Subsection 144-101-II-5.01 - DEFINITIONS5.01-1Advanced Life Support (ALS) ambulance service is one that provides complex specialized life-sustaining equipment. Such ambulance vehicles shall be appropriately licensed and equipped, and be staffed by appropriately licensed personnel who are trained and authorized to provide advanced life support. Such training includes administering IVs, establishing and maintaining a member's airway, defibrillation of the heart, and performing other ALS procedures or providing services including, but not limited to, cardiac monitoring.5.01-2Air Ambulance Service provides rapid transportation by air when the member's condition is such that the time needed to transport, or the necessity of transportation by land poses a threat to life or seriously endangers the health of the member. Examples are as follows: (1) hemodynamic, pulmonary, and/or neurological instability with potential for rapid deterioration requiring critical care life support (monitoring, personnel, medications, and/or specific equipment) during transport that is not available from the local ground ambulance service, (2) the member's clinical condition requires that the time spent out of the hospital environment (in transport mode) be as short as possible, and/or (3) the member is located in an area which is inaccessible to regular ground traffic.5.01-3Ambulance Services are those services, which are conditionally, temporarily, or fully licensed, in the state or province where services are provided as documented by written evidence from the appropriate governing board, andthat provide emergency care and/or transportation for the ill or injured person, as ordered or approved by a physician, when it is medically necessary.5.01-4Ambulance Service for Emergency Involuntary Admission to a Psychiatric Facility is a one way trip from a place of origin to an inpatient psychiatric facility performed under the auspices of an "Application for Emergency Involuntary Admission to a Psychiatric Facility," sometimes referred to as a "Blue Paper," which is endorsed by a judge of a Maine court of competent jurisdiction.5.01-5Base Rate for Ambulance Service is the rate allowable for reimbursement for a one way trip from a place of origin to an authorized destination. A Base Rate excludes mileage charges which are billed for loaded miles only, but includes designated supplies, equipment, and ancillary services. 5.01-6Basic Life Support (BLS) ambulance service is one that provides transportation plus the equipment and staff required for basic medical services. These services include, but are not limited to, the following within the scope of the staff's licensure: control of bleeding; splinting fractures; treatment of shock; delivery of babies; cardiopulmonary resuscitation (CPR); and automatic interpretation defibrillation.5.01-7Ground Mileage Per Statute Mile ("Loaded Miles")are the miles a MaineCare member is transported from the point of pick-up to the point of destination by the ambulance. 5.01-8 In-state ambulance providers are those ambulance providers based within Maine borders.Providers which are based within fifteen (15) miles of the Maine/New Hampshire border are treated the same as Maine-based ambulance providers in all aspects of policy requirements, enrollment, rates of reimbursement, and payment methodologies. 5.01-9Out-of-state ambulance providers are those ambulance providers based outside state of Maine borders, with the exception of providers which are based within fifteen (15) miles of the Maine/New Hampshire border.(All transports provided by out-of-state ambulance providers to MaineCare members require prior authorization.)5.01-10Out-of-state ambulance servicesare defined as those ambulance transports provided to MaineCare member(s) to a location outside of state of Maine borders.Maine-based providers who are providing services to a location out-of-state act as out-of-state providers, are bound by the same requirements as out-of-state providers, and must obtain prior authorization or retroactive prior authorization. 5.01-11Medical Necessity is established when any other method of transportation is contraindicated for that member's medical condition. Examples of medical necessity include, but are not limited to: (1) the necessity to transport the member immediately as a result of an accident, injury, or acute illness; (2) the necessity to restrain the member; (3) the member being unconscious or in shock; (4) the member requiring oxygen or other emergency treatment during transportation; (5) the requirement to keep the member immobile due to a fracture or a suspected fracture not yet set; (6) the member having sustained an acute stroke or myocardial infarction; (7) the member suffering severe hemorrhage; (8) confinement of the member to bed before and after the ambulance trip; (9) the necessity to move the member by stretcher only.If the condition is one of the last two (8, 9) cited above, the reason why the member was bed confined or could only be moved by stretcher must be documented in the member's record.5.01-12 Reasonableness in regard to the use of ambulance service is determined by the treatment of the illness or injury involved. Reimbursement may be denied on the grounds that the use of the ambulance service was unreasonable with respect to the treatment of the illness or injury involved.5.01-13Specialty Care Transport (SCT)is the interfacility transportation of a critically injured or ill member by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-paramedic. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-5, subsec. 144-101-II-5.01