(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);
(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 noncovered services as described in this section, if the requirements of WAC
182-502-0160 are met.
[Statutory Authority: RCW
41.05.021,
41.05.160, 2015 c 157, 2017 c 273, and 2016 1st sp.s. c 29. WSR 20-17-010, § 182-546-0250, filed 8/6/20, effective 9/6/20. Statutory Authority: RCW
41.05.021,
41.05.160, and 2017 c 273. WSR 19-19-090, § 182-546-0250, filed 9/18/19, effective 10/19/19. WSR 11-14-075, 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. WSR 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. WSR 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. WSR 01-03-084, § 388-546-0250, filed 1/16/01, effective 2/16/01.]