(1) The medicaid agency pays for emergency
ambulance transportation provided to clients who are in another state or U.S.
territory according to the provisions of WAC
182-501-0180,
182-501-0182,
and
182-502-0120.
(2) To receive payment from the agency, an
out-of-state ambulance provider must:
(a)
Meet the licensing requirements for Washington state and of the ambulance
provider's home state or province;
(b) Have an approved core provider agreement
with the agency.
(3) The
agency pays for emergency ambulance transportation provided out-of-state for
eligible clients when the transport is:
(a)
Within the scope of the client's medical care program;
(c) To the closest, most
appropriate treatment facility.
(4) The agency does not pay for an ambulance
transport provided in another state for a client when:
(a) The client's medical eligibility program
covers health care services within Washington state or designated bordering
cities only. See WAC
182-546-0150
and
182-546-0200(5);
(b) The transport was nonemergency and was
not prior authorized by the agency.
(5) The agency pays for emergency ambulance
transportation at the lower of:
(a) The
provider's billed amount; or
(b)
The rate established by the agency.
(6) The agency does not pay for nonemergency
(ground or air ambulance) transportation outside the state of Washington (i.e.,
both origin and destination points are outside the state's borders).
(7) An ambulance provider who transports a
client to a facility outside the state (excluding designated bordering cities
or brings a client into the state from a location outside the state (excluding
designated border cities) must obtain prior authorization from the agency for a
nonemergency transport in order to be paid. See WAC
182-546-4000
for transports under the ITA.
Notes
Wash. Admin.
Code §
182-546-0800
Amended by
WSR
20-17-010, Filed 8/6/2020, effective
9/6/2020
11-14-075, recodified as §182-546-0800, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.500, and
74.09.035. 08-08-064, §
388-546-0800, filed 3/31/08, effective 5/1/08. Statutory Authority:
RCW
74.04.057,
74.08.090, and
74.09.510. 04-17-118, §
388-546-0800, 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, §
388-546-0800, filed 1/16/01, effective
2/16/01.
