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 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; and(3) Waiting time for transportation as follows: a. Prior to transporting the recipient while the recipient is being stabilized; andb. Up to a maximum of 2 hours, rounded to the nearest half-hour. (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 is authorized 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