Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.492 - Payment for Medical Transportation

Current through Register Vol. 48, No. 28, July 12, 2024
Notwithstanding the provisions set forth in subsections (a)
				  through (h), beginning July 1, 2002, the reimbursement rates paid for medical
				  transportation services shall be the lesser of the provider's usual and
				  customary charge to the general public or 94 percent of the fiscal year 2002
				  rate otherwise determined by the Department under this Section. Notwithstanding
				  Section
				  140.405,
				  beginning with date of service July 1, 2013 and thereafter, the Department's
				  established maximum rate for ambulance services shall be equivalent to 100% of
				  the rate in effect on June 30, 2012, as reflected on the Department's Fee
				  Schedule, except when a rate that is higher than the rate in effect on June 30,
				  2012 is specified in subsection (h). Payment for medical transportation
				  services shall be made in accordance with the methodologies outlined in this
				  Section. Base rate reimbursement is determined by the county in which the
				  vehicle is, or the vehicles are, based. In no case shall rates exceed the
				  Medicare allowable, where applicable, or the rates charged to the general
				  public.
a) For dates of service prior
				to July 1, 2006, medicar providers shall be paid a base rate, which includes
				the first ten miles (20 miles round trip), a mileage rate and a fixed amount
				for an employee or non-employee attendant. Loaded miles, i.e., those miles for
				which the provider is actually transporting an individual, after ten miles (20
				miles round trip) shall be reimbursed.
b) For dates of service prior to July 1,
				2006, service car providers shall be paid a base rate, which includes the first
				ten miles (20 miles round trip), a mileage rate and a fixed amount for a
				non-employee attendant. Loaded miles, i.e., those miles for which the provider
				is actually transporting an individual, after ten miles (20 miles round trip)
				shall be reimbursed.
c) For dates
				of service on or after July 1, 2006, medicar providers and service car
				providers shall be paid at a base rate, a mileage rate and a fixed amount for
				an attendant. Payment for an attendant is subject to the requirements in
				Section
				140.490(e)(5).
				Mileage reimbursement is made for loaded miles, i.e., those miles for which the
				provider is actually transporting an individual. Mileage for multiple
				passengers is reimbursed pursuant to Section
				140.490(d).
d) Private auto providers shall be paid for
				loaded miles at a mileage rate.
e)
				Payment for transportation services provided by common carrier, such as
				commercial airplanes, buses and trains, shall be at the usual community
				rate.
f) Taxicabs in an area
				regulated by a municipality or township shall be reimbursed at the community
				rate and a fixed amount for an attendant. Payment for an attendant is subject
				to the requirements in Section
				140.490(e).
g) Taxicabs in non-regulated areas shall be
				reimbursed at a rate as determined by the Department and a fixed amount for an
				attendant. Payment for an attendant is subject to the requirements in Section
				140.490(e).
				The Department rate shall be reviewed on an annual basis each July.
h) The Department shall pay for medically
				necessary ambulance services provided in accordance with Section
				140.490 at
				a base, mileage rate (loaded miles) and a rate for oxygen, as appropriate.
				Payment shall also be made for Advanced Life Support (ALS) at an all inclusive
				rate, which includes the base rate, supplies, and all other services, excluding
				mileage. However, for ALS services provided on or after July 1, 1993, separate
				reimbursement shall be made for oxygen when used and appropriately billed.
				Loaded miles for ALS trips shall be reimbursed at the per mile rate. Payment
				shall also be made for Specialty Care Transport (SCT). Rates shall be reviewed
				beginning November 1, 1986, and each November thereafter, according to the
				methodology set forth in subsections (h)(1) through (5). Revised rates pursuant
				to this methodology shall be effective with services provided on or after July
				1 of the succeeding year.
1) Payment shall be
				made at a basic rate for Basic Life Support (BLS) services that is provider
				specific. The basic rate shall be the lesser of the provider's usual and
				customary charge to the general public, as reflected on the provider's claim
				form, or 80 percent of the 50th percentile of the
				Medicare prevailing charge for Basic Life Support for the designated Medicare
				Locality, except that any basic rate previously approved by the Department that
				exceeds these parameters shall remain in force. The rate of annual increase
				shall not exceed five percent. Beginning with dates of service July 1, 2018 and
				thereafter, the Department's established maximum rate for BLS services shall be
				equivalent to 112% of the rate in effect on June 30, 2018, as reflected on the
				Department's Fee Schedule.
2)
				Payment for loaded miles shall be at a rate per mile. If a natural disaster,
				weather or other conditions necessitate the use of a route other than the most
				direct route, reimbursement will be based on the actual distance traveled. The
				rate per mile shall be 50 percent of the 50th
				percentile of the Medicare prevailing mileage charge for Medicare Locality 16.
				The annual rate of increase shall not exceed five percent. Beginning with dates
				of service July 1, 2018 and thereafter, regardless of the county in which the
				vehicle is based, loaded miles shall be paid at the lesser of the provider's
				usual and customary charge to the general public, as reflected on the
				provider's claim, or the Department's established rate of $5.60
				per mile, as reflected on the Department's Fee Schedule.
3) Payment for oxygen shall be made at a flat
				rate statewide. The rate shall be 50 percent of the
				50th percentile of the Medicare prevailing charge
				for Medicare Locality 16. The annual rate of increase shall not exceed five
				percent.
4) Payment for Advanced
				Life Support (ALS) services shall be at the lesser of the provider's usual
				charge, or a maximum allowable rate statewide. The maximum rate shall be 80
				percent of the difference between the Medicare 50th
				percentile prevailing charge for Basic Life Support services and Advanced Life
				Support services for Medicare Locality 16. The annual rate of increase shall
				not exceed five percent. Beginning with dates of service July 1, 2018 and
				thereafter, the Department's established maximum rate for ALS services shall be
				equivalent to 112% of the rate in effect on June 30, 2018, as reflected on the
				Department's Fee Schedule.
5)
				Beginning with dates of service July 1, 2018 and thereafter, payment for SCT
				shall be made at the lesser of the provider's usual and customary charge to the
				general public, as reflected on the provider's claim, or the Department's
				established rate, which is equivalent to 112% of the ALS rate in effect on June
				30, 2018, as reflected on the Department's Fee Schedule.