Section He-W 572.04 - Covered Services(a) The following ambulance services, in the case of an emergency medical condition, shall be covered: (1) Transportation to the nearest acute care hospital with appropriate treatment facilities, including loaded mileage and routine disposable supplies used en-route;(2) Transportation from an acute care hospital inpatient bed or acute care hospital emergency department to an inpatient psychiatric facility or a designated receiving facility for admission; and(3) Transportation from one acute care hospital to another acute care hospital when the necessary treatment or diagnostic testing cannot be provided by the originating hospital and the recipient is discharged from the originating hospital.(b) Air ambulance services, in the case of an emergency medical condition, shall be covered if the recipient's condition is such that:(1) The recipient cannot be safely transported in a timely basis via an ALS ground transportation with appropriate staff; and(2) The recipient is at imminent risk of losing life or limb if the fastest means of transport is not utilized to move the recipient to the nearest facility capable of treating the recipient.(c) Scheduled and routine ambulance transportation, as defined in He-W 572.01(k), to and from the destination, including loaded mileage and routine disposable supplies used en-route, shall be covered when the service has been determined medically necessary in accordance with He-W 572.06.(d) Waiting time for scheduled and routine ambulance transportation authorized pursuant to He-W 572.06 shall be covered up to a maximum of 2 hours, rounded to the nearest half hour.N.H. Admin. Code § He-W 572.04
(See Revision Note at chapter heading He-W 500); ss by #6641, eff 11-27-97; EXPIRED: 11-27-05
New. #8502, INTERIM, eff 12-2-05, EXPIRES: 5-31-06; ss by #8638, eff 5-30-06; ss by #10294, eff 12-1-13; ss by #10294, eff 12-1-13
Amended by Number 2, Filed January 11, 2024, Proposed by #13840, Effective 12/29/2023, Expires 6/26/2024.Amended by Number 28, Filed July 11, 2024, Proposed by #14007, Effective 6/25/2024, Expires 6/25/2034.