Section 182-546-0250 - Ambulance transportation- Noncovered services(1) The medicaid agency does not cover ambulance services when the transportation is: (a) Not medically necessary based on the client's condition at the time of service (see exception at WAC 182-546-1000 );(b) Refused by the client (see exception for ITA clients in WAC 182-546-4100 through 182-546-4300 );(c) For a client who is deceased at the time the ambulance arrives at the scene;(d) For a client who dies after the ambulance arrives at the scene but prior to transport and the ambulance crew provided minimal to no medical interventions/supplies at the scene (see WAC 182-546-0500(2) );(e) Requested for the convenience of the client or the client's family;(f) More expensive than bringing the necessary medical service(s) to the client's location in nonemergency situations;(g) To transfer a client from a medical facility to the client's residence (except when the residence is a nursing facility);(h) Requested solely because a client has no other means of transportation;(i) Provided by other than licensed ambulance providers (e.g., wheelchair vans, cabulance, stretcher cars); or(j) Not to the nearest appropriate medical facility.(2) If transport does not occur, the agency does not cover the ambulance service, except as provided in WAC 182-546-0500(2) and 182-531-1740 Treat and refer services.(3) The agency evaluates requests for services that are listed as noncovered in this chapter under the provisions of WAC 182-501-0160.(4) For ambulance services that are otherwise covered under this chapter but are subject to one or more limitations or other restrictions, the agency evaluates, on a case-by-case basis, requests to exceed the specified limits or restrictions. The agency approves such requests when medically necessary, according to the provisions of WAC 182-501-0165 and 182-501-0169.(5) An ambulance provider may bill a client for noncov-ered services as described in this section, if the requirements of WAC 182-502-0160 are met.Wash. Admin. Code § 182-546-0250
Amended by WSR 19-19-090, Filed 9/18/2019, effective 10/19/2019Amended by WSR 20-17-010, Filed 8/6/2020, effective 9/6/202011-14-075, recodified as § 182-546-0250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 06-24-036, § 388-546-0250, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.04.057, 74.08.090, and 74.09.510. 04-17-118, § 388-546-0250, filed 8/17/04, effective 9/17/04. Statutory Authority: RCW 74.08.090, 74.09.500, 74.04.050, 74.04.055, and 74.04.057. 01-03-084, § 388-546-0250, filed 1/16/01, effective 2/16/01.