048-15 Wyo. Code R. §§ 15-7 - Covered Services

The terms in this section shall be interpreted under the definitions and classifications established by the Office of Emergency Medical Services Rules.

(a) Emergency ground ambulance transportation is a covered service.

(i) Ground ambulance is any motor vehicle maintained, operated or advertised for the medical care and transportation of patients upon any street, highway or public way, or any motor vehicle owned and operated on a regular basis by the State of Wyoming or any agency, municipality, city, town, county or political subdivision of Wyoming for medical care and transportation of patients upon any street, highway or public way.

(b) Basic Life Support (BLS) or Advanced Life Support (ALS).

(i) Basic Life Support (BLS) is treatment rendered by personnel licensed at the Emergency Medical Responder (EMR) or basic Emergency Medical Technician (EMT) level, including, but not limited to, procedures such as bandaging, splinting, basic first aid, and performing CPR.

(ii) Advanced life support (ALS) is treatment rendered by personnel licensed at the Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT) level, with additional training in accordance with Wyoming Emergency Medical Services Rules certifying them to perform additional procedures including, but not limited, to cardiac monitoring and defibrillation, advanced airway management, intravenous therapy, and the administration of medications.

(A) Advanced Life Support Level 1- Emergency (ALS1- emergency) is transportation by ground ambulance with provision of medically necessary supplies, oxygen, and at least one ALS intervention. The ambulance and its crew shall meet licensure standards for ALS care.

(I) An ALS intervention refers to the provision of care outside the scope of a basic EMT and shall be medically necessary.

(B) Advanced Life Support Level 2 (ALS2) is the provision of medically necessary supplies and services including (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids); or (2) ground ambulance transport, the provision of medically necessary supplies and services, and at least one of the ALS2 procedures listed below:

(I) Manual defibrillation/cardio version;

(II) Endotracheal intubation;

(III) Central venous line;

(IV) Cardiac pacing;

(V) Chest decompression;

(VI) Surgical airway; or

(VII) Intraosseous line.

(iii) ALS or BLS ground ambulance is a covered service if:

(A) The use of any other method of transportation would endanger the health of the client;

(B) The client is transported to the nearest appropriate facility which offers services sufficient to meet the medical needs of the client;

(C) The client is admitted to the receiving facility as an inpatient or an outpatient;

(D) The service is medically necessary; and

(E) The service was actually rendered to the

(iv) An ALS assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

(c) Non-emergency transportation. Non-emergency transportation provided in a ground ambulance is a covered service if any other mode of transportation would endanger the health or life of the individual and the individual is:

(i) Continuously dependent on oxygen;

(ii) Continuously confined to bed;

(iii) Unable to perform any physical activity without discomfort because of a cardiac disease;

(iv) Receiving intravenous treatment;

(v) Heavily sedated;

(vi) Comatose;

(vii) Post pneumo/encephalogram, myelogram, spinal tap, or cardiac catheterization;

(viii) Unable to have flexion at the hip because of hip spicas or other casts;

(ix) In need of isolette in perinatal period; or

(x) Unconscious or semi-conscious.

(d) Advanced Life Support Level 1- Non-Emergent (ALS1- non-emergent) in non-emergent circumstances.

(i) ALS1 - non-emergent is a covered service if the requirements in Section 7(b)(iii) of this Chapter are met.

(e) Air ambulance services are covered when:

(i) Services are provided by a fixed-wing aircraft or helicopter licensed to provide ambulance services, and

(ii) One of the following requirements is met:

(A) The client has a life-threatening condition and the use of any other method of transportation, including ground ambulance, would endanger the health of the client;

(B) The client's location is inaccessible by ground ambulance; or

(C) Air transport is more cost effective than any alternative method of transportation.

(f) Community Emergency Medical Services, as described and certified by the Office of Emergency Medical Services (OEMS), includes Community Emergency Medical Services - Technician (CEMS-T) and Community Emergency Medical Services - Clinician (CEMS-C). Community Emergency Medical Services are a covered service if the requirements in this section are met:

(i) Community Emergency Medical Services - Technician (CEMS-T)

(A) Providers (both the agency and the individual) shall have a current endorsement of CEMS-T from the Office of Emergency Medical Services.

(B) Services shall be provided in response to a call for service and include:

(I) Appropriately treating and releasing clients, rather than providing transportation to a hospital or emergency department;

(II) Treating and transporting clients to appropriate destinations other than a hospital or an emergency department;

(III) Treatment and referral to a primary care or urgent care facility; or

(IV) Assessment of the client and reporting to a primary care provider to determine an appropriate course of action.

(C) Provider documentation shall be entered into the electronic reporting system maintained by the OEMS and fully document services provided to the client.

(ii) Community Emergency Medical Services - Clinician (CEMS-C)

(A) Providers (both the agency and the individual) shall have a current endorsement of CEMS-C from the Office of Emergency Medical Services.

(B) Services provided by the CEMS-C certified provider shall be:

(I) Within the scope of practice for the license held by the CEMS-C provider;

(II) Provided under the direct written or verbal order of a physician;

(III) Services that are likely to prevent admission to a hospital, nursing home, or other institutionalized care setting;

(IV) Coordinated with care received by the client from other community providers in order to prevent duplication of services; and

(V) Identified in a written, well documented plan of care, which may include:

(1.) Health assessments;

(2.) Chronic disease monitoring and education;

(3.) Medication compliance;

(4.) Immunizations and vaccinations;

(5.) Laboratory specimen collection;

(6.) Hospital discharge follow-up care; and

(7.) Minor medical procedures.

(C) Services provided, physician's orders, and the plan of care shall be documented in the client's comprehensive medical record maintained by the ambulance agency and supplied to the Department upon request.

Notes

048-15 Wyo. Code R. §§ 15-7

Amended, Eff. 2/8/2017. Amended, Eff. 5/14/2018.