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Library: Policy

317:30-5-336.8. Special situations

Issued 12-21-06

(a) Continuous or round trip transport.

  • (1) If a member is transported to a destination and returned to their original point of pickup, coverage includes payment for the primary transport and the return transport.

  • (2) If the provider is required to remain and attend the member between transports, the provider may claim waiting time.

(b) Nursing facility.

  • (1) Ambulance or stretcher transportation from nursing home to nursing home (skilled or intermediate care) is covered if the discharging institution is not certified and the admitting nursing home is certified.

  • (2) Nursing home to nursing home transports are covered if the member requires care not available at the discharging facility, and the member's medical status requires ambulance transport.

(c) Multiple members per transport.

  • (1) When more than one eligible member is transported at the same time, the only acceptable duplication of charges is half the base rate.

  • (2) Separate claims must be submitted for each member.

  • (3) No mileage or waiting time is to be charged for additional members.  These services are included in the reimbursement of the first claim.

(d) Multiple transports per member.  More than one transport per member on the same date of service is covered when the member received a different level of service on each transport (e.g., Advanced Life Support 1 and Basic Life Support).  When more than one transport with the same level of care occurs on the same day medical necessity must be documented.

(e) Multiple arrivals.  When multiple units respond to a call for services, only the entity that actually provides services for the member may bill and be paid for the services by the OHCA.  The entity that rendered service/care bills for all services furnished.

(f) No transport.  If member refuses treatment after immediate aid has been provided the ambulance may bill the base rate for the level of service and waiting time.

(g) Pronouncement of death.

  • (1) If the member dies before dispatch, no payment is available.

  • (2) If the member dies after dispatch, but before the member is loaded, payment is allowed for the base rate but no mileage.

  • (3) If the member dies after pickup, payment is available for the base rate and mileage.

  • (4) Time of death is the point at which the member is pronounced dead by an individual authorized by the state to make such pronouncements.

(h) Out of state transports.

  • (1) Out of state, non-emergency transports require prior authorization.

  • (2) The ambulance provider, home health agency, hospital, nursing facility, physician, case manager or social worker may request this authorization.  The ambulance provider must retain the physician's order of medical necessity in the member's file to support the need for ambulance transportation.

  • (3) When a member is transported by ground ambulance to or from an air ambulance for out-of-state services, the ground and air ambulance providers providing the transports must bill OHCA independently.  When the OHCA is unable to contract for the out-of-state ground transport, the ground and air ambulance charges (air service, medical team, ground transportation) may be consolidated and billed when the following conditions apply.

    • (A) The air ambulance provider furnishing air transportation (hereafter referred to as "the entity") arranges for ground transportation services and has a contract on file with the OHCA to subcontract for ground ambulance;

    • (B) The contract includes the requirement that the entity certifies that the ground transportation provider meets the minimum state licensure requirements in the state in which the service is provided;

    • (C) The entity certifies that the payment will be made to the ground provider;

(i) Neonatal transports.

  • (1) Coverage of neonatal transport includes neonatal base rate, loaded mileage, transfer isolette, and waiting time.

  • (2) The intensive care transport of critically ill neonate(s) (i.e. newborns to approved, designated neonatal intensive care units) is a covered service.

  • (3) When a trained hospital medical team from the receiving or transferring hospital accompanies a newborn on the transport ambulance services, the primary care of the newborn is the hospital team's responsibility, reimbursement for the hospital team is made to the hospital as part of the hospital rate.

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