Ambulance Transportation Services

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.015 Ambulance Transportation Services

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 39 No. 28, February 11, 2013 issue of the Florida Administrative Register.

59G-4.015 Ambulance Transportation Services.

(2) All ambulance transportation providers enrolled in the Florida Medicaid program must be in compliance with the provisions of the Florida Medicaid Ambulance Transportation Services Coverage and Limitations Handbook, __________, incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbook may be obtained by calling the Provider Services Contact Center at 1-800-289-7799 and selecting Option 7.

The following changes have been made to the Florida Medicaid Ambulance Transportation Services Coverage and Limitations Handbook.

Page 1-2 Purpose and Definitions

The following labels and definitions are added and the section will now read in alphabetical order.

Advanced Life Support (ALS)

The provision of medically necessary supplies and services during ground ambulance transportation, including the provision of at least one ALS intervention. The ALS intervention must be medically necessary and in accordance with state and local laws, required to be done by an emergency medical technician-intermediate (EMT-Intermediate) or EMT-Paramedic.

Advanced Life Support, Level 2 (ALS2)

The provision of medically necessary supplies and services during ground ambulance transportation, 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) medically necessary supplies and services, and the provision of at least one of the following ALS2 procedures: manual defibrillation/cardioversion; endotracheal intubation; central venous line; cardiac pacing; chest decompression; surgical airway; or intraosseous line. The medically necessary services must be provided by an emergency medical technician-intermediate (EMT-intermediate) or EMT-Paramedic.

Basic Life Support (BLS)

The provision of medically necessary supplies and services during ground ambulance transportation. The ambulance must be staffed by an individual who is qualified in accordance with state and local laws as an emergency medical technician-basic (EMT-Basic).

Specialty Care Transport (SCT)

Interfacility transportation of a critically injured or ill beneficiary 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. SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for example, emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional training.

Page 2-5 Levels of Life Support Services for Ground Ambulances

The section will now read:

Medicaid will reimburse for ground ambulance services when the recipient’s condition falls within one or more of the condition codes listed on the Medical Conditions List pending Medicaid eligibilty on the date of service.

Medicaid reimburses an all-inclusive fee for Advanced Life Support (ALS), Advanced Life Support Level 2 (ALS2), Basic Life Support (BLS), and Specialty Care Transport (SCT) service levels. Medicaid reimbursement for ALS, ALS2, BLS, or SCT is based on the recipient’s medical condition at the time of transport as listed on the Medical Conditions List, as well as the level of life support service(s) provided for the recipient during transport. The Medical Conditions List indicates whether a condition requires ALS or BLS services.

Medicaid will not pay ALS rates when the recipient’s condition, as listed on the Medical Conditions List, requires only BLS services, even if the vehicle is licensed and equipped for ALS services. Medicaid will also not pay ALS2 or SCT rates when the specific criteria defining those emergency services are not met or cannot be verified.

Page 2-5 Air Ambulance

The label will now read In-State Air Ambulance

The third bullet is deleted.

Page 2-6 Out-of-County Ground Transport

The last sentence in the first paragraph will now read:

This rate begins at the point of pickup.

Page 2-11 Authorization for Negotiated Rates

The first bullet will now read:

Out-of-county transports greater than 30 miles from the point of pickup or

The second through fourth bullets are deleted.

Page A-2, Appendix A, Ground Ambulance Emergency Codes, Standard Fee

The standard fee for Code A0433 is now $250.00.

The standard fee for Code A0434 is now $295.00.