Rule 37.86.2601 - AMBULANCE SERVICES, DEFINITIONS(1) "Air ambulance services" means ambulance services provided by aircraft. There are two categories of air ambulance services, namely, fixed wing (airplane) and rotary wing (helicopter) aircraft. (a) Fixed wing air ambulance services are furnished when the recipient's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by fixed wing air ambulance may be necessary because the recipient's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, for example, heavy traffic, preclude such rapid delivery. Transport by fixed wing air ambulance may also be necessary because the recipient is inaccessible by land or water ambulance vehicle.(b) Rotary wing air ambulance services are furnished when the recipient's medical condition is such that transport by ground ambulance, in whole or in part, is not appropriate. Generally, transport by rotary wing air ambulance may be necessary because the recipient's condition requires rapid transport to a treatment facility, and either great distances or other obstacles, for example, heavy traffic, preclude such rapid delivery. Transport by rotary wing air ambulance may also be necessary because the recipient is inaccessible by land or water ambulance vehicle.(2) "Ambulance" means a vehicle that: (a) is specifically designed for transporting the sick or injured;(b) contains a stretcher, linens, first aid supplies, oxygen equipment, and other lifesaving equipment required by state or local laws; and(c) is staffed with personnel trained to provide first aid treatment.(3) "Ambulance services" means services provided by a licensed ambulance provider in the ground or air transportation of a sick or injured person in a specially designed and equipped vehicle as defined above, which includes a trained ambulance attendant who is licensed or certified as required by state law.(4) "Appropriate facility" means an institution equipped to provide the required hospital or nursing care for the illness or injury involved. In the case of a hospital, it also means that a physician or a physician specialist is available to provide the necessary care required to treat the patient's condition. However, the fact that the patient's personal physician does not have staff privileges in a hospital is not a consideration in determining whether the hospital is an appropriate facility.(5) "Emergency services" means services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of such severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.(6) "Ground ambulance services" means ambulance services provided by a vehicle designed to operate on the ground, including both water and land. Ground ambulance services include: (a) Basic life support (BLS), which includes, when medically necessary, the provision of BLS services as defined in the national EMS education and practice blueprint for the EMT-basic, including other basic life support services, or 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);(b) Basic life support emergency, which is furnished, when medically necessary, as specified above in (6)(a), in response to an emergency as defined in this rule;(c) Advanced life support, level 1 (ALS1), which includes, when medically necessary, provision of an assessment by an ALS provider trained to the level of the emergency medical technician-intermediate or paramedic as defined in the national EMS education and practice blueprint or in accordance with state and local laws or the provision of one or more ALS interventions, that is, a procedure beyond the scope of an EMT-basic as defined in (6)(a). An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.(d) Advanced life support, level 1 (ALS1) emergency, which includes, when medically necessary, the provision of ALS1 services specified in (6)(c) above, in response to an emergency as defined in this rule;(e) Advanced life support, level 2 (ALS2), which includes, when medically necessary, supplies and services including the administration of at least three separate administrations of one or more different medications or the provision of at least one of the following ALS procedures: (i) manual defibrillation/cardioversion;(ii) endotracheal intubation;(iii) central venous line;(f) Specialty care transport (SCT), which includes, when medically necessary, for a critically-injured or ill recipient, a level of interfacility service provided beyond the scope of the paramedic. SCT is necessary when a recipient's condition requires ongoing care that must be provided by one of more health professionals in an appropriate specialty area such as nursing, medicine, respiratory care, cardiovascular care or paramedic with additional training.(7) "Nonemergency" means all scheduled transportation, regardless of origin and destination, that does not meet the above criteria for emergency. By definition, hospital discharge trips, trips to and from end stage renal disease (ESRD) facilities for maintenance dialysis, trips to and from other outpatient facilities for chemotherapy or radiation therapy, and other diagnostic and therapeutic services are scheduled runs and, therefore, are considered to be "nonemergency" services.Mont. Admin. r. 37.86.2601
NEW, 1980 MAR p. 1764, Eff. 6/27/80; AMD, 1993 MAR p. 2819, Eff. 1/1/94; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1183, Eff. 7/6/01; AMD, 2003 MAR p. 1200, Eff. 6/13/03.53-6-113, MCA; IMP, 53-6-101, 53-6-113, 53-6-141, MCA;