Okla. Admin. Code § 317:30-5-336.3

Current through Vol. 42, No. 4, November 1, 2024

Section 317:30-5-336.3 - Destination and transport outside of locality

(a) Transportation is covered from the point of origin to the Hospital, Critical Access Hospital or Nursing Facility that is capable of providing the required level and type of care for the member.

(b) Ambulance transportation from a hospital with a higher level of care to a hospital with a lower level of care in the locality is covered, provided all other criteria are met and approved by the OHCA.

(c) Non-emergency transportation to the outpatient facilities of a Hospital, free-standing Ambulatory Surgery Center (ASC), Independent Diagnostic Testing Facility (IDTF), Physician's office or other outpatient facility is compensable if the member's condition necessitates ambulance or stretcher transportation and all other conditions are met.

(d) Ambulance Transportation to a Veteran's Administration (VA) Hospital is covered when the trip has not been authorized by the VA.

(e) If ambulance transportation is provided out of the transport locality, the claim must be documented with the reason for the transport outside of the service area.

(f) If it is determined the member was transported out of locality and the closest facility could have cared for the member, payment will be made only for the distance to the nearest medical institution with the appropriate facilities.

(g) Any transportation which begins or ends outside of the Oklahoma geographic border requires prior authorization. The exception to this rule is if transportation begins or ends within one hundred (100) miles of Oklahoma's geographic border, no prior authorization is required.

Okla. Admin. Code § 317:30-5-336.3

Added at 24 Ok Reg 601, eff 12-21-06 (emergency); Added at 24 Ok Reg 920, eff 5-11-07

Amended by Oklahoma Register, Volume 40, Issue 24, September 1, 2023, eff. 9/11/2023