Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 33 - TRANSPORTATION BY AMBULANCE › Section 317:30-5-335.1 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms, when used in this subchapter
					 shall have the following meaning, unless the context clearly indicates
					 otherwise.
"Ambulance"
means a motor vehicle, watercraft,
					 or aircraft that is primarily used or designated as available to provide
					 transportation and basic life support or advanced life support.
"Bed confined"
means that the member is unable
					 to get up from bed without assistance, unable to ambulate, and unable to sit in
					 a chair or wheelchair. The term bed confined is not synonymous with bed rest or
					 non-ambulatory.
"Continuous or round trip"
means an ambulance
					 service in which the member is transported to the hospital, the physician deems
					 it medically necessary for the ambulance to wait, and the member is then
					 transported to a more appropriate facility for care or back to the place of
					 origin.
"Emergency/ Emergent"
means a serious
					 situation or occurrence that happens unexpectedly and demands immediate action
					 such as a medical condition manifesting itself by acute symptoms of sufficient
					 severity (including severe pain) such that the absence of immediate medical
					 attention could reasonably be expected, by a reasonable and prudent layperson,
					 to result in placing the member's health in serious jeopardy, serious
					 impairment to bodily function, or serious dysfunction of any bodily organ or
					 part.
"Emergency transfer"
means the movement of an
					 acutely ill or injured member from the scene to a health care facility
					 (pre-hospital), or the movement of an acutely ill or injured member from one
					 health care facility to another health care facility (inter-facility).
"Loaded mileage"
means the number of miles for
					 which the member is transported in the ambulance.
"Locality"
means the service area surrounding
					 the facility from which individuals normally travel or are expected to travel
					 to seek medical care.
"Medically necessary transport"
means an
					 ambulance transport that is required because no other effective and less costly
					 mode of transportation can be used due to the member's medical condition. The
					 transport is required to transfer the member to and/or from a medically
					 necessary service not available at the primary location.
"Nearest appropriate facility"
means that the
					 receiving institution is generally equipped to provide the needed hospital or
					 skilled nursing care for the illness or injury involved. In the case of a
					 hospital, it also means that a physician or physician specialist is available
					 to provide the necessary care required to treat the member's condition. The
					 fact that a particular physician does or does not have staff privileges in a
					 hospital is not a consideration in determining whether the hospital has
					 appropriate facilities. Thus, ambulance service to a more distant hospital
					 solely to avail a member of the service of a specific physician or physician
					 specialist does not make the hospital in which the physician has staff
					 privileges the nearest hospital with appropriate facilities.
"Non-emergency transfer"
means the movement of
					 any member in an ambulance other than an emergency transfer.
"Stretcher service"
means a non-emergency
					 transport by a ground vehicle that is approved by the OSDH which is designed
					 and equipped to transport individuals on a stretcher or gurney type apparatus
					 that is operated to accommodate an incapacitated or disabled person who does
					 not require medical monitoring, aid, care or treatment during transport.
Added at 24 Ok Reg 303, eff 12-1-06 (emergency) ; Added
						at 24 Ok Reg 601, eff 12-21-06 (emergency) ; Added at 24 Ok Reg 920, eff
						5-11-07 ; Amended at 30 Ok Reg 1164, eff
						7-1-13