1. and amendment thereof, new subsections (b)(2)(C)2.-3., and amendment of Note refiled 8-28-96 as an emergency; operative 9-30-96 (Register 96, No. 35). A Certificate of Compliance must be transmitted to OAL by 1-28-97 or emergency language will be repealed by operation of law on the following day.
8. Editorial correction of subsection (b)(2)(C)3. (Register 97, No. 11).
9. Certificate of Compliance as to 8-28-96 order transmitted to OAL 1-23-97 and filed 3-10-97 (Register 97, No. 11).
10. Change without regulatory effect amending subsection (b)(2)(C), repealing subsections (b)(2)(C)1.-3. and amending Note filed 6-12-2006 pursuant to section 100, title 1, California Code of Regulations (Register 2006, No. 24).
11. Redesignation of former subsection (a)(2)(A) as new subsection (a)(2)(A)1., new subsection (a)(2)(A)2., redesignation of former subsection (a)(3)(B) as new subsection (a)(3)(B)1., new subsection (a)(3)(B)2. and amendment of Note filed 12-10-2015; operative
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