Ala. Admin. Code r. 560-X-18-.15
Current through Register Vol. 42, No. 12, September 30, 2024
Section 560-X-18-.15 - Air Transportation Services(1) Covered Services (a) Air transportation services are covered for adults and children with authorization required prior to payment. Air transportation may be rendered only when basic and advanced life support land ambulance services are not appropriate. Medical appropriateness may be established when the time of need to transport by land or the instability, inaccessibility, or other obstacles to land transportation poses a threat to survival or seriously endangers the recipient's health. In certain cases when time required to transport by land as opposed to air endangers the recipient's life or health, services may be authorized. Air transportation will not be provided for convenience.(b) Medicaid requires that the patient is taken to the nearest hospital having appropriate facilities, physicians, or physician specialist needed to treat the patient's condition. The hospital must also have a bed or specialized treatment unit immediately available. If the patient is not taken to the nearest appropriate hospital, payment will be limited to the rate for the distance from the pick up point to the nearest appropriate hospital.(c) If it is determined that land ambulance service would have been more appropriate, payment for air transportation will be based on the amount payable for land transportation. Trips less than 75 loaded air miles are not considered to be appropriate unless extreme, extenuating circumstances are present and documented.(2) Enrollment - Air ambulance providers must be enrolled as a Medicare provider and if required, licensed by the state in which services are provided.(3) Authorization Approvals - All air transportation must be approved by the Alabama Medicaid Agency. Requests must be received by Medicaid's Fiscal Agent no later than the tenth business day after the service was rendered. Written requests must include:(b) Any other pertinent medical data as deemed necessary to document air transportation.(c) Any services requiring immediate transportation requires the above documentation, a copy of the flight record, and progress notes from institution that requested air transport and documentation of reason why ground transport is not feasible.(4) Claims - After written requests have been approved an authorization number will be assigned by Medicaid's Fiscal Agent. Claims should then be submitted to Medicaid's Fiscal Agent for payment consideration. Claim forms are furnished by the Fiscal Agent. Providers are limited to billing only those procedure codes listed in the Air Ambulance Provider Billing Manual. Only one lift-off fee will be reimbursed per trip. Author: Ginger Collum, Program Manager, Clinic/Ancillary Services
Ala. Admin. Code r. 560-X-18-.15
Rule effective October 1, 1982. Emergency rule effective June 28, 1991. Amended effective October 12, 1991. Effective date of amendment is April 14, 1992; April 15, 1993. Amended: Filed July 7, 1994; effective August 12, 1994. Amended: Filed September 8, 1998; effective October 13, 1998. Amended: Filed February 8, 2002; effective March 15, 2002. Amended: Filed May 10, 2002; effective June 14, 2002. Amended: Filed May 12, 2004; effective June 16, 2004.Statutory Authority: State Plan; 42 C.F.R. §431.53; Title XIX, Social Security Act.