Ala. Admin. Code r. 560-X-18-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-18-.04 - Scope Of Ambulance Transportation Service Operations

(1) All transportation must be medically necessary and reasonable. Documentation must state the condition(s) that show necessity of ambulance service, (and indicate why patient could not be transported by another mode of transportation).

(2) No payment may be made for ambulance service if some other means of transportation could be utilized without endangering the recipient's health.

(3) Emergency ambulance services are provided to eligible recipients between:

(a) Scene (address) of emergency and local hospital.

(b) Nursing home and local hospital.

(c) Local hospital and specialized hospital (Example: from Montgomery and University of Alabama Hospital in Birmingham).

(d) Exception: Ambulance service to a physician's office is not considered an emergency.

(4) Payment may be made if the eligible recipient expires enroute to or from a health care facility. Payment may not be made if the recipient was pronounced dead by a legally authorized individual prior to transport.

(5) More than one eligible recipient may be transferred in the same ambulance at the same time. A separate claim form must be filed for each recipient.

(6) Nonemergency ambulance service is provided to eligible recipients who must be bed-confined or have a debilitating physical condition(s) that require travel by stretcher only and require transportation to receive medical services.

Ala. Admin. Code r. 560-X-18-.04

Rule effective October 1, 1982. Emergency rule effective June 28, 1991. Amended effective October 12, 1991; April 14, 1992. Amended: Filed July 7, 1994; effective August 12, 1994. Amended: Filed February 7, 1996; effective March 14, 1996. Amended: Filed July 12, 2001; effective August 16, 2001. Amended: Filed May 10, 2002; effective June 14, 2002. Amended: Filed January 7, 2009; effective February 11, 2009.

Author: Carol Akin, Associate Director, Clinic/Ancillary Services

Statutory Authority: State Plan; 42 C.F.R. § 431.53; Title XIX, Social Security Act.