10 Colo. Code Regs. § 2505-10-8.018
Current through Register Vol. 47, No. 16, August 25, 2024
Section 10 CCR 2505-10-8.018 - EMERGENCY MEDICAL TRANSPORTATION8.018.1.DEFINITIONS8.018.1.A. Air Ambulance means a Fixed-Wing or Rotor-Wing Air Ambulance equipped with medically necessary supplies to provide Emergency Medical Transportation.8.018.1.B. Client means a person enrolled in the Medical Assistance Program.8.018.1.C. Emergency Medical Services (EMS) Provider means an individual who has a current and valid emergency medical service provider certificate issued by the Department of Public Health and Environment (CDPHE) and includes Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), Emergency Medical Technician Intermediate (EMT-I), and Paramedic, in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight at 6 CCR 1015-3, Chapter Two.8.018.1.D. Emergency Medical Technician (EMT) means an individual who has a current and valid EMT certificate issued by CDPHE and who is authorized to provide basic emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight at 6 CCR 1015-3, Chapter Two. 8.018.1.E. Emergency Medical Transportation means Ground Ambulance or Air Ambulance transportation during which Clients who are ill, injured, or otherwise mentally or physically incapacitated receive needed emergency medical services en route.8.018.1.F. Facility means a general hospital, hospital unit, psychiatric hospital, rehabilitation hospital, Acute Treatment Unit (ATU), or Crisis Stabilization Unit (CSU), as well as any location that is an alternative site determined to be part of a hospital, Critical Access Hospital (CAH) or Skilled Nursing Facility (SNF), community mental health centers, federally qualified health centers (FQHCs), physician's offices, urgent care facilities, ambulatory surgery centers (ASCs), any other location furnishing dialysis services outside of the End Stage Renal Disease (ESRD) facility, and the beneficiary's home..8.018.1.G. Fixed-Wing Air Ambulance means a fixed-wing aircraft that is certified as a Fixed-Wing Air Ambulance by the Federal Aviation Administration. 8.018.1.H. Ground Ambulance means a ground vehicle, including a water ambulance, equipped with medically necessary supplies to provide Emergency Medical Transportation.8.018.1.I. Interfacility Transportation means transportation of a Client from one Facility to another Facility. 8.018.1.J. Life-Sustaining Supplies means oxygen and oxygen supplies required for life-sustaining treatment during transport via ambulance.8.018.1.K. Mileage means the number of miles the Client is transported in the ambulance.8.018.1.L. Non-Emergent Medical Transportation (NEMT) means transportation to or from medically necessary non-emergency treatment that is covered by the Colorado Medical Assistance Program under Section 8.014 . Non-emergency care may be scheduled or unscheduled. This may include urgent care transportation and hospital discharge transportation.8.018.1.M. Paramedic means an individual who has a current and valid Paramedic certificate issued by CDPHE and who is authorized to provide acts of advanced emergency medical care in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight at 6 CCR 1015-3, Chapter Two. For the purposes of these rules, Paramedic includes the historic Emergency Medical Service Provider level of EMT-Paramedic (EMT-P).8.018.1.N. Paramedic with Critical Care Endorsement means an individual who has a current and valid Paramedic certificate issued by CDPHE and who has met the requirements in CDPHE rule to obtain a critical care endorsement from CDPHE and is authorized to provide acts in accordance with the Rules Pertaining to EMS Practice and Medical Director Oversight relating to critical care, as set forth in C.R.S. § 25-3.5-206.8.018.1.O. Rotor-Wing Air Ambulance means a helicopter that is certified as an ambulance by the Federal Aviation Administration. 8.018.1.P. Specialty Care Transport (SCT) means interfacility Ground Ambulance transportation of a critically injured or ill Client from a stabilizing hospital to a hospital with full capabilities to treat the Client's case. SCT is necessary when a Client's condition requires ongoing care during transport at a level of service beyond the scope of the EMT, that must be furnished by one or more health professionals in an appropriate specialty area including, but not limited to, nursing, emergency medicine, respiratory care, cardiovascular care, or a Paramedic with Critical Care Endorsement.8.018.2.CLIENT ELIGIBILITY8.018.2.A. Emergency Medical Transportation is a benefit for all Colorado Medical Assistance Program Clients who are ill, injured, or otherwise mentally or physically incapacitated and in need of immediate medical attention to prevent permanent injury or loss of life. 8.018.3.PROVIDER ELIGIBILITY8.018.3.A. Providers must enroll with the Colorado Medical Assistance Program as an Emergency Medical Transportation provider to be eligible for reimbursement. Enrolled Emergency Medical Transportation providers must: 1. Meet all provider screening requirements in Section 8.125.2. Comply with commercial liability insurance requirements.3. Maintain and comply with the appropriate licensure:a. Ground Ambulance license as required by CDPHE statute at C.R.S. § 25-3.5-301 and 6 CCR 1015-3, Chapter Four.b. Air Ambulance license as required by CDPHE statute at C.R.S. § 25-3.5-307 and 6 CCR 1015-3, Chapter Five.4. License, operate, and equip Ground and Air Ambulances in accordance with federal and state regulations.8.018.4.COVERED SERVICES8.018.4.A. Emergency Medical Transportation is a covered service when medically necessary, as defined in Section 8.076.1.8 ., and in accordance with this Section 8.018.4.8.018.4.B. Ground Ambulance 1. The following Ground Ambulance Emergency Medical Transportation services are covered: a. Transportation to the closest, most appropriate Facility.b. Basic life support (BLS) or advanced life support (ALS) required to maintain life during transport from the Client's pickup point to the treating Facility. i. BLS includes: 1. Cardiopulmonary resuscitation, without cardiac/hemodynamic monitoring or other invasive techniques;2. Suctioning en route (not deep suctioning); and3. Airway control/positioning.ii. ALS includes ALS Levels 1 and 2 in accordance with 42 CFR § 414.605 (2019), which is hereby incorporated by reference. This incorporation by reference excludes later amendments to, or editions of, the referenced materials. Pursuant to C.R.S. § 24-4-103 (12.5), the Department maintains copies of this incorporated text in its entirety, available for public inspection during regular business hours, at: Colorado Department of Health Care Policy and Financing, 1570 Grant Street, Denver, CO, 80203. Certified copies of incorporated materials are provided at cost upon request. 1. ALS Level 1 includes the provision of at least one ALS intervention required to be furnished by ALS personnel.2. ALS Level 2 includes: a. Administration of at least three medications by intravenous push/bolus or by continuous infusion, excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (Dextrose, Normal Saline, Ringer's Lactate); orb. The provision of at least one of the following ALS procedures: i. Manual defibrillation/cardioversion.ii. Endotracheal intubation.iii. Central venous line.c. Specialty Care Transport when medically necessary to reach the closest, most appropriate Facility.d. Department-approved supplies used during Emergency Medical Transportation, including Life-Sustaining Supplies, are separately reimbursable when medically necessary.8.018.4.C. Air Ambulance 1. Air Ambulance Emergency Medical Transportation services are covered when:a. They meet the criteria at Section 8.018.4.B.1.a.-b.; and b. The point of pick up is inaccessible by a Ground Ambulance, or great distances or other obstacles prohibit transporting the Client by land to the nearest appropriate medical Facility.8.018.4.D. Interfacility Transportation 1. Interfacility Transportation is covered when:a. The Client requires a transfer from one Facility to another.b. The Client requires ALS or BLS services.2. Interfacility Transportation can be provided via Ground or Air Ambulance.8.018.5.NON-COVERED SERVICES AND GENERAL LIMITATIONS8.018.5.A. The following services are not covered or reimbursable to Emergency Medical Transportation providers as part of an Emergency Medical Transportation service: 1. Waiting time and cancellations.2. Transportation of additional passengers.3. Response calls when determined no transportation is needed or approved.4. Charges when the Client is not in the vehicle.5. Non-benefit services (e.g., first aid) provided at the scene when transportation is not necessary.6. Transportation which is covered by another entity.7. Transportation to local treatment programs not enrolled in Colorado Medical Assistance Program.8. Transportation of a Client who is deceased prior to transport.9. Pick up or delivery of prescriptions or supplies.10. Transportation arranged for a Client's convenience when there is no reasonable risk of permanent injury or loss of life.11. Transportation to non-emergency medical appointments or services. See Section 8.014 for NEMT services.8.018.6.PRIOR AUTHORIZATION8.018.6.A. Prior Authorization is not required for Emergency Medical Transportation.45 CR 22, November 25, 2022, effective 10/14/202246 CR 06, March 25, 2023, effective 2/10/202346 CR 11, June 10, 2023, effective 5/12/2023